About the service: Serenity Care 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. The service was a large home, bigger than most domestic style properties. However, despite the size of the property it was only registered for the support of up to 5 people. At the time of our inspection there were 3 people living in the home. Signs remained outside to indicate it was a care home however staff were discouraged from wearing anything that suggested they were care staff when coming and going with people.

The service also provides personal care to 50 people living in their own homes in Gainsborough and in Grantham.

The service had been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with a learning disability were supported to live as ordinary a life as any citizen.

People’s experience of using this service:

There was not a system in place to carry out quality checks in either the residential setting or the homecare service.

Medicines were not consistently managed safely. Arrangements were not in place to store and manage medicines safely.

Risk assessments had not been completed for people living in the residential setting.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways [promotion of choice and control, independence, inclusion] e.g. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People said they felt safe. There was sufficient staff to support people.

People enjoyed the meals and their dietary needs had been catered for. Staff supported people to have a healthy diet.

Care plans for people living in the residential setting did not contain information about people and their care needs. Care plans for people receiving care in their own home were completed and included information to assist with the provision of personalised care.

Staff had received training to support their role. Staff had started to receive supervision and plans were in place to ensure people received this on a regular basis.

People had good health care support from professionals. The provider and staff worked in partnership with health and care professionals.

Staff were aware of people's life history and preferences and they used this information to develop positive relationships and deliver person centred care. People felt well cared for by staff who treated them with respect and dignity.

People in the residential setting had access to a range of activities including participating in leisure pursuits in the local community.

The environment was not fully adapted to support people living with learning disability. A refurbishment plan was in place to address this.

The home was not clean in some areas and arrangements were not in place to manage the risk of cross infection.

The provider had displayed the latest rating on the website. When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.

Rating at last inspection: Requires Improvement (Report Published). At our previous comprehensive inspection in October 2017 the service was rated overall requires improvement. We found a breach of Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010.

At this inspection we found a continuous breach of Regulation 17 and a breach of Regulation 12.

We have taken this into account in determining the rating.

Why we inspected: This inspection was a planned inspection based on the previous rating.

Follow up: We will ask the provider for an action plan to indicate when they

This inspection took place on 11October 2017 and was unannounced. At our last inspection the overall rating for North warren house was 'good'. The safe domain was rated as ‘requires improvement’. North Warren House provides residential care for people who are living with dementia. It provides accommodation for up to 15 people who require personal and nursing care. At the time of our inspection there were 15 people living at the home. It also provides personal care in people’s homes to older people and people living with physical and mental disabilities.

There were two registered managers in post. One for the residential home and another for the homecare service. 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.

On the day of our inspection staff interacted well with people in the residential home. People and their relatives using both parts of the service told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Systems for monitoring medicines were not consistent with national guidance. Arrangements were not consistently in place to ensure the safe administration and management of medicines.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had usually been completed.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day. Where people had special dietary requirements we saw that these were provided for.

There was usually sufficient staff available to meet people’s needs. Staff responded in an appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Some staff had received supervision however supervisions had not been completed for all staff in both areas of care. People were supported to access leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans put in place to address any issues which were identified. However the audits had failed to identify the issues found at this inspection. The provider had failed to fully address the issues raised at our previous inspection. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

This inspection took place on 15 September 2016 and was unannounced. North Warren House provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 15 people who require personal and nursing care. At the time of our inspection there were 13 people living at the home. It also provides a personal care service to people living in their own homes.

There was 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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines records did not consistently confirm that medicines were administered as prescribed. Medication administration sheets (MARS) were not always fully completed.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. Risk assessments were completed in the residential home however there were gaps in risk assessments for people using the homecare service. People had access to healthcare professionals such as the GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. It was not easy for people to make choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were usually sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had not received regular formal supervision but felt supported in their roles.

Staff obtained people’s consent before providing care to them. People were provided with access to activities and leisure pursuits.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans were in place to address any issues which were identified. Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

This inspection took place on 14 July 2015 and was unannounced. North Warren provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 15 people who require personal and nursing care. At the time of our inspection there were 13 people living at the home. The provider also provides personal care to people in their own homes. At the time of our inspection the provider was providing personal care to 42 people.

At the time of our inspection there was 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

On the day of our inspection we found that staff interacted well with people and people were cared for safely. People told us that they felt safe and well cared for. Staff were able to tell us about how to keep people safe. The provider had systems and processes in place to keep people safe.

The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed, and care planned and delivered

to meet those needs. People had access to other healthcare professionals such as a dietician and GP and were supported to eat enough to keep them healthy. People had access to drinks during the day and had choices at mealtimes and where people had special dietary requirements we saw that these were provided for.

Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered.

Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision.

We saw that staff obtained people’s consent before providing care to them. People did not have access to activities and community facilities.

Staff felt able to raise concerns and issues with management. We found relatives were clear about the process for raising concerns and were confident that they would be listened to. However, the complaints process not on display and therefore not everyone was able to access this.

Regular audits were not carried out. Audits were not in place for areas such as falls and infection control however the registered manager told us that they were in the process of developing these.

Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with a visiting district nurse, six people who used the service and five relatives (one of whom was also a member of staff) and asked them for their views. We also spoke with two care workers, the registered manager and the provider. We looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and received care and support that met their needs. A person who used the service told us, “It is entirely up to me what I wear. I come down when I want to and when you have breakfast is up to you.” Another person told us, “I have help where I need it, but they don’t push it at you. I wouldn’t want to lose my independence.”

We found people who used the service were kept safe and protected from harm. Staff knew how to respond to any allegation of abuse. A person who used the service told us, “I only have to press the bell and there is someone there. I am not made to feel a nuisance, they just reassure me. That is just what I need.”

We found the staff team were supported through training and the provider monitored the quality of the service and responded to people’s views. A person told us, “They do seem to be well trained, they are anxious to help without being intense.”