This focused inspection took place on 24 April 2018 and was unannounced. The last comprehensive inspection of the service was on 25, 26 and 29 January 2018 when we found one breach of the Care Quality Commission (Registration) Regulations 2009 as the provider did not inform CQC of the outcomes of applications they had made to the local authority for authorisation to deprive people of their liberty. At the inspection in April 2018 we looked at the key questions Safe and Well-led and found that the provider and registered manager had made improvements to ensure they sent statutory notifications to CQC and monitored accidents and incidents to keep people safe.

No risks, concerns or significant improvements were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection

Threen House Nursing Home 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 provides accommodation and nursing care for up to 26 older people in a converted, detached property. When we carried out this inspection 11 people were using the service.

The service had a manager who registered with the Care Quality Commission in December 2017. 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 using the service were cared for safely as staff completed training in safeguarding and whistleblowing and were clear about reporting any concerns.

Staff reviewed possible risks to people using the service and took action to mitigate these.

The provider carried out checks to ensure new staff were suitable to work with people using the service and there were enough staff deployed to meet people’s needs.

People received the medicines they needed safely and as prescribed.

The provider had appointed a qualified and experienced manager who started work at the service in August 2017. People’s relatives and staff told us the service was well managed.

The registered manager had appointed teams of staff that were champions in skin integrity, infection control, falls prevention and health and safety. They had also reviewed systems to improve the management of health and safety, including the reviewing of incidents and accidents.

The provider consulted people using the service, their relatives and staff about the care and support people received.

This comprehensive inspection took place on 25, 26 and 29 January 2018. The visit on 25 January was unannounced and we told the provider we would return on 26 and 29 January to complete the inspection.

At our last comprehensive inspection on 9 and 10 August 2017 we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not comply with regulations when carrying out regulated activities and had not taken action to address concerns raised in previous inspection reports; the provider did not carry out checks on nurses and care staff they employed to make sure they were suitable to work with people using the service; health and safety checks the provider carried out did not always identify possible risks to people using the service; staff did not receive the training they needed to care for and support people using the service and the provider did not always deploy staff in a way that ensured the safety of people using the service; some parts of the premises were in need of redecoration or refurbishment and staff did not always treat people using the service with respect and the provider did not always demonstrate respect for people’s dignity and privacy.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, is the service Safe, Effective, Caring and Well-led to at least good. The provider sent us an action plan dated 13 October 2017 in which they told us they had already completed actions to improve standards in the service.

Threen House Nursing Home 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 accommodates up to 26 older people in one adapted building.

The provider is registered with the Care Quality Commission (CQC) as an individual and there is a condition on their registration that they appoint a registered manager. The provider appointed a manager in August 2017 and they completed their registration with the Care Quality Commission on 29 December 2017. 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.’

At this inspection we found one breach of the Care Quality Commission (Registration) Regulations 2009 as the provider did not inform CQC of the outcomes of applications they had made to the local authority for authorisation to deprive people of their liberty.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Whilst the provider analysed individual incidents and accidents to make sure people received the support they needed, they did not systematically analyse all incidents, accidents and pressure ulcers to identify if there was any action that needed to be taken at a service level to prevent recurrence.

There were systems in place to keep people safe and staff had the training they needed to follow these.

The provider and registered manager assessed possible risks to people using the service and took action to mitigate these. The provider and registered manager also carried out checks on nurses and care staff they employed to make sure they were suitable to work with people using the service.

Staff had the training and support they needed to provide effective care and support to people using the service.

People using the service and their relatives told us they were involved in planning their care and could make decisions about the support t

This inspection took place on 09 and 10 August 2017. The visit on 09 August was unannounced and we told the provider we would return on 10 August to complete the inspection.

The last comprehensive inspection of the service was in February 2017. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not operate effective systems to investigate possible abuse; the provider did not always manage people’s medicines safely; staff did not have the training and supervision they needed to provide safe and appropriate care for people; the provider did not arrange appropriate activities that met people’s needs and preferences and audits and checks carried out by the provider did not identify improvements that were needed to the quality of care provided. We also found one breach of the Care Quality Commission (Registration) Regulations 2009 as the provider did not inform the CQC of possible safeguarding incidents.

Following the inspection we issued the provider with three Warning Notices and gave them two months to comply with the Regulations. There is a condition in place, agreed with the provider that they must not admit new people to the service, without the written agreement of the Care Quality Commission.

In May 2017 we carried out a focused inspection to review actions the provider had taken in response to the Warning Notices and also discussed information of concern we received from the registered manager regarding staff recruitment. We found the provider and the registered manager had made some progress towards meeting the requirements of the Warning Notices, although further work was needed.

Threen House is a registered care home for older people who require nursing or personal care, some of whom are living with the experience of dementia. The service can accommodate up to 26 older people, in single or shared rooms. At the time of this inspection, 12 people were using the service.

The service did not have a registered manager at the time of this 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 is registered with the Care Quality Commission (CQC) as an individual and has a condition of registration to have a registered manager. The provider appointed a manager in August 2016 and they were registered by CQC on 07 May 2017. The manager left the service later in May 2017 and another manager appointed by the provider in June 2017 resigned after three weeks in post. The provider informed CQC they had appointed another manager who was due to start work in the service at the end of August 2017.

The provider did not comply with regulations when carrying out regulated activities and had not taken action to address all of the concerns raised in previous inspection reports.

The provider did not carry out checks on staff they employed to make sure they were suitable to work with people using the service. This may have placed people at risk of unsafe or inappropriate care.

Health and safety checks the provider carried out did not always identify possible risks to people using the service.

Staff did not receive the training they needed to care for and support people using the service and the provider did not always deploy staff in a way that ensured the safety of people using the service.

Some parts of the premises were in need of redecoration or refurbishment.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. We are taking enforcement action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports a

This inspection took place on 10 May 2017 and was unannounced. The last inspection of the service was in February 2017 when we found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not notify the local authority or the Care Quality Commission (CQC) of possible safeguarding incidents, the care and treatment of service users was not always appropriate and did not meet their needs or reflect their preferences, the registered person did not manage medicines safely, the registered person did not operate systems and processes effectively to investigate any allegations or evidence of abuse, the registered person did not operate effective systems to assess, monitor and improve the quality and safety of the services provided and persons employed in the service did not receive appropriate support, training, supervision or appraisal to enable them to carry out the duties they were employed to perform. Following the inspection we issued the provider with three Warning Notices and gave them two months to comply with the Regulations. The provider also agreed not to admit new people to the service, without the written agreement of the Care Quality Commission.

At this inspection we reviewed actions the provider had taken in response to the Warning Notices and also discussed information of concern we received from the registered manager regarding staff recruitment. We found the provider and the registered manager had made some progress towards meeting the requirements of the Warning Notices, although further work was needed.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Threen House Nursing Home’ on our website at www.cqc.org.uk.

As we have rated one of the five questions we ask as 'Inadequate' the service remains in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Threen House is a registered care home for older people who require nursing or personal care, some of whom are living with the experience of dementia. The service can accommodate up to 26 older people, in single or shared rooms. At the time of this inspection, 13 people were using the service.

The service had a registered manager who was appointed by the provider in August 2016. However, during this inspection the registered manager told us they had given in their notice to the provider and would be leaving shortly. 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 one breach of the Health and Social Care Act 2008 (Regulate

This inspection took place on 2nd and 3rd February 2017. The visit on 2nd February was unannounced and we told the provider we would return on 3rd February to complete the inspection.

The last comprehensive inspection of the service was in July 2016 following which we issued the provider with a Warning Notice that required them to improve risk management, staff training and the ways staff supported people with moving and handling. The provider sent us an action plan on 8 September 2016 telling us about the actions they had taken. We carried out a follow up inspection in November 2016 and found that the provider had made some progress to address the concerns we raised but further action was needed to ensure people were cared for safely.

The service had been rated as Inadequate since July 2015 and is therefore in special measures.

Threen House is a registered care home for older people who require nursing or personal care, some of whom are living with the experience of dementia. The service can accommodate up to 26 older people, in single or shared rooms. At the time of this inspection, 13 people were using the service.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.

People did not always receive their medicines safely as staff did not always complete administration records correctly and agreements to administer some medicines covertly were not agreed with all of the people involved in the person’s care.

The provider was unable to evidence that staff had the training, supervision and appraisals they needed to care for people effectively.

The provider did not have a programme of daily planned activities and people’s care records included very few mentions of any activities taking place. For long periods of the day, people sat in the lounge or conservatory with little stimulation.

The provider carried out some checks and audits to monitor quality in the service but these were not always up to date or effective. For example, the annual development plan for the service the provider produced was dated 2012 and audits had not identified gaps in staff training, supervision and appraisals.

The provider did not notify the local authority’s safeguarding adults team and the CQC of possible safeguarding concerns so that these could be independently investigated.

The provider carried out checks before new staff started to work to ensure they were suitable to care for and support people using the service.

There were sufficient staff to meet people’s care and support needs as well as carrying out other tasks including people’s laundry. We did not see people waiting excessive amounts of time for help and support. People told us they felt well cared for and staff were kind and caring. People’s relatives also told us people were well cared for. We saw care staff treated people with respect and understood the need for privacy.

People’s health needs were met as they could access the healthcare services they needed.

During the inspection we did not see any examples of people who were deprived of their liberty unlawfully. We also saw that, where people did not have capacity to make their own decision about an aspect of their care, the provider worked with their relatives and others to make a decision in their best interest.

People told us they enjoyed the food provided in the service and the provider had introduced more variety and choices.

The provider had improved the ways they recorded people’s care needs. People using the service had a plan of care that included details of their health and personal care needs and how nurses and care staff in the service would meet these.

The provider had a

This inspection took place on 16 November 2016 and was unannounced. Following our last inspection in July 2016 we issued the provider with a Warning Notice that required them to improve risk management, staff training and the ways staff supported people with moving and handling. The provider sent us an action plan on 8 September 2016 telling us about the actions they had taken. Although they were not able to say when they would achieve compliance with the Warning Notice, the provider had made contact with the Clinical Commissioning Group (CCG) to request assessments of people’s care needs and arranged training for staff. We carried out this inspection to check whether the provider had addressed the issues highlighted in the Warning Notice and made the required improvements to the way people were cared for and supported. We found that the provider had made some progress to address the concerns we raised but further action was needed to ensure people were cared for safely.

Threen House is a registered care home for older people who require nursing or personal care, some of whom are living with the experience of dementia. The service can accommodate up to 26 older people, in single or shared rooms. At the time of this inspection, 16 people were using the service. The service did not have a 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.

The previous registered manager left the service in May 2016. The provider appointed a new manager in June 2016 but they left the service in July 2016. The provider then appointed the current manager in August 2016. The manager told us they were waiting for their Disclosure and Barring Service (DBS) check to enable them to register with the Care Quality Commission.

We found the provider had made some improvements to the way they assessed and managed risks to people using the service but this was not consistent. Some risk assessments provided clear information and guidance for staff but others were not completed correctly and did not reflect people’s care and support needs.

We found a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider and manager did not ensure they followed the service’s policy for risk assessment, risk management and care planning and failed to carry out audits of completed risk assessments and care plans to ensure these were completed correctly.

There were sufficient staff to meet people’s care needs and the provider had carried out checks on new staff to make sure they were suitable to work with people using the service.

The provider and manager had arranged for an external trainer to provide moving and handling training for all nurses and care staff and had obtained some new equipment. The provider was also trialling other equipment on loan from the local Clinical Commissioning Group (CCG) to address the specific moving and handling needs of one person. During the inspection we saw staff supported people in a safe and caring way when they helped them to move around the service. Occupational therapy staff from the CCG had assessed the mobility, moving and handling support needs of each person using the service.

There were enough staff to care for and support people and we saw they did this in a caring and professional way. The provider worked regularly in the service as a care assistant.

This inspection took place on 24, 25 and 26 July 2016. The visits on 24 and 25 July were unannounced and we told the provider we would return on 26 July to complete the inspection.

We inspected the service on 21 July 2015 and found breaches of regulations covering safeguarding people using the service, recruitment procedures, staff training, the management of complaints, safe care and treatment and failure to notify the Care Quality Commission of significant events affecting people using the service. We placed the service in special measures and took enforcement action. This included issuing four Warning Notices and imposing a condition on the provider’s registration on 01 September 2016 that prevented them from admitting new people to the service without the written agreement of CQC. The provider sent us representations against the imposed condition but we did not uphold these and confirmed the condition on their registration on 16 June 2016.

We also carried out a further inspection on 12, 13, 17 and 18 January 2016 to monitor the provider’s progress in meeting the requirements we made following the July 2015 inspection. At this inspection we found medicines were not being managed safely, people were not always receiving their medicines as prescribed, staff had completed some training but there was no evidence the provider had checked staff understood the training they completed and applied it to their daily work, the provider did not have systems to support staff through the use of supervision or appraisals and the provider did not operate effective systems for planning the care and support people received.

As the provider had not demonstrated improvements and the service was still rated as Inadequate, it remained in special measures. We also took enforcement action and issued a Notice of Proposal to cancel the provider’s registration. The provider sent us representations against our proposal to cancel their registration and we have carried out this inspection to continue monitoring the provider’s progress in addressing the issues we have identified at previous inspections.

At this inspection we found the provider had improved the management of people’s medicines and had started to meet the requirements of the Deprivation of Liberty Safeguards (DoLS). However, concerns remained about standards of care planning, risk management, staff recruitment and training and some care practices.

Threen House is a registered care home for older people who require nursing or personal care, some of whom are living with the experience of dementia. The service can accommodate up to 26 older people, in single or shared rooms. Following the inspection in January 2016 we placed a condition on the provider’s registration that prevented them from admitting new people to the service without our written agreement. When we inspected, 15 people were living in the service.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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. The previous registered manager resigned from her post in May 2016. The provider appointed a new manager who applied to register with CQC on 8th June 2016. However, the manager resigned shortly before this inspection.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. All six breaches were repeated breaches of those we found at our inspection in January 2016. The provider did not mitigate risks to people using the service, staff did not move or transfer people safely, staff recruitment checks were incomplete, the provider did not assess the competence of staff to carry out their work, staff did not have access to supervision or appraisals of

This inspection took place on 12, 13, 17 and 18 January 2015. The visits on 12 and 17 January were unannounced and we told the provider we would return on 13 and 18 January to complete the inspection. At our last inspection in July 2015 we found six breaches of the Regulations. At this inspection we found the provider had made some improvements to the way they managed safeguarding concerns and complaints but they had made little progress to ensure care was delivered safely or improve the monitoring of the quality of the service.

Threen House Nursing Home is a registered care home for people who require nursing or personal care. The service can accommodate up to 26 older people. At the time of this inspection, 17 people were living in the service and three people were staying for periods of respite care. Some people using the service had general nursing needs and others were living with dementia.

The service had a registered manager who had worked in the home for more than 20 years. The registered manager told us she had submitted her notice and planned to work part-time in the service as a nurse, once the provider appointed a new 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.

Medicines were not being managed safely, and people were not always receiving their medicines as prescribed.

The provider did not always deploy staff effectively to make sure people were cared for safely.

Records showed staff had completed some training but there was no evidence the provider had checked staff understood the training they completed and applied it to their daily work.

The provider did not have systems to support staff through the use of supervision or appraisals.

There was little evidence people were involved in planning the care and support they received.

The provider did not operate effective systems for planning the care and support people received.

The provider had not displayed the service’s Inadequate quality rating from our last inspection.

Although the provider carried out some checks to monitor the quality of the service provided, these were not always effective.

The registered manager did not fully understand their responsibilities in relation to the Mental Capacity Act and the Deprivation of Liberty Safeguards. People’s liberty was not restricted unlawfully but the registered manager did not always follow the principles of the Mental Capacity Act 2005.

The provider had improved the management of safeguarding incidents since our last inspection.

The provider had improved the way they managed complaints. There was evidence the provider recorded and investigated complaints.

Care records showed people accessed health care services.

Some people and their relatives told us staff were caring. Most staff were gentle and patient and took time to speak to people and understand their wishes.

Some staff had little interaction with people using the service or the people they were working with. Other staff were much happier, talking with people and each other, smiling and welcoming.

People using the service, staff and relatives commented positively about the provider.

Some health and safety checks and audits the provider completed were up to date.

The provider sent quality surveys to people using the service and their relatives. 93% of people who responded rated all aspects of the service as ‘excellent’. 7% of people rated all aspects of the service as ‘good’. Nobody rated any aspect of the service as ‘fair’ or ‘poor’.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this

We carried out an unannounced comprehensive inspection of this service on 2 and 3 February 2015. After that inspection we received concerns in relation to the care and treatment of people using the service. As a result we undertook a focused inspection to look into those concerns on 21 July 2015. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Threen House Nursing Home on our website at www.cqc.org.uk.

Threen House Nursing Home is a registered care home for people who require nursing or personal care. The home can accommodate up to 26 older people. At the time of this inspection, 18 people were living in the home. Some people using the service had general nursing needs, others were living with dementia and some were receiving end of life care.

The home had a registered manager who was a qualified nurse and had worked at the home for 20 years. 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 six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009

.

The registered person failed to report allegations of abuse to the local authority or the Care Quality Commission (CQC).

The registered person failed to operate effective recruitment procedures.

Staff did not receive the training necessary to enable them to carry out the duties they were employed to perform.

The registered person failed to accept, record and respond to complaints made about the care and treatment of people using the service.

The registered person had failed to ensure care and treatment was provided in a safe way for people using the service.

The registered person failed to notify the CQC about significant events affecting people using the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We spoke with four people who used the service and two family members. We spoke with the registered manager, a staff nurse and two care workers. We also spoke to a social worker from a local authority safeguarding team and an acupuncturist. We looked at six care records and five staff records.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. There were sufficient staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. A person who used the service told us “I feel quite secure here.” We saw evidence that all staff had received safeguarding training and those with whom we spoke demonstrated an understanding of the signs of abuse and were familiar with the safeguarding policy of the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that there are systems in place so that if a person lacks the capacity to consent to their care or treatment, their freedom is not restricted more than necessary, and any restriction is in their best interests. We saw the registered manager had appropriate policies and procedures in place to provide staff with guidance about legal requirements. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people’s care and support needs and they developed a good relationship with them. A family member told us “living here has turned my relative’s life around.” We saw staff had received training to meet the needs of the people living at the home.

We were told by the registered manager how staff had not received supervision for a considerable length of time prior to our inspection. Appropriate supervision and appraisal is a requirement of regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This meant the provider could not demonstrate the staff employed to work at the home were properly supervised and appraised. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers were patient and gave encouragement when supporting people. A visiting acupuncturist told us “the attitude of the carers is really caring and lovely.” We observed how a care worker comforted a person who used the service when they became distressed.

Is the service responsive?

The registered manager told us they assessed people’s needs before they moved into the home. Records confirmed people’s preferences, interests and diverse needs had been recorded and care and support had been provided which met their wishes. People had been supported to maintain relationships with their relatives. A family member told us how “the carers are so responsive to my relative’s needs, which change on an almost day to day basis.”

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. We saw how a variety of people were asked for their feedback on the service provided. A family member told us “the manager is around a lot.” Staff told us they were clear about their roles and responsibilities. They also told us management support was good and there was a manager on call 24 hours a day.

People we spoke with commented that they were supported at Threen House by staff and had no concerns about their care. People made comments such as “It’s just like home” and “everyone is very friendly”. Relatives we spoke with praised Threen House for providing a homely environment and friendly staff.

People had their personal and health care needs assessed and a care plan was developed to reflect these needs and to enable staff to deliver safe care.

There were systems in place for the safe maintenance of the environment and equipment. We saw health and safety risk assessments, audits and servicing contracts were planned to maintain a safe environment for people.

The provider takes account of the views of people who use the service and their relatives. There were systems in place for investigating complaints and gathering people’s views of the quality of care provided at Three House.

On this visit we spoke with two people who use the service and two relatives. People indicated they were satisfied with the care they received and had no concerns. Visitors we spoke with said they were confident in the management of the home. One relative said they visited the home when they wished and helped with their family member. Relatives said they were involved, had observed that drinks were always available and people were encouraged to drink. Relatives said that the home monitored people's diet and nutrition was good.

We found that care plans had been reviewed and included information on the level of support people needed with eating and drinking. Information had been given to relatives requesting their signature agreeing to the care plan, if people who use the service were not able to sign.

We observed staff assisting people at lunch time, talking to them and supporting them Staff training had been planned 2013 offering courses in person centered care.

During our visit we spoke with six people who use the service. They told us that they got good support from the staff and that they could lead the lives they wanted to. They said that staff were responsive to their healthcare needs and made appointments for them to see a GP when they requested this.

People told us that staff had time to spend with them, and we observed this happening at the service, where some staff spent time talking with people in the lounge areas. We did not see staff spending time with people who were in their rooms, but a nurse told us that staff would sit and do activities with people who preferred to spend time in their room. Some people spoke about the support they received with personal care. They said they were supported to do what they could for themselves and that staff would assist them only when necessary.

People were positive about the care and treatment they received. They said they get the right support to lead the lives they wanted to. The staff we spoke with were enthusiastic about their work and spoke fondly about the people who use the service. However, we found that people who were not able to do things for themselves were not always treated with respect when being assisted to eat.

This inspection took place on 2 and 3 February 2015. The visit on 2 February was unannounced and we told the provider we would return on 3 February to complete the inspection.

At our last inspection on 21 July 2014, we found the provider failed to ensure that staff had opportunities to discuss their performance and identify learning and development needs through supervision and appraisal. This was a breach of Regulation 23 HSCA 2008 (Regulated Activities) Regulations 2010. At this inspection, we found the provider and registered manager had addressed the concerns we identified and staff were receiving the support they needed through supervision and appraisal.

Threen House Nursing Home is a registered care home for people who require nursing or personal care. The home can accommodate up to 26 older people. At the time of this inspection, 19 people were living in the home. Some people using the service had general nursing needs, others were living with dementia and some were receiving end of life care.

The home had a registered manager who had worked at the home for 20 years. 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 had not completed checks on people employed in the home to make sure they were suitable to work with people using the service. This was a breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Staff supported people in a caring and professional way, respecting their privacy and dignity.

Care records clearly reflected people’s health and social care needs and staff regularly reviewed each person’s care and support. The registered manager, senior staff, nurses and care staff communicated effectively to make sure all staff were up to date with each person’s care and support needs.

Staff had the training they needed to care for people. Nurses and care staff were able to tell us about people’s individual needs and how they met these in the home.

Staff understood and followed the provider’s safeguarding and whistleblowing procedures. They also understood the importance of reporting any concerns about the welfare of people using the service.

People and their relatives told us they knew about the provider’s complaints procedure. They were confident the provider and the registered manager would respond to any concerns they might have.

People consistently received their medicines safely and as prescribed.

We found the service to be meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

The provider and registered manager followed effective systems to monitor the quality of the service.