The inspection took place on 06 September 2018 and was unannounced. At the last inspection of the service in December 2017 the provider was rated as Good in all five key questions. At this inspection, we found that the key questions of Safe, Responsive and Well Led were now rated as Requires Improvement.

We inspected the service as we were made aware a person’s advance wishes in respect of resuscitation had not been followed. The provider had taken steps to ensure this avoidable and concerning event did not reoccur for other people and had notified the appropriate external agencies.

The Poplars 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 Poplars is registered to provide care, nursing and accommodation to a maximum of 58 older people, some with a physical disability. At the time of the inspection, there were 51 people living at the home.

There was no registered manager in post, an acting manager had been in the role since January 2018, but had yet to register with CQC. The acting manager was not available on the day of 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. The provider was taking measures to ensure that a registered manager was appointed.

This is the first time that the service has been rated Requires Improvement.

Administration and recording of medicines given was done safely. Medicines were not always stored adequately or safely. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed. Staff were available to people, but there were concerns over numbers of staff. Staff were not always recruited safely. Accidents and incidents were responded to appropriately, but recordings did not always reflect this. The environment was not always safe for people.

Staff had the skills and knowledge required to support people effectively. Staff had an understanding of the Mental Capacity Act and how best to support people in line with its principals. People felt the meals were adequate and staff were supportive when people required assistance to eat. Staff gained people’s consent before assisting or supporting them. Staff received an induction prior to them working for the service and could access ongoing training to assist them in their role. Staff could access supervision and felt able to ask for assistance from management should they need it. Staff supported people’s healthcare needs.

Staff were caring towards people. People were encouraged to retain an appropriate level of independence and choices were given to people where it was appropriate. Privacy and dignity were maintained on most occasions.

Care plans were in place and updated monthly, but were not reviewed annually with the person’s input. People’s preferences for how they wished to receive support were known and considered by the care staff. There was some level of activities, but this was not consistent. People knew how to raise complaints, but the recording of them was not clear. End of life care was considered.

There had been a lack of registered manager for some months and not everyone knew who the acting manager was. There had been a lack of opportunity for people and relatives to share their opinions on the service. Quality assurance audits were carried out, but these did not identify concerns in all areas and did not always give enough information. We received notifications as required.

We carried out an unannounced comprehensive inspection of this service on 14 December 2017.

The Poplars Nursing Home is a home for people who receive accommodation and nursing care. A maximum of 58 people can live at the home. There were 47 people living at home on the day of the inspection. At the last inspection, the service was rated Good and at this inspection we found the service remained Good.

People living in the home, their friends and relatives told us that staff support and guidance made the home safe. People told us that staff assistance maintained their safety and staff understood how they were able to minimise the risk to people’s safety. We saw staff help people and support them by offering guidance or care that reduced their risks. Nursing and care staff understood their responsibilities in reporting any suspected risk of abuse to the management team who would take action. Staff were available for people and had their care needs met in a timely way. People told us their medicines were manged and administered for the by the nursing staff.

Staff knew the care and support needs of people and people told us staff were knowledgeable about their care and support needs. Staff told us their training courses and guidance from senior care and nursing staff and managers maintained their skill and knowledge. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had a choice of where that ate their meals, and while there was two menu options there was mixed feedback from people and their relatives about this not always being offered. People had been asked the previous day, and on occasion we heard an alternative offered to people on the day of the inspection. The provider was given this feedback to look at how best to consistently support meal choice. Where people needed support to eat and drink enough to keep them healthy, staff provided assistance. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People were seen talking with staff and spent time relaxing with them. Relatives we spoke with told us staff were kind and friendly. Staff told us they took time to get to know people and their families. Family member were updated about their family member’s well being from staff. People’s privacy and dignity was supported by staff when they needed personal care or assistance. People’s daily preferences were known by staff and those choices and decisions were respected. Staff promoted a people’s independence and encouraged people to be involved in their care and support.

People’s care needs had been planned, with their relatives involvement where agreed. Care plans included care and support needs and were reviewed and updated regularly. People told us activities offered in the home. People also told us they enjoyed reading or socialising with others in the home.

People and relatives were aware of who they would make a complaint to if needed, but not all had seen the providers complaint policy. People told us they would talk though things with staff or if they were not happy with their care.

The manager provided leadership for the staff team and people had the opportunity to state their views and opinions with surveys. The provider had a range of audits in place to monitor the quality and safety of people’s care and support. Action plans were developed to maintain the home and care of people. The provider’s planned improvements were followed up to ensure they were implemented.

This unannounced inspection took place on 29 February 2016. At our last inspection in February 2014, we found that the provider was meeting the regulations we assessed associated with the Health and Social Care Act 2008.

The Poplars is registered to accommodate and deliver nursing and personal care to a maximum of 47 people. People who live there may have needs associated with old age or physical disability. At the time of our inspection 30 people were living there.

The manager was registered with us as is required by law. 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 that overall medicines were administered, stored and disposed of safely. There were systems in place to protect people from abuse and harm. Staff had a clear knowledge of how to protect people and understood their responsibilities for reporting any incidents, accidents or issues of concern. People felt there were a suitable number of staff on duty with the skills, experience and training in order to meet their needs. People using the service, their relatives and staff were satisfied that there were enough staff available within the service.

Staff supporting people had access to a range of training to provide them with a level of skills and knowledge to deliver care safely and efficiently. Staff were able to give an account of what a Deprivation of Liberties Safeguard (DoLS) meant for people subject to them and described how they complied with the terms of the authorisation when supporting that person. Mealtimes were structured in a way that encouraged people to identify it as a social event and an opportunity to interact with others. People felt they had good access to health care support when required and that staff responded to health care issues in a timely manner

People were happy living at the home and felt that staff treated them with dignity and respect. Staff interacted with people in a positive manner and used encouraging language whilst helping them to maintain their independence as far as was practicable. People told us they were provided with the information about the service and their care and treatment that they needed. People were supported to observe their cultural preferences and spiritual beliefs.

People were supported to make decisions about their lives and discuss things that were important to them. Staff were responsive to people when they needed assistance. People’s life history, likes, dislikes and preferences were known and staff were knowledgeable about how to meet their needs in line with these. Information was on display about how to make a complaint. The provider demonstrated to us how they had effectively acknowledged, investigated and responded to complaints that they had received.

People and staff spoke confidently about the leadership skills of the registered manager. People were involved in meetings and were able to influence how the service was run. People were confident that the registered manager would respond positively to their requests and staff were happy working at the home. The registered manager undertook regular checks on the quality and safety of the service.

We carried out an inspection to help us answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?”

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with three people using the service and two of their relatives, four care staff supporting them and looking at six care records.

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

Is the service safe?

People who used the service and their relatives told us that they felt safe. Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported.

The home had appropriate policies and procedures to protect people’s rights and choices and gain their consent to the care and support they received. The home's policies reflected the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff had received training in how to protect people's rights and understood legal requirements.

Staff knew about risk management plans and we saw that they supported people in line with those plans.

The registered manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way. The staff had the training and support required to ensure that people’s needs were met.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

Is the service effective?

People’s health and care needs were assessed with them and where people wanted family members were involved. People told us they were involved in the care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the care staff.

Care staff received the appropriate training to meet the diverse needs of people who used the service.

Visitors confirmed that they could visit when they wanted to and spend time alone in privacy if they wished.

Is the service caring?

People were supported by staff that were kind and caring. We saw that care staff gave people encouragement and were patient with them. One relative told us, “I visit my relative regularly and the staff are very caring”.

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to engage in a range of different activities each day.

People were aware of the home’s complaints procedure and knew how to raise concerns. One relative told us, “They are responsive to my relative’s changing needs”.

Where care staff had noticed people's changing needs, their care plans had been updated to reflect this.

Is the service well led?

The service had quality assurance and risk management systems in place. Records seen by us indicated that shortfalls in the service were addressed promptly.

The staff were well supported to ensure they had the skills and knowledge to carry out the care people needed. Care staff were given feedback about their performance so improvements could be made where needed.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the home was well organised and they felt supported by their manager.

There were 35 people living there on the day of our inspection. We spoke with six people who lived there, three of their relatives, five members of staff and the registered manager.

We saw good interactions between people who lived there and staff. We observed that people were at ease in the company of staff. One person told us, “The staff treat me well here.”

We saw that people's needs had been assessed by a range of health professionals and people's healthcare needs had been monitored and met. A relative told us, “My relative is well cared for here.”

People were encouraged to eat a healthy and nutritious diet. People told us that they had a choice of what to eat and liked the food provided.

Systems were in place to ensure that people were safeguarded from harm and the risk of abuse.

Staff had the skills and knowledge to know how to safely support people who lived there to meet their needs. Staff told us that they were well supported in their role and this helped them to know how to support people who lived there.

People were asked for their views about the home and these were listened to. We saw that audits were completed and action was taken to make improvements where needed.