We carried out an unannounced comprehensive inspection on 14 December 2016. At our last inspection on 23 November 2015 we found three breaches of the Health and Social Care Act 2008. Breaches found at the inspection in November 2015 included risks associated with the unsafe management of medicines; Deprivation of Liberty of Safeguards (DoLS) authorisations to deprive people of their liberty had not been obtained in accordance with the Mental Capacity Act (MCA) 2005 and incidents were not always notified to the CQC of without delay. The provider sent us an action plan detailing the action they would take to meet the outstanding legal requirements.

At this inspection on 14 December 2016 we checked that the action plan had been completed and the breaches identified at the last inspection had been addressed. Improvements had been made in relation to management of medicines and records. Medicine Administration Records (MAR) charts were completed in full, the controlled drugs record book had been completed and countersigned by a second signatory as required. DoLS authorisations had been obtained in accordance with the MCA 2005 and incidents had been notified to the CQC without delay.

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 about how the service is run.

Safeguarding adult's procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Risks to people using the service were assessed and risk assessments and care plans provided clear information and guidance for staff. Medicines were stored, administered and recorded appropriately.

There were enough staff to meet people's needs. The provider conducted appropriate recruitment checks before staff started work.

Staff received adequate training and support to carry out their roles and staff training was up to date. Staff received regular supervisions and annual appraisals. There were processes in place to ensure staff new to the service were inducted into the service appropriately.

The registered manager and staff demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA). Staff asked people for their consent before they provided care.

People were protected from the risk of poor nutrition and had access to a range of healthcare professionals in order to maintain good health.

People were treated with kindness and compassion and people's privacy and dignity and confidentiality was respected. People were supported to be independent where possible such as attending to some aspects of their own personal care.

Staff were knowledgeable about people's individual needs. People's cultural needs and religious beliefs were recorded to ensure that staff took account of people's needs and wishes.

People were involved in their care planning and the care and support they received was personalised and staff respected their wishes and met their needs. Care plans and risk assessments provided clear information for staff on how to support people using the service with their needs. Care plans were reflective of people's individual care needs and preferences and were reviewed on a regular basis.

People knew about the service's complaints procedure and said they believed their complaints would be investigated and action taken if necessary.

There were effective processes in place to monitor the quality and safety of the service and the registered manager recognised the importance of regularly monitoring the quality of the service provided.

Regular staff meetings took place and people were provided with opportunities to provide feedback about the service. Pe

This inspection took place on 23 November 2015 and was unannounced. At the last inspection on 17, 18 and 23 March 2015 we had found breaches of legal requirements in respect of management of medicines and maintaining records. The provider had sent an action plan to tell us how they would address the issues found. We carried out this inspection to check the action plan had been completed and to provide a fresh rating for the service.

Archers Point is a residential care home that is registered to provide accommodation and care for up to 33 older people some of whom may have dementia. On the day of the inspection there were 19 people using the service.

There was an established registered manager in place. 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 on 23 November 2015 the breaches identified at the last inspection had been addressed. Improvements had been made in relation to management of medicines and records. Medicines were kept securely and disposed of promptly and the records for prescribed creams were consistently kept. Pre-assessments were completed with everyone who used the service including people on respite and interim care plans were set up for all new residents to identify their needs.

At this inspection we identified a breach where people were not protected against the risks associated with the unsafe management of medicines; we found gaps in the recording of medicines administered to people. The controlled drugs record book had not been countersigned by a second signatory as required. You can see what action we have told the provider to take at the back of the full version of this report.

There were safeguarding adults from abuse policies and procedures in place to protect people using the service from the risk of abuse. Staff were knowledgeable about how to report concerns and were aware of the potential signs of abuse to look for. However, we found improvements were needed following an incidentat the home the registered manager had failed to notify the relevant safeguarding authorities. Since the inspection the manager has told us they have made the required notification, however we were not been able to monitor this at the time of the inspection.

People told us they felt safe and staff treated them in a caring and dignified manner. People’s wishes with regards to their care were recorded within care plans. Care plans were reflective of people’s individual care and preferences. People’s cultural and religious beliefs were recorded to ensure that staff took account of people’s needs and wishes.

People were involved in decisions around their care and support, and had access to a range of healthcare professionals when required. Care plans reflected people’s individual needs and people told us they enjoyed the activities on offer at the service.

Staff had received training around the Mental Capacity Act 2005 (MCA 2005). However, we found that DoLs authorisations had not been sought for people living at the service whose freedom to leave the home was being restricted for their safety. By not obtaining the appropriate authorisations there was a risk that people were deprived of their liberty without lawful authority. You can see what action we have told the provider to take at the back of the full version of this report.

There were safe staff recruitment practices in place which ensured that people were cared for by staff who were appropriate for their role minimising risks to people using the service.

People were supported by staff who had received appropriate training to meet their needs. Training records demonstrated staff were provided with suitable training to ensure their development needs were met. Staff were supported in their roles through regular training and supervision.

People told us that there were enough staff available to safely meet their needs and we saw that staff were available to support people where required.

People’s concerns and complaints were listened to, investigated and responded to in a timely and appropriate manner. People and their relatives knew how to make a complaint.

People were supported appropriately to eat and drink sufficient quantities to maintain a balanced diet and ensure their well-being. Care plans and records reflected people’s nutritional needs. People were supported to maintain a balanced diet and told us they enjoyed the range of meals on offer.

Incidents and accidents involving the safety of people using the service were recorded and acted on appropriately. However, we found that following an incidentat the home the registered manager had failed to notify the CQC of this incident without delay. You can see what action we have told the provider to take at the back of the full version of this report.

People and staff told us they felt the service was well managed and that the registered manager and the home manager would take action to address any concerns they raised.

The provider had policies and processes in place to monitor and evaluate the quality of care and support people received. However, action plans were not always in place to identify issues and ensure remedies were actioned and this required improvement.

At our last inspection of the service on the 9 June 2014 we found the provider had breached a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that people’s consent may not always have been sought before care was delivered and that people’s ability to make decisions for themselves was not always assessed. We had concerns about potential risk to people as we identified the provider had not taken the necessary steps to ensure that each person who used the service received prompt and appropriate care and support. The planning and delivery of care did not always reflect people’s needs. Parts of the premises and equipment were not clean, infection control procedures were not always in place and there was an unpleasant odour. There were insufficient staff numbers at all times according to the provider’s own requirements and adequate quality assurance mechanisms were not in place.

We took enforcement action and served four warning notices on the provider as they had failed to comply with Regulations 9,10,12, and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We also issued a compliance action in respect of Regulation 18 of the Health and Social Care Act. We also referred this to the local authority safeguarding and commissioning teams.

We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notices and compliance action. The inspection team who carried out this inspection consisted of two adult social care inspectors. On the day of the inspection there were 22 people using the service. During the inspection, the team worked together to answer four of our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with seven people using the service, three relatives, seven of the care staff, the provider, registered manager and head of care. We used our short observational frame work for inspectors (SOFI) to give us information about the care of people who were not able to express themselves. We observed interactions between staff and people using the service in the communal areas throughout the day. We looked at 10 care plans and other records related to the service such as staff duty rosters, cleaning schedules and audits. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People we spoke with said that they were well cared for. One person told us “It is marvellous here; they have made me feel very comfortable.” Another person said “The staff are very nice and I am well looked after.” Relatives we spoke with were mostly positive about the service. One person said “I just can’t fault it, there is kindness and care. I have never needed to complain.”

We observed staff to interact in a positive way with people and their visitors. They spoke kindly with people and engaged with them at times during the day. Staff checked for people’s consent before delivering care.

There were now more accurate records of people’s preferences for their care. People’s consent to care was recorded and there was an assessment to consider if they had the capacity to make certain decisions for themselves. There were some mechanisms in place to ascertain the views of people who used the service although there was no evidence that these were actioned or taken into account.

Is the service safe?

People did not always receive the appropriate care to meet their needs. Most but not all risk assessments we looked at had been reviewed.CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS), and to report on what we find. We found that the provider did not always follow the Mental Capacity Act (2005) code of practice and was unaware of recent changes to their responsibilities in relation to the act.

We found the environment was cleaner throughout and more hygienic; the smell was much improved although there was still some odour in the hallway and some bedrooms.

There were sufficient levels of staff employed at the service. New permanent staff had been employed and the provider now used agency staff at night or in the day to cover any last minute gaps due to leave or sickness.

Is the service responsive?

Care plans were improved and more accurately reflected people’s current needs. Although this work was not yet fully completed. There was evidence of people’s or their relative’s involvement in their care.

People were supported to maintain their relationships with family and friends. We observed that people were provided with some activities to stimulate them.

People we spoke with told us they had not needed to raise a complaint. They knew how to raise informal complaints and were aware there was a complaints policy. The complaints policy was not very visible for people at the service or their visitors. The policy on display differed from that in the service user guide but neither were accurate in terms of what steps to take if someone was unhappy with the provider's response.

The inspection team who carried out this inspection consisted of two adult social care inspectors. During the inspection, the team worked together to answer five key 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, speaking with six people using the service, a relative, six of the care staff supporting them, a cook and kitchen assistant, the provider partners one of whom was also the registered manager and head of care. We talked with four professionals who visited the service on the day of the inspection. We used our short observational frame work for inspectors (SOFI) to give us information about the care of people who were not able to express themselves. We also looked at ten care plans and other records related to the service such as staff duty rosters, cleaning schedules and audits. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People we spoke with said that they were well looked after. One person told us “It’s very good here I have no complaints.” Another person told us “The staff are good as far as it goes.” We spoke with a visitor to the service who told us they came most days. They said “I come most days at different times and the staff here are very good. They are always smiling and happy. [My relative] is always clean and tidy and their health has improved and they have put on weight. I have peace of mind now.” We observed staff to speak kindly with people and most of the time they checked for their consent before delivering care.

There were some records related to people’s preferences for their care. However, people’s consent to care was not always recorded and there had not always been an assessment to consider if they had the capacity to make certain decisions for themselves. Information from other professionals was not always accurately recorded and where it had been recorded it was not incorporated into the care plan.

People told us they enjoyed the food and we saw they were provided with adequate nutrition. The service had scored the top rating of 5 on the 'Scores for the Doors' assessment at the last visit by Environmental Health on 29 November 2013.

People were able to see a health professional when necessary. Care plans were not always up to date and did not always reflect people’s current needs. Risk assessments had been completed but not always regularly reviewed and where they had been completed and risks identified a care plan was not always in place.

Is the service safe?

People did not always receive the appropriate care to meet their needs. For example people identified as at high risk of falls did not have a plan in place to reduce this risk. People with pressure areas were at risk of receiving incorrect care and treatment as their care plans did not detail what care was needed to meet those needs or did not identify where the pressure area was. There was no analysis of a high number of accidents and incidents that had taken place in the first six months of this year.

We found the environment was not clean and hygienic. There was a strong smell of urine and faeces in the communal areas for much of the day. While we saw some cleaning being done by the family member of the provider who was we understand normally employed in a financial/maintenance role. We observed that the toilets were in an unclean state for much of the morning. The cleaning schedule had not been completed since the end of May as the cleaner was on leave. There was evidence that some cleaning tasks were not regularly undertaken and there were inadequate processes in place to reduce the risk of infection.

The service had a contingency plan for emergencies but lacked evacuation plans for all individuals in need of assistance. We found that adequate checks were being made on equipment at the service. Staff were being provided with essential training for their roles but there were insufficient numbers of staff on duty on some shifts according to the providers agreed staffing levels to meet people’s needs adequately and safely.

Is the service responsive?

Records confirmed some people’s preferences and diverse needs had been recorded and care and support was provided that met their wishes. People were supported to maintain their relationships with family and friends. There was no keyworker system in operation for people to discuss any important issues with a specific member of staff.

There was no evidence that regular meetings with people who used the service were held or that formal reviews of their care plan took place involving them or their family members. The service did not actively seek out the views of the people who used it. The complaints policy was available but or their visitors but the provider’s complaint investigation tool was not being used to record any response.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. People received sufficient amounts of food and drink. We saw that people were referred appropriately to health care professionals when this was needed but instructions they gave were not always adequately recorded. Staff were provided with opportunities to complete and refresh essential training.

The service carried out an annual survey with people at the service and their relatives. However no action plan was in place to address the findings from the last survey. There was no evidence therefore that responses were being used to inform improvements.

While some audits were carried out these were limited in nature to health and safety checks and medication audits. There was no system in place to highlight inadequacies in several areas such as gaps in important areas of people's care plans, cleaning records or hygiene records.

Is the service well led?

The day to day management of the home was undertaken by the head of care. The registered manager was present on the day of the inspection but left the head of care with responsibility for the inspection.

We identified concerns across several areas of care at the inspection which had not been identified by the registered manager or provider. Or where they had, for example, the inadequate staffing levels, they had not been addressed. We found that regular staff meetings to help improve the consistency and level of care throughout the service were taking place quarterly. But seniors meetings were due to be held to provide over sight and effective management of the service on a six monthly basis. We found there had only been one seniors meeting held In November 2013 since the head of care started at the service in 2012.

On this occasion, we did not speak with people using the service as part of our inspection. We found the provider had made improvements in the documentation of care plans and other records related to people's care.

People we spoke with said that the staff were friendly and respectful and they were mostly satisfied with the care provided at the nursing home. However, some people also said that there were not enough activities to keep them occupied. The relatives we spoke with said they were very happy with the care provided at the home.

At our last inspection of January 2013 we had raised concerns with the way people’s care was delivered, lack of appropriate infection control practices, staff’s understanding of safeguarding of vulnerable adults and staff training and supervision.

At our inspection of May 2013 we found that people received suitable care based on an assessment of their needs. Staff received regular training and supervision and improvements had been made in the cleanliness of the environment and in the infection control practices. However, although people's care plans had appropriate risk assessments and reflected people’s needs, not all information was suitably and correctly recorded.

People told us that they had seen their care plan and were satisfied with what was written in it. They said that they received care and support to meet their health and personal care needs and that staff looked after them well.

People told us that they were generally happy with the service they received. They felt safe and were able to express their views and concerns to the manager. Family members told us that people appeared happy; that the home was “nice and warm”; and that staff looked after people well.

At our last two visits, we had major concerns with how peoples medicines were managed which could have placed people at risk. A warning notice was issued to the provider in December 2011 requiring urgent improvements for the safety of people at the service. At this visit we found that significant improvements had been made.People are now given the medicines they need, safely and as prescribed, medicines are stored safely, and records are completed accurately.

People had been involved in their assessments and care planning processes.

We observed medicines being given to people during the day, and we saw that medicines were not always given correctly, either in relation to food or other instructions such as in water, or swallowed whole, or chewed.

Staff giving medicines did not fully understand what medications they were administering; this potentially placed people at risk, because not taking their medicines correctly in relation to food or other instructions may have made the medicines less effective or put people at increased risk of developing side effects.

We were supported on this review by a Pharmacy Inspector to look at Management of medicines.

Staff told us that until September 2010 it was usual practice to start getting people out of bed at 6.00am. However, with the addition of nine extra beds to the home in October 2010 but with no additional night staff, they now wake people who use service at 5.00am. People are not given a choice about what time they want to get up.

People and their family members told us that the food was nice and beds and bed linen were kept clean. One person stated that “it is a bit boring, we have occasional concerts”.

In general, people told us that staff were available to attend to their needs, but sometime they were delayed. People were able to see external healthcare professionals when they needed. Staff help arrange appointments with GP and nurses. A family member acting on behalf of a person told us that “if she is not happy she will talk to the manager and is sorted out”.

This inspection took place on 17, 18 and 23 March 2015 and was unannounced. At the last inspection on 16 September 2014 we had found breaches of legal requirements in respect of people’s consent to care, their care and welfare and systems to monitor the quality of the service. The provider had sent an action plan to tell us how they would address the issues found. We carried out this inspection to check the action plan had been completed and to provide a rating for the service.

Archers Point is a residential care home that is registered to provide accommodation and care for up to 33 older people some of whom may have dementia. On the day of the inspection there were 23 people using the service.

There was an established registered manager in place. 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.

Following the CQC (Care Quality Commission) inspection in June 2014 and safeguarding concerns, there had been a local authority suspension of placements in place and an action plan worked on by the service. The local authority lifted the suspension of placements in January 2015 following improvements noted at recent visits.

At this inspection the breaches identified at the last inspection had been addressed. Improvements had been made to the planning and delivery of care to meet people’s needs. Arrangements to record people’s consent or where people lacked capacity to make decisions to follow the Mental Capacity Act (MCA) Code of Practice were in place. There had been improvements to the way the provider monitored the quality of the service.

However we identified some breaches in the storing, administration and disposal of medicines and with record keeping and storage. Medicines were not always kept securely or disposed of promptly and the records for prescribed creams were not consistently kept. Competency checks on staff administering medicines were not carried out and a staff member described an unsafe method of administering medicines. You can see the action we have asked the provider to take at the back of the full version of this report.

People told us they felt safe and well cared for. Risks to people were identified and monitored and steps taken to reduce risk. However guidance to staff was not always clearly recorded in people’s records. Some checks on equipment were not recorded and there was a risk they may not be completed.

Staff recruitment processes were robust and there were adequate numbers of staff employed although we identified an absence of care staff present in the communal areas for parts of the inspection. There were processes to minimise the risk of infection although we identified areas for improvement.

Staff had appropriate training and support to carry out their role. They were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. These are laws and guidance to protect people who do not have capacity to make some decisions. We received positive feedback from health professionals working with the service about improvements that had taken place in the care provided at the home. People and relatives spoke warmly about the staff and we observed them to be kind and caring. People had plans for their care and support that met their needs. However, records of people’s personal care were not accurately completed or securely stored. People were aware of how to complain if they needed to.

People’s views about the service were sought and acted upon. However, some improvements were identified for the managing of the service. Records were not securely kept. The provider did not have adequate training for the role he carried out in daily contact with people at the service. Staff felt there had been improvements in the quality of care but gave mixed feedback about how the service was run.