This inspection took place on 12 June 2017 and was unannounced. Yaxley House is registered to provide personal care and support for up to 34 people, some of whom are living with dementia. At the time of our inspection 31 people were using the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). However, the home had recently appointed manager and they were in the process of submitting their application to become the registered manager of the 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 about how the service is run.

At our last inspection on 19 September 2016 we found that the service needed to make improvements in staffing levels and deployment and to ensuring people’s social needs were met. At this inspection we found that improvements were underway. The service had recruited staff to the laundry and to provide activities and further staff were waiting the outcome of pre-employment checks before starting work in the service. The provider had also introduced a new care recording and planning system whereby staff used a smart phone to input data. This saved staff spending time sitting at a computer away from people.

Care plans did not demonstrate people’s involvement in their care planning. However, people were aware of their care plans and the manager told us how they liaised with people and their relatives in an informal way.

Risk assessments were in place to minimise the risk of harm to people. The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff knew how to respond if they had any concerns. There were systems in place to ensure people received their medicines as prescribed.

Staff received appropriate training. Checks were carried out before staff began work to ensure they were appropriate to work in the service.

People were supported to have maximum 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.

There were audits in place to check the quality of the service people received. The provider was actively improving the service with implementation of a new care planning and recording system. The system was smart phone based for care staff and meant they did not have to spend time away from people recording the care that had been provided.

This inspection took place on 12 June 2017 and was unannounced. Yaxley House is registered to provide personal care and support for up to 34 people, some of whom are living with dementia. At the time of our inspection 31 people were using the service.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with the Care Quality Commission (CQC). However, the home had recently appointed manager and they were in the process of submitting their application to become the registered manager of the 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 about how the service is run.

At our last inspection on 19 September 2016 we found that the service needed to make improvements in staffing levels and deployment and to ensuring people’s social needs were met. At this inspection we found that improvements were underway. The service had recruited staff to the laundry and to provide activities and further staff were waiting the outcome of pre-employment checks before starting work in the service. The provider had also introduced a new care recording and planning system whereby staff used a smart phone to input data. This saved staff spending time sitting at a computer away from people.

Care plans did not demonstrate people’s involvement in their care planning. However, people were aware of their care plans and the manager told us how they liaised with people and their relatives in an informal way.

Risk assessments were in place to minimise the risk of harm to people. The provider had policies and procedures in place to guide staff in safeguarding vulnerable adults from abuse, and staff knew how to respond if they had any concerns. There were systems in place to ensure people received their medicines as prescribed.

Staff received appropriate training. Checks were carried out before staff began work to ensure they were appropriate to work in the service.

People were supported to have maximum 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.

There were audits in place to check the quality of the service people received. The provider was actively improving the service with implementation of a new care planning and recording system. The system was smart phone based for care staff and meant they did not have to spend time away from people recording the care that had been provided.

We spoke with two people who used the service, and one relative of a person who used the service. We also spoke with the registered manager and a senior member of staff from Kingsley Healthcare. We looked at five people's care records. Other records viewed included health and safety checks, staff meeting minutes and quality assurance records. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

One person we spoke with told us, "I sometimes don't feel safe", but didn't wish to share the reasons why they didn't feel safe. Another person we spoke with told us, "I feel safe, I think I'm OK."

We found that people were not always being protected from the risks of malnutrition or dehydration. However, the service already had some plans in place to address these issues.

We found that people were not always being protected from the risks of developing a pressure sore, or a worsening in a current pressure sore. The service did not always take preventative steps to protect people at risk. However, the service had already identified some of the issues raised, and already had plans in place to rectify these issues.

Is the service effective?

People's care records showed that care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. The care records for people were regularly reviewed, but contained information that was out of date, or conflicted with other care documents.

Is the service caring?

We observed that staff did not always interact with people using the service in a caring way. We observed staff displaying annoyance or frustration with people using the service, whom they were trying to support. We observed staff speaking to people using the service in a way which did not promote the person’s right to choice, or encourage them to allow staff to help them.

We observed that care staff repeatedly ignored one person using the service throughout our inspection, who would have benefited from interaction with staff.

People using the service told us they did not have a lot of interaction with staff. One person told us, "Oh, it's nice to speak to someone." When asked if they had conversations with people often, the person told us "No, staff don't have time to speak to me, and I'm stuck in this bed."

Another person using the service told us, "Thank you for talking to me. People don't often have time to talk to me."

This meant that we did not feel assured that people's emotional and social needs were being met by staff.

Is the service responsive?

The service had already taken some action to address shortfalls in the service, which were identified by the Suffolk Safeguarding team.

However, some issues identified during our inspection had not been previously identified by the management of the service. This meant that we could not be assured that the staff working at the service, and the management of the service were responsive to people's changing needs.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed.

During our inspection, we spoke briefly with three people who used the service. Their feedback did not relate to the standard we were inspecting on this occasion.

We looked at medication records and found that action had now been taken to improve the recording of medicines which we had found to be unsatisfactory during our last inspection in August 2013.

This was a follow up inspection to check that the service had taken the actions they had told us about following our inspection of 23 November 2012.

We did not speak directly with any people who used the service but looked at a range of records relating to their care and treatment.

This was a follow up inspection to check that the service had taken the actions they told us they would take following our inspection on the 22 August 2012.

We did not speak directly with any people who used the service on this occasion, although we did speak with relatives who were visiting two of the people who used the service.

We found that although the service were now compliant with outcomes 4 and 14, the records held by the service in respect of care planning were not adequate.

We spoke with four people who used the service, with three relatives visiting on the day of our inspection and with five members of staff. A new provider took over the service in March 2012 but the day to day management and staffing had not changed.

One person who used the service told us that staff were "Very good" and another person said they had never had a problem. Another person told us that the staff "Help me when needed."

Although people told us that they felt well cared for, records we looked at did not show how the individual needs of the people were always identified or met. This meant that care and support did not always reflect individual need and choice.

People were protected against the risk of abuse by the provider's policies and procedures but not all staff had received appropriate training in safeguarding or other areas.

During our inspection we spoke with five people who used the service. They told us that the care and support they received from the service was very good. One person said, "The staff here are great, I have everything I need." Another person said, "They look after me very well and there is always something to do." They went on to tell us they enjoyed a game of cards with one of the staff and always had a daily newspaper delivered.

We looked at people's care records. These were detailed and up to date and showed staff how the person's individual needs should be safely met. Staff records showed that suitable recruitment checks were in place and that regular training was provided to all staff.

The premises were well maintained and records we looked at showed that required checks and maintenance were being done.

We looked at records for the administration of medication and at procedures followed when giving people prescribed medication. We found that records were not being completed accurately and that required checks had not been carried out. Audits to ensure accuracy were not effective. We were therefore not satisfied that medication was managed safely.