This inspection took place on 7 and 8 November 2018 and was unannounced.

The Moat House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates 72 people in one adapted building, comprising of five suites known as Willow, Oak, Aspen, Maple and Thistle. People residing in Willow require support to manage their dementia and nursing needs. Oak provides nursing care. Aspen accommodates people living with dementia. Maple is the residential unit and Thistle is for people who require minimal support to live independently. At the time of our inspection there were 58 people using the service. This service was registered by the Care Quality Commission (CQC) on 25 August 2017 under a new provider RV Care Homes Limited. The last inspection under the previous provider, R V Moat House Limited in August 2016 was rated good. This is the first inspection under the new provider.

The service does not currently have a registered manager 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. The previous registered manager resigned on the 22 June 2018. A new manager commenced in post on 11 June 2018, however, resigned on the 10 September 2018. Since this date a turnaround manager employed by the provider has been managing the service. They are making an application to be registered as the manager with CQC until a new manager is appointed.

Our inspection found the new provider had implemented their own systems to ensure performance, risks and regulatory requirements were understood and managed. However, these new systems were still being embedded and it was difficult to see how these were being used to assess and monitor the overall quality of the service. Although risks to people using the service were generally anticipated and managed well, there were occasions where risks had not been recognised. Safety concerns had not been identified and addressed quickly enough to prevent people being exposed to harm, or a significant risk of harm occurring. However, where an incident had occurred, lessons had been learned and measures taken to prevent a similar incident happening again.

People, their relatives and staff had mixed opinions about staffing levels. The provider had a dependency assessment tool they used to determine the number of staff needed. Rotas showed these numbers were being maintained, however the turnover of staff and high use of agency had added to the frustrations about staffing. The manager had taken steps to resolve this by arranging for regular agency staff to be booked to provide consistency. Ongoing issues with recruitment, largely due to the rural location, were being addressed by the provider. Recruitment processes ensured potential staff were of good character and suitable to work with people using the service.

Improvements were needed to ensure records kept about peoples’ medicines and the care they received, were accurate. Changes in people’s needs had not always been updated in their care plans, to ensure staff were working to the most up to date information. Staff were not using charts to monitor changes in people’s behaviours correctly to ascertain, potential triggers, or reflect they had been used to action change to prevent further incidents. The manager was aware that staff training was not up to date and below the percentage the provider expected. This had been addressed at a staff meeting. They had arranged for staff to complete training where there were gaps, including syringe driver, catheter care and managing