Ince Blundell Hall provides accommodation, support and nursing care for up to 22 people. The service is owned and managed by the Augustinian Nursing Sisters, several of whom have lived and worked in the service for many years. The service admits people for long term care but also offers short term support for people who require respite care.

This inspection was carried out over two days on 6 and 7 September 2017 and was unannounced.

At the last inspection in June 2016 we found the service in breach of three regulations the service was given a quality rating of ‘Requires improvement’. We followed this up in November 2016 and found improvements had been made and all three breaches were met. The service remained ‘Requires improvement’ as we needed to ensure consistency would be maintained.

At this inspection we found consistent standards were being maintained, although there had been a recent change in the leadership of the home.

There was a new manager in post who had commenced working at the home two months prior to our inspection. The previous registered manager had left in June 2017. The manager was yet to register with the Commission (CQC). 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.

We found medicines were being safely managed. The administration records for some medicines such as external applications [creams] and prescribed ‘thickeners’ for drinks (for people with swallowing difficulties) could be further improved.

We looked at how staff were recruited and the processes to ensure staff were suitable to work at Ince Blundell Hall. We saw required checks had been made to help ensure staff employed were ‘fit’ to work with vulnerable people.

We found there were sufficient staff on duty to meet people’s care needs.

Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst help ensure people’s safety.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Training records confirmed staff had undertaken safeguarding training in-house. All of the staff we spoke with were clear about the need to report any concerns they had.

Arrangements were in place for checking the environment to ensure it was safe. For example, health and safety checks were completed on a regular basis so hazards could be identified. Maintenance was assessed and planned well so that people were living in a comfortable and safe environment.

The home was clean and there were systems in place to manage the control of infection.

Staff said they were supported through induction, appraisal and the home’s training programme.

We found the home supported people very well to provide effective outcomes for their health and wellbeing. We saw there was regular and effective referral and liaison with health care professionals when needed to support people. Feedback from visiting health care professionals we spoke with was positive.

People we spoke with said they were happy living at Ince Blundell Hall. Staff interacted well with people living at the home and they showed a caring nature with appropriate interventions to support people. We found a caring ethos throughout the service.

People told us their privacy was respected and staff were careful to ensure people’s dignity was maintained.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made. People felt involved in their care and there was evidence in the care files to show how people had been included i

This inspection took place on 28 November 2016 and was unannounced.

Ince Blundell Hall provides accommodation, support and nursing care for up to 22 people. The service is owned and managed by the Augustinian Nursing Sisters, several of whom have lived and worked in the service for many years. The service admits people for long term care but also offers short term support for people who require respite care. The home is a Catholic service although is open to people outside this faith. The home is a listed building, set within 55 acres of well-maintained grounds and has many features within it, such as a private chapel.

During the inspection, there were 12 people living in the home.

During the last inspection in June 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment and person centred care and we issued warning notices in relation to these areas. The provider was also not meeting legal requirements in relation to protecting people from abuse and improper treatment and we issued a requirement notice regarding this. During this focused inspection we checked to see whether improvements had been made in these areas and to ensure legal requirements were being met. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Augustinian Nursing Sisters Ince Blundell Hall on our website at www.cqc.org.uk.

A manager was in post and had begun the process of applying to become the registered manager. 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.

When we carried out the last unannounced comprehensive inspection in June 2016, we identified concerns in relation to the management of medicines and risk management. During this inspection we looked to see if the provider had made improvements and to ensure they were compliant with legislation and found that improvements had been made.

We found that drugs to be disposed of were recorded appropriately and signed by two staff members in line with best practice. Controlled medicines administered were signed electronically by two staff and times of administration were recorded on the system.

The medicine policy viewed during the last inspection was not reflective of the system in use within the home as an electronic medicine management system had been implemented but was not reflected within the policy. The policy we viewed during this inspection had been updated and provided clear guidance to staff on how medicines were to be managed within the home.

We found that the provider had made improvements with regards to medicines management and legal requirements were now being met.

In June 2016 we identified concerns regarding identified risks to people not being safely managed. During this inspection, we found that improvements had been made and when risk reduction measures were recorded within people’s care plans, there was evidence that these were implemented and legal requirements were now being met.

During the last inspection in March 2016, we identified concerns regarding the application procedures in use to deprive people of their liberty to receive care or treatment. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). During this inspection we found that improvements had been made and appropriate DoLS applications had been made to the local authority for those people who required them. The manager told us they would continue to assess people and make further applications when necessary.

We found that the provider had made improvements with regards to Deprivation of L

This inspection took place on 23 and 24 June 2016 and was unannounced.

Ince Blundell Hall provides accommodation, support and nursing care for up to 22 people. The service admits people for long term care but also offers short term support for people who require respite care. The home is a Catholic service although is open to people outside this faith. The home is a listed building, set within 55 acres of well-maintained grounds and has many features within it, such as a private chapel.

During the inspection, there were 21 people living in the home.

A registered manager was in post. 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.

During this visit we completed a comprehensive inspection, but we also checked to see whether the provider had completed the actions they told us they would take following the last inspection in October 2015.

We found during the last inspection that medicines were not always managed safely. During this inspection we found that medicines were still not always managed safely. Staff had not completed competency assessments in relation to medicines and the medicines policy had not been updated to reflect the electronic systems in place. Although the stock balances we checked were accurate, audits showed that there were regular inaccuracies in the stock balances.

We received mixed feedback regarding staffing levels from people living in the home and staff. A number of staff had left the home and others were due to leave and agency staff were being utilised to help ensure there were enough staff to meet people’s needs. Although some people told us they did not feel there were enough staff, nobody told us that they had to wait long for the support they required.

People we spoke with told us they felt safe living in Ince Blundell Hall.

We found through discussion that staff had a good understanding of safeguarding processes and had completed training regarding this.

We found that accidents and incidents were recorded and reported appropriately. Audits were completed and any actions identified were completed to help reduce further incidents.

Risk management systems were in place to assess and manage risks in relation to the environment as well as risks to individuals. We found that actions had been taken to minimise risks identified in people’s risk assessments.

Safe recruitment processes were evident within the home to ensure staff were suitable to work with vulnerable people.

Staff had completed mental capacity and Deprivation of Liberty Safeguards (DoLS) training; however we found that DoLS applications were not always made for people who may require one. Records showed that consent was sought in line with current legislation.

Staff were supported in their role through induction, supervision, appraisals and regular training. Staff we spoke with told us they felt well supported and were able to raise any issues with the registered manager when required.

Most people told us they enjoyed the food available in the home and they had enough to eat, but did not always have a choice of meal. Staff told us people had a choice of meals and could have alternative meals and snacks whenever they wanted. The chef was aware of people’s dietary needs and preferences and told us they always prepared an alternative meal when they knew a person did not like the meal on the menu.

People told us staff were kind and caring and treated them with respect. People’s dignity and privacy was respected by staff during the inspection and interactions between staff and people living in the home were warm and genuine. People told us that their independence was encouraged.

People we spoke with did not recall being involved with the crea

We spoke with two people who were able to tell us about their views and experiences of the service. Both people told us they were satisfied with the care and support provided to them. One person said, “Everybody is very caring and they make sure everything is as it should be.” Both people we spoke with said they were always treated with dignity and respect. We were told the food was enjoyable and that their preferences were taken into account.

The home is a Catholic service although is open to people outside this faith. Many of the people using the service were from the Catholic clergy. People told us they receive excellent spiritual support and many regularly attended morning mass or use the chapel for prayer and reflection. People using the service were supported to access the grounds.

We found improvements had been made since our last inspection in September 2012 when we found staff did not have access to all the information they needed to respond appropriately to safeguarding concerns. However, the service still needed to fully implement plans to put in place regular supervision arrangements.

We spent time with seven people who were living in the home. Six people were able to tell us about their views and experiences of the Augustinian Nursing Sisters. Overall, people expressed they were very happy with the care and support provided to them. One person said “This is a very good nursing home” and that “I am treated with dignity and respect.” Another person said “The staff are absolutely first class and will do anything for you.” All the people we spoke with said they enjoyed the food and a number commented on the home always being very clean.

We spoke with two people who were visiting friends or relatives who live in the home. All were pleased with the care and support being provided. One person said “this place is very special” and “the care provided gives us so much peace of mind as a family.” Another visitor told us that everybody had been really kind.

This unannounced inspection of The Augustinian Nursing Sisters Ince Blundell Hall took place on 7 & 9 October 2015.

Ince Blundell Hall provides accommodation, support and nursing care for up to 22 people. The service is owned and managed by the Augustinian Nursing Sisters, several of whom have lived and worked in the service for many years. The service admits people for long term care but also offers short term support for people who require respite care. The home is a Catholic service although is open to people outside this faith. The home is a listed building, set within 55 acres of well-maintained grounds and has many features within it, such as a private chapel.

A registered manager was in post. 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 living in Ince Blundell Hall told us they felt the home was a safe place to live and that they were supported by the staff and external health care professionals to maintain their health and wellbeing. People told us a doctor would be contacted if they were unwell.

Not all staff had received safeguarding training to enable them to identify and respond appropriately to potential allegations of abuse.

Records we viewed and checks we made, showed us medicines were not always managed safely. There were however effective processes in place to support people to administer their own medicines safely. People we spoke with told us they received their medicines when they needed them.

Procedures for reporting accidents and incidents were in place; however they were not always followed. There were some systems in place to maintain the safety of the home, such as maintenance and a fire risk assessment. There were however some risks that were not minimised, such as the safe storage of chemicals. The home was accessible; it had a passenger lift and stair lifts available and corridors were kept clear in order to prevent accidents.

We saw risk assessments in areas such as nutrition, mobility, pressure relief and use of bed rails. However, risk assessments were not always in place to identify potential risks, such as falls.

Staff recruitment checks were completed prior to employment to ensure staff were suitable to work with vulnerable people. Not all staff had the required photographic identification held within their personnel files. Staff felt well supported in their role and had completed an induction on commencement of their post. Staff felt this induction was sufficient to ensure they could meet people’s needs. Not all staff had completed an appraisal or supervisions and some staff had not completed all mandatory training courses.

Our observations showed us there were adequate numbers of staff on duty to meet people’s needs, however a needs based assessment tool to identify the number of staff required, was not in place. People told us there were mostly sufficient numbers of staff available to support them and that staff were staff were kind and caring and treated them with respect. We observed positive interactions between staff and people living in the home. We observed staff maintaining people’s privacy and dignity and their confidential records were stored securely. Staff we spoke with had a good understanding of people’s needs and their preferences.

People’s consent was not always sought regarding their care and treatment in line with the Mental Capacity Act (2005). We made a recommendation regarding this in the main body of the report.

People we spoke with gave positive feedback regarding meals; however there was no choice of meal available. People told us if they did not like the meal, they could ask for an alternative.

People told us their religious needs were met by staff. They were supported to attend mass each day if they chose to. People told us there was a lack of regular activities provided in the home.

Relatives and people living in the home told us visitors could visit any time, encouraging people to maintain relationships.

We viewed care plans that reflected people’s preferences and were reviewed regularly. Not all care was planned effectively to meet identified needs and risks were not always assessed regularly.

The home had a policy and procedure for managing complaints which was on display within the home. People we spoke with told us they felt able to speak to staff and were confident they would be listened to.

We received positive feedback regarding the management of the home from staff, people living in the home and visitors. Staff were encouraged to share their views of the service through regular meetings.

Systems were not in place to gather views from people living in Ince Blundell Hall or their relatives and there were no effective processes in place for the management of the home to ensure the quality and safety of the service. This meant the concerns highlighted on this inspection had not been identified by the service.

You can see what action we told the provider to take at the back of the full version of the report.