About the service: The Hay Wain provides accommodation for older people, some of whom may live with dementia. The service can accommodate up to 10 people. On the day of our inspection visit seven people were accommodated.

People’s experience of using this service:

People experienced a very individualised service that met their expressed needs in a personalised way. Due to the small scale of this service people were able to make suggestions and express wishes that were quickly met. People were able to lead a lifestyle of their choosing with good access to appropriate healthcare services.

We found that the premises were safely maintained. Previously we had concerns about fire safety checks, but these were now being consistently completed.

Previously we had asked for improvements in the safe management of people’s medicines. People now experienced safe systems for administering their medicines. People received their medicines as prescribed. One person told us, “I have no problems with getting my medicines as I need them.”

People at this service were well cared for by sufficient numbers of dedicated staff. People’s feedback was consistently positive about the care, support and staff. One person told us, “I feel safe and the staff are kind.”

Audits were in place to enable the registered manager to monitor the quality of the service. This included oversight of fire safety and medicines management.

Rating at last inspection: We rated The Hay Wain as requires improvement in safe and well led. This made an overall rating of requires improvement. We published our report on 29 January 2019.

Why we inspected: This was a focused inspection that looked at safe and well led.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Hay Wain is a residential care home that provides accommodation and personal care for up to 10 older people, some of whom are living with dementia. There were eight people living in the service when we inspected on 22 November 2018. This was an unannounced comprehensive inspection. The home is situated on the edge of the town of Haverhill in Suffolk.

The Hay Wain is a ‘care home’. People in care homes receive accommodation and 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.

There was a registered manager in post at the time of our inspection however they were not at work when we inspected. A registered manager is a person who has registered with CQC 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. On the same site as The Hay Wain, the provider also had another ‘sister home’, The Meadows Care Home which is a residential home for up to 65 older people. The registered manager of The Hay Wain also managed The Meadows Care Home.

We previously inspected this service in June 2017 and rated it Good overall with well-led rated ‘Requires Improvement’. Since that date the provider changed their company name from Minster Haverhill Ltd to Minster Care Management Limited. This resulted in a new registration for the provider and the ‘archiving’ of the previous rating. At this inspection we found that the home still required improvement in well led and in addition we found concerns in the key question of Safe. The management oversight of the service continued to be cause for concern and audits were still not effective at identifying issues. The home has been rated Requires Improvement overall at this inspection.

This service was selected to be part of our national review, looking at the quality of oral health care support for people living in care homes. The inspection team included a dental inspector who looked in detail at how well the service supported people with their oral health. This includes support with oral hygiene and access to dentists. We will publish our national report of our findings and recommendations in 2019.

The premises were not always safely maintained, fire safety checks had not been completed as planned. Improvements were needed to the safe management of people’s medicines.

Audits were in place to enable the registered manager to monitor service quality however, these were not effective as they had failed to pick up the lack of fire safety checks and the improvements needed to the safe management and storage of people’s medicines.

There were sufficient staff to meet people’s needs in a timely manner. The provider operated safe recruitment procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People received a service that was caring. Staff knew people's needs well and were responsive and supportive.

People's mental capacity was appropriately assessed and their rights were protected. Care staff had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and they understood the importance of people being supported to make decisions for themselves.

Staff knew people well and had a good knowledge of their needs. They treated people with kindness. People were encouraged to do what they could for themselves, but support was available when they needed it.

People were supported according to person-centred care plans, which reflected their needs and preferences. These were regularly reviewed with people and their relatives. People had the opportunity to engage in activities if they wished. The service had a complaints procedure which was