The provider, Royal Masonic Benevolent Institution (RMBI) is part of the Masonic Charitable Foundation whose motto is ‘a new charity for Freemasons, for families, for everyone’ and runs 20 care services nationally. Cadogan Court in Exeter is registered to provide accommodation for up to 70 people who require nursing and personal care. The needs of people in the home varied. Some people had complex nursing needs and were cared for in bed; some people had mental health needs and needed support and supervision, while other people were relatively independent and needed little support. At the time we visited, 42 people lived at the service.

The service consists of seven units over three floors. However, at the time of the inspection people were living in five of the units because a refurbishment programme was in progress and Osborn and Elliot units were closed; Holman, Barrington and Colenso-Jones were providing care for older people who required residential care; Kneel was providing nursing care for older people; and Alford was providing care for older people living with dementia.

A comprehensive inspection of the service was carried out on 27 February 2017 and 02 and 07 March 2017. At that inspection we identified five breaches of regulations, related to staffing, quality monitoring, safe care and treatment, dignity and respect and person-centred care. We took enforcement action in relation to the staffing and quality monitoring breaches, by serving warning notices on the provider and registered manager. This required the provider to make urgent improvements in staffing by 14 April 2017 and to improve quality monitoring processes by 09 October 2017, due to the serious and major impact on the safety and quality of services people received. We issued requirements for the other three breaches of regulations, safe care and treatment, dignity and respect and person-centred care. The overall rating for the service at that inspection was ‘Inadequate’ and the service was therefore placed in ‘special measures’. Services in special measures are 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.

We carried out an unannounced focused inspection on 12, 14 and 20 July 2017 to check that the required improvements had been made following the comprehensive inspection in February and March 2017. At this inspection we looked at the breaches of regulation related to safe care and treatment and person-centred care. Higher staffing levels put in place at the previous inspection were being maintained for 90 percent of the time. However, further work was needed to ensure people’s plans fully reflected their needs and risks. We identified a new breach of regulation because some risks were not always identified or managed well. Action was taken during the inspection regarding these concerns. Following the inspection, we wrote to the provider to formally request information about the actions they had taken to minimise the specific risks we had identified. They sent us the information we requested, detailing the actions they were taking.

A further comprehensive inspection was carried out on 16, 17, 22, 25 and 30 October 2017. At this inspection we identified breaches of regulations related to safe care and treatment, safeguarding people from abuse and improper treatment, staffing and quality monitoring. The service was in ‘special measures’ and the provider had not made the significant improvements required within the six-month time frame. This had a serious and major impact on the safety and quality of services people received. We proposed to remove this location from the providers registration, however the provider appealed this proposal through the care standards tribunal. CQC did n

The provider, Royal Masonic Benevolent Institution (RMBI) is part of the Masonic Charitable Foundation whose motto is ‘a new charity for Freemasons, for families, for everyone’ and runs 20 care services nationally. Cadogan Court in Exeter is registered to provide accommodation for up to 70 people who require nursing and personal care. The service consists of seven units over three floors known as; Holman, Barrington and Colenso-Jones, which provide care for older people who require residential care; Kneel and Osborn, which provide nursing care for older people; and Alford and Eliot, which provide care for older people living with dementia. Alford unit opened as a specialist dementia care unit in 2016. The needs of people in the home varied. Some people had complex nursing needs and were cared for in bed; some people had mental health needs and needed support and supervision, while other people were relatively independent and needed little support. At the time we visited, 51 people lived at the service.

There was a manager employed at the home, although they had not yet registered with the Care Quality Commission to manage the service.

The last comprehensive inspection of the service was carried out on 27 February 2017 and 02 and 07 March 2017. At that inspection we identified five breaches of regulations, related to staffing, quality monitoring, safe care and treatment, dignity and respect and person centred care. We took enforcement action in relation to the staffing and quality monitoring breaches, by serving a warning notice on the provider and registered manager. This required the provider to make urgent improvements in staffing by 14 April 2017 and to improve quality monitoring processes by 09 October 2017, due to the serious and major impact on the safety and quality of services people received. They were failing to ensure there were sufficient numbers of, competent, skilled and experienced staff to meet people's needs. We issued requirements for the other three breaches of regulations, safe care and treatment, dignity and respect and person centred care. The overall rating for the service at that inspection was ‘Inadequate’ and the service was therefore placed in ‘special measures’. Services in special measures are 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.

Staffing levels were increased during this inspection in response to the concerns raised. Following the inspection the provider sent us an action plan, outlining the improvements being made and a weekly ‘continuous improvement plan’ (CIP) to the local authority and the Care Quality Commission, identifying the areas of risk and the actions they were taking to address them.

The service continued to work in partnership with the local authority quality assurance and improvement team (QAIT) to help improve their systems and processes.

We carried out an unannounced focused inspection on 12, 14 and 20 July 2017 to check that the required improvements had been made following the comprehensive inspection in February and March 2017. At this inspection we looked at the breaches of regulation related to safe care and treatment and person centred care. The higher staffing levels put in place at the previous inspection were being maintained for 90 percent of the time. However, further work was needed to ensure people’s plans fully reflected their needs and risks. We identified a new breach of regulation because some risks were not always identified or managed well. Action was taken during the inspection regarding these concerns. Following the inspection we wrote to the provider to formally request information about the actions they had taken to minimise the specific risks we had identified. They sent us

We carried out an unannounced focused inspection on 12, 14 and 20 July 2017. The provider, Royal Masonic Benevolent Institution (RMBI) is part of the Masonic Charitable Foundation whose motto is ‘a new charity for Freemasons, for families, for everyone’ and runs 20 care services nationally. Cadogan Court in Exeter is registered to provide accommodation for up to 70 people who require nursing and personal care. The service consists of seven units over three floors known as; Holman, Barrington and Colenso-Jones, which provide care for older people who require residential care; Kneel and Osborn, which provide nursing care for older people; and Alford and Eliot, which provide care for older people living with dementia. Alford unit opened as a specialist dementia care unit in 2016. The needs of people in the home varied. Some people had complex nursing needs and remained in bed; some people had mental health needs and needed support and supervision while other people were relatively independent and needed little support. At the time we visited, 53 people lived at the service.

This focused inspection was to follow up if the required improvements had been made following our last inspection on 27 February 2017 and 2 and 7 March 2017. We had identified five breaches of regulations, related to staffing, quality monitoring, safe care and treatment, dignity and respect and person centred care. We took enforcement action in relation to the staffing and quality monitoring breaches, by serving a warning notice on the provider and registered manager. This required the provider to make urgent improvements in staffing by 14 April 2017 due to the serious and major impact on the safety and quality of services people received. They were failing in ensuring there were sufficient numbers of, competent, skilled and experienced staff to meet people's needs. We did not look at quality monitoring at this inspection because we had given the provider until October 2017 to have become compliant.

We issued requirements for the other three breaches of regulations, safe care and treatment, dignity and respect and person centred care. At this inspection we looked at the safe care and treatment and person centred care breaches. We found there had been some improvements but further work was needed to ensure people’s plans fully reflected their needs and risks. We identified a new breach of regulation because some risks were not always identified or managed well. The provider took action about this during the inspection.

Since the inspection in February 2017 we have received an action plan from the provider which outlined the improvements being made. The provider is also sending a ‘continuous improvement plan’ (CIP) each week to the local authority and the Care Quality Commission (CQC) identifying the areas of risk and the actions they are taking to address them. The service had continued to also work in partnership with the local authority quality assurance and improvement team (QAIT) to help improve their systems and processes.

The provider had attended a local authority whole service safeguarding meeting in November 2016 because of concerns which had highlighted issues in relation to the risk management of falls, medicine management, poor practice around moving and handling, insufficient staffing levels, lack of supervision for staff and care plans not being up to date. The local authority were assured at the time by the high levels of assurances given by the provider around how they were going to address the concerns. The meeting had decided these were more an issue of quality and so the safeguarding process was closed. This was with a view that the provider would work with the local authority QAIT and continue to improve the areas of concern.

However Cadogan Court has been the subject of a whole home multiagency safeguarding investigation since 18 April 2017. Whole service investigations are held where there are indications that care and safety fa

This inspection took place on 28 February, 2 and 7 March 2017. The provider, Royal Masonic Benevolent Institution (RMBI) is part of the Masonic Charitable Foundation whose motto is ‘a new charity for Freemasons, for families, for everyone’ and runs 20 care services nationally. Cadogan Court in Exeter is registered to provide accommodation for up to 70 people who require nursing and personal care. The service consists of seven units over three floors known as; Holman, Barrington and Colenso-Jones, which provide care for older people who require residential care; Kneel and Osborn, which provide nursing care for older people; and Alford and Eliot, which provide care for older people living with dementia. Alford unit had recently opened as a specialist dementia care unit, since the last inspection. The needs of people in the home varied. Some people had complex nursing needs and remained in bed; some people had mental health needs and needed support and supervision while other people were relatively independent and needed little support. At the time we visited, 64 people lived at the home.

There was a registered manager employed at the home. 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 and associated Regulations about how the service is run.

At the last inspection in July 2016 we found the domains of ‘safe’, ‘effective’ and ‘responsive’ required improvement. At the time, people, relatives and staff expressed concern that agency staff (staff used from an agency to support permanent staff on a temporary basis) did not always have the knowledge and skills to meet people's needs safely. In addition some care plans had not always provided the guidance staff needed to meet people's care needs safely and effectively. At this inspection we found this had been addressed and systems were in place to ensure agency staff could easily access important information they needed to meet people’s needs. Care plans were now comprehensive and ensured staff had good information to ensure they knew how to meet people’s care needs. At the last inspection we found that people's legal rights had not always been fully protected because some people had restrictions in place, such as bed rails or pressure mats, but there had been no consideration of whether these restrictions were in their best interests. At this inspection we found this had been addressed and the home was meeting these legal obligations. People had access to healthcare services for on-going healthcare support, however at the July 2016 inspection health and social care professionals had not always known if their recommendations had been shared with staff or acted on due to a breakdown in communication.

At the last inspection in July 2016 we also rated ‘well led’ as requiring improvement. This was because the home had been without a registered manager for five months, and at the time of the inspection was managed by the current registered manager who at that time was newly registered with the Care Quality Commission. At that inspection staff told us the previous manager had "not been there very much", and there had been little improvement in the service over an 18 month period. The provider and new registered manager had identified where improvements were needed and developed a comprehensive service improvement plan. However, whilst we were confident that the provider had recognised the failings and put in place actions to address them, previous systems had not been successful in maintaining the quality of service provision. At that time it was therefore not yet possible to determine whether these actions would be effective in keeping people safe and improving the quality of support provided. Therefore, at that time some aspects of the service were not well led