We inspected this service on 22 March, 30 May and 14 June 2018.

Station House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Station House is registered to provide nursing care for up to 71 older people. There are two separate units, one for people living with dementia, the other for people who need general nursing or residential care. The service provides long term care for people with nursing and / or dementia care needs. It also provides Intermediate Managed Care and Transitional Care. The aim of Intermediate Managed Care is to promote recovery and independence following an illness or accident. The aim of Transitional Care is to offer care and support for a short period of time, usually when there has been a health and /or social crisis. At the time of the inspection 62 people lived at or were placed at the home.

At our last inspection in June and July 2017, we had found that the service was not safe, responsive or well led and was not always effective and caring. We identified breaches of regulations including regulation 9 (person centred care), 10 (Dignity and respect) 11, (need for consent), 12 (safe care and treatment), 13 (safeguarding service users from abuse and improper treatment, 16 (Receiving and acting on complaints), 17 (good governance) and 20 (Duty of candour) of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We took enforcement action and the service was put into special measures.

After our inspection in June and July 2017, the provider submitted an action plan to the Care Quality Commission (CQC) outlining the action they would take to improve the service.

At this inspection, we found that significant improvement had been made in all aspects of service delivery. We found that some further improvements were required and the improvements that had been made needed to be sustained. The overall rating for the service is upgraded to: requires improvement.

We found that the atmosphere in the home was relaxed and sociable. All the people spoken with including all relatives made positive comments about the staff and the standard of care provided.

We found that the home’s safeguarding systems, processes and practices had improved markedly. People were protected from abuse, neglect, harassment and breaches of their dignity and respect.

Managers and staff were knowledgeable about adult safeguarding procedures. They knew what action to take and enjoyed good working relationships with the local social services team.

There was a sufficient number of suitably trained and qualified staff on duty to meet the needs of the people who lived at the home. The staff presented in buoyant mood and told us that their morale had improved. They told us that they appreciated the support, direction and leadership of the new manager.

All people spoken with praised the standard of catering in the home and we could see that they enjoyed a varied and nutritious diet.

Care and nursing staff respected and promoted people’s privacy, dignity and independence. They were caring and compassionate in their approach and encouraged people to express their views and actively involved in making decisions about their care and support. Managers and staff acted in accordance with the Mental Capacity Act and ensured that people received the right kind of assistance to support them in making decisions.

Healthcare professionals were involved in people's care and visiting health and social care professionals made positive comments about the standard of care provided.

People’s concerns and complaints were listened and responded to and used to improve the quality of care provided.

Nursing and care staff were aware of the need to support people approaching the

We undertook an urgent inspection on 30 June 2017 following receipt of serious concerns which were sent to the Commission earlier that month. This unannounced inspection was undertaken to check on people's safety, welfare and the general management of the home. On 7 July and 10 July we broadened this inspection into a comprehensive inspection to look at all aspects of service delivery.

Station House is registered to provide nursing care for up to 71 older people. There are two separate units, one for people living with dementia, the other for people who need general nursing or residential care. The service provides long term care for people with nursing and / or dementia care needs. It also provides Intermediate Managed Care and Transitional Care. The aim of Intermediate Managed Care is to promote recovery and independence following an illness or accident. The aim of Transitional Care is to offer care and support for a short period of time, usually when there has been a health and /or social crisis. At the time of the inspection 62 people lived at or were placed at the home.

At the last inspection in August 2016 the service was meeting the requirements of the regulations that were inspected at that time. However, we had found that the service was not always safe because medicines were not always administered safely and securely and made a recommendation about the safe administration and security of medicines.

This location requires a registered manager to be in post. A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection, we found that the provider was in breach of regulations 6, 9, 11, 12, 13, 16, 17 and 20 of the Health and Social Care Act Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We found that the service was not safe, responsive or well led and not always effective and caring. During the course of the inspection, the response and actions of the registered manager, did not demonstrate that that they had the necessary competencies to manage the home safely and effectively. Quality assurance systems were in place but these had failed to identify uncontrolled risks presented to the people who lived at the home. There was evidence of a failure to analyse incidents and learn from experience when things had gone wrong.

Most of the people spoken with told us that they were safe and received safe and effective care but others expressed concern and one person did not want us to raise their concerns with the staff for fear of repercussions. We found that the management team were not taking effective action to safeguard vulnerable people when they were made aware of allegations of abuse and instances of actual abuse which had resulted in physical and or emotional harm. The registered manager was defensive and had failed to share evidence of actual abuse and allegations of abuse with the Commission and the local safeguarding authority. This had left vulnerable people without adequate protection. The Commission are looking into specific incidents prior to making regulatory decisions about the incidents known to us.

Investigation into evidence and allegations of abuse were not always carried out thoroughly or effectively so vulnerable people remained at risk. Complaints made by people who used the service and their representatives were not always recorded in the complaints system and a vulnerable person was served notice within 24 hours of their admission to the home because they had contacted an outside agency to raise concerns about the care they had received.

Care and nursing staff were found to be pr

This inspection took place on 2 August 2016 and was an unannounced inspection.

Station House is registered to provide nursing care for up to 71 older people. There are two separate units, one for people living with dementia, the other for people who need general nursing or residential care. The service provides long term care for people with nursing and / or dementia care needs. It also provides Intermediate Managed Care and Transitional Care. The aim of Intermediate Managed Care is to promote recovery and independence following an illness or accident. The aim of Transitional Care is to offer care and support for a short period of time, usually when there has been a health and /or social crisis.

At the time of the inspection 70 people lived at or were placed at the home.

At the last inspection in July 2014 the service was meeting the requirements of the regulations that were inspected at that time.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe living at Station House and liked living there. People said they received their medicines when they needed them. However staff did not always administer medicines safely and securely.

We have made a recommendation about the safe administration and security of medicines.

The registered provider had procedures to protect people from abuse and unsafe care. Staff were proactive in reporting possible safeguarding concerns and took immediate action to reduce risks where they became aware of a safeguarding concern.

We looked at how the home was being staffed. We saw there were enough staff to provide safe care. People we spoke with were satisfied with staffing levels.

Recruitment and selection was carried out safely with appropriate checks made before new staff started working in the home. This reduced the risk of employing unsuitable people.

People told us they were offered a choice of healthy and nutritious meals. Drinks were available throughout the day and people’s dietary and fluid intake was sufficient for good nutrition. People were complimentary about the meals.

Staff had received training in care which gave them the skills and knowledge to provide support to people.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). This enabled staff to work within the law to support people who may lack capacity to make their own decisions.

People we spoke with said staff were friendly, caring and respectful assisted them in a timely way. They said staff supported them to remain as independent as they could be. People and their relatives felt their needs and wishes were listened to and acted on. We saw staff were familiar with people’s care needs, likes, dislikes and wishes and supported them in the way people wanted.

There was a transparent and open culture that encouraged people to express any ideas or concerns. People said staff were easy to talk to and encouraged people to raise questions.

There were procedures to monitor the quality of the service. The registered manager sought people’s views in a variety of ways and dealt with any issues of quality quickly and appropriately. Staff told us she supported them and communicated well.

We undertook an inspection of Station House on 07 July 2014.

During the inspection we spoke with the deputy manager, the unit manager, the activities coordinator and three staff members. We also spoke with seven of the people who lived in the home and three of their relatives.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We spoke to staff and they showed a clear understanding of consent issues. They demonstrated to us that people living in the home may be able to give consent in some circumstances but would need support in others. We saw that the staff had undertaken updated Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training in March 2014 and they told us that this had been useful in improving the support they offered to people.

We looked at the safeguarding policy. This was available in the office. All the staff we spoke to were aware of the policies and how to access them. The deputy manager was able to demonstrate a good understanding of the reporting systems for the local authority and the Care Quality Commission in relation to safeguarding people. They described to us the processes that were currently being carried out to ensure that Deprivation of Liberty Safeguards referrals were made to the local authority for people who lived in the home that they had assessed required it to protect them from harm.

Is the service effective?

We saw that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We looked in some detail at the care and support provided to five people who lived in the home. These records included the person's care plans, risk assessments, and records about the support they had received from professional people outside of the home. We found the information in each person's care plan was detailed and reflected the person's needs.

We saw that the home maintained very good relationships with the local GPs who looked after the people living in the home. We saw that formal meetings were held every three months with the management team and the GPs. The deputy manager told us that they speak informally at the weekly visits. They also told us that the home had installed broadband so that the GPs could access their systems remotely and prescribe instantly in the home as required to meet the medical needs of people quicker.

Is the service caring?

During our inspection we spoke with seven people who lived in the home and three relatives. They all spoke highly of the staff who supported them and the care that they received. One person said "The staff here are lovely. I feel very lucky to be here." A relative told us "They are brilliant. They care for Dad and they are good with our family. They care for all of us really."

During our inspection we observed staff supporting people in a respectful way and asking them for consent prior to carrying out tasks.

Is the service responsive?

The unit manager from the dementia unit told us that Dementia Care Mapping was being used in the home. Dementia Care Mapping (DCM) is a tool developed by Bradford University to measure the care and interaction that a person with dementia receives in their care setting. The data is then used to look at the person's care and their care plan and make improvements to their daily life and their sense of well-being and opportunities for engagement in meaningful activities. The unit manager showed us how the environment had been improved to support the well being of the people who lived there and how this had impacted on people's care in a positive way.

We spoke to the activities coordinator and saw that many different activities took place in the home. On the day of our inspection a local television crew were filming the music therapy session in the home. We were told that a music therapist had been working with some of the people who lived in the home supported by musicians from the Manchester Camerata chamber orchestra. This had been very successful in improving communication and interaction for people. We spoke with some of the people who lived in the home and they were very excited about the prospect of being on the television.

Is the service well led?

Team meetings were regularly being held. We saw that there were head of department meetings, unit meetings, night staff meetings and clinical meetings as well as general staff meetings. We saw that the registered manager had held specific meetings to respond to requests made by staff. The staff we spoke to made very positive comments about the management team in the home, including the manager, deputy manager and unit managers. The staff described them as "very supportive". Comments included; "I can raise concerns whenever I like. If I tell them it's important they stop what they are doing and listen to me." Staff also said that they had been supported with personal issues and that this was appreciated.

We looked at the staff rotas for the six week period prior to our inspection. We saw that staffing levels were fairly consistent. We discussed staffing levels with the deputy manager. They told us that the home had enough staff to meet the needs of the people who lived there. They told us that every effort was made to cover shifts when staff were on holiday or were unwell. The home did not use agency staff, the sought cover from within their existing team. We were also told by staff that the registered manager and the deputy manager would cover shifts on days or nights if required.

During our inspection we spoke with five people who used the service and a visitor. Overall people spoke positively about the care and support they received. People commented; “Nothing is too much trouble”, “The staff are all very good and look after [my relative] well” and “They [the staff] response to any of our requests”. The visitor also told us that they were able to visit at any time and were always made welcome.

Where they were able people were consulted with about their care and treatment. However assessments to show a person ‘lacked capacity’ to make specific decisions for themselves were not in place. Additional records where decisions had been made on behalf of a person were not always completed in sufficient detail. This did not demonstrate that people’s rights were upheld in accordance with relevant legislation.

People's care records contained enough information to show how they were to be supported and cared for. People told us they were well looked after. Comments made included; “They are looking after me very well, it is very free and easy here” and “The staff are fantastic, it’s really very good indeed”. Also “It’s first class” and “The staff are all very good and look after him well”.

We saw that staff worked closely with other health and social care agencies so that people's needs were effectively met. We were also made aware of the systems that were in place to make sure information was passed on when a person's care was transferred to another service.

People were provided with a choice of suitable and nutritious food and hydration to ensure their nutritional needs were met. One person we spoke with told us, “The food is good and there is always a choice. I could have a cooked breakfast, but I choose not to”.

The home gathered relevant information and carried out checks on people who had applied to work at the home. All records were in place prior to people commencing work. Interview records lacked detail about the applicant’s knowledge and experience or how the decisions were made about their suitability.

The provider had systems in place for receiving, handling and responding appropriately to complaints. People were provided with clear information about the procedure in place for handling complaints.

During our visit we spoke with people who used the service, a number of relatives who were visiting the home and a GP. We also used the Short Observational Framework for Inspection (SOFI) in the unit that provides accommodation for people living with dementia. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One of the people who lived in the home told us they had spoken with people about the home before they made the decision to move in. They told us the feedback they had received from friends and others was “very positive” They told us they “were very happy about their stay in the home” and the choices they were offered in their daily lives.

The relatives and GP spoken with told us that they were regular visitors to the home and they had always seen staff treat people with respect and maintain their dignity. One relative told us that staff “looked after (their family member) very well” Another relative told us the “care in the home was very good”

One person who lived in the home told us that staff “were lovely”. They also told us that staff did not always have time to have a chat as “they were kept very busy especially at weekends”

One of the people who lived in the home told us they “felt safe” and that they valued the “security of the home and the welcome they had received when they arrived”

The relatives told us they had no concerns or worries about the safety and well-being of their family members.

One of the people who lived in the home told us they found staff to be very welcoming, they also said that they felt safer having staff around all the time.

The comments we received from the other visitors we spoke with were all positive about the staff and how they helped and supported the people who lived in the home.

People who use the service told us that they were treated with dignity and respect and they were involved in all aspects of their care. They also said they were happy living at the home and the care and support they received was good. One person told us; "the staff are excellent".

People told us that the quality of food was good and they had choices about their food.

There were no issues about the numbers of staff on duty or that call bells were not answered quickly.