The inspection took place on 5 and 19 March 2018 and was unannounced.

Caythorpe Residential 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. It accommodates 14 people in one adapted building. There were 11 people living at the home when we inspected.

The home is owned by a single person and they have also registered as the 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.

At the last inspection we found that the provider was in breach of Regulation 19, fit and proper person’s employed and Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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 question of safe and well led to at least good.

At this inspection we found that the provider had made the necessary improvements in care provided. They had ensured that enhanced disclosure and barring checks had been completed on all staff and had ensured that the systems to monitor the quality of care provided were effective.

At the last inspection the home was rated as requires improvement. At this inspection we found that the provider had improved the quality of care provided for people and was rated as good.

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 enough staff to meet people’s needs. Staff had received training which supported them to provide safe care to people. Medicines were safely administered and staff knew how to protect people from the risk of infection.

People were able to make choices about their food, clothing and how they spent their time. People’s dignity was respected and people’s abilities were recognised and encouraged to maintain their independence.

Systems were in place to monitor the quality of care provided and action was taken to resolve any concerns found. People were given the opportunity to comment about the care they received and the information was used to drive improvements in the quality of care.

The inspection took place on 3 May 2017 and was unannounced.

The home provides residential care for up to 14 older people some of whom may be living with a dementia. Fourteen people were living at the home on the day of our inspection.

The home was owned by an individual person and they were also the registered manager for the home. We have referred to this person as the provider throughout the report. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The provider was not meeting the legal requirements in two areas of care provided. They had failed to ensure that the correct checks were completed to ensure staff were safe to work with people living at the home. They had failed to ensure that the systems to monitor the quality and safety of care were effective. You can see the actions we have asked the provider to take at the back of this report.

There were enough staff in place to care for the people living at the home. Staff received training when they first started working at the home to ensure that they had the skills needed to provide safe care for people. However, the frequency of training to refresh and update their skills did not support staff to be up to date with current best practice.

Where people had been unable to make the decision to live at the home the provider had submitted appropriate applications for assessment under the Deprivation of Liberty Safeguards. However, it was not always clear who was legally entitled to make decisions for people and if decisions had been made in people's best interests.

Most staff were kind and caring and there was a pleasant relaxed atmosphere in the home. Although people did raise concerns about an individual member of staff who could be more abrupt. People’s dignity was not fully respected in the care they received and people’s independence was at times restricted by their care.

Medicines were safely stored and staff administered the medicines in a safe methodical manner to reduce the risk of errors. However, one person had not received some pain medicine due to a lack of clarity on how it should be administered. In addition, it was not clearly recorded why people had been offered medicines prescribed to be taken only when needed.

People were happy with the quality of food available to them and were supported to maintain a healthy weight. People were offered a choice of hot and cold drinks throughout the day to ensure they stayed hydrated.

Care plans recorded the risks to people while receiving care and provided information to support staff to provide safe care. However, they did not contain enough information to support staff to personalise the care to people’s individual needs. People were supported to access activities which helped them to stay mobile and to engage with and access the local community.

People were happy to raise complaints or concerns with the provider and were confident they would be resolved. Systems in place to monitor the quality of care provided were not always effective and did not support the provider to drive improvements in the care people received.

This was an unannounced inspection carried out on 23 August 2016.

Caythorpe Residential Home can provide accommodation and personal care for 14 older people and people who live with dementia. There were 14 people living in the service at the time of our inspection.

The provider of the service was a sole trader. This meant that the person who was the sole trader acted as both the provider of the service and the registered manager. In this report we refer to this individual as being, ‘the registered person’. The registered person has a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We carried out an unannounced comprehensive inspection of this service on 27 April 2016 and found that there were three breaches of legal requirements. We found that people were not consistently receiving safe care. This was because medicines were not being safely managed and, people were not fully protected from the risk of accidents. In addition, people were not consistently helped to reduce the risk of acquiring infections. A further shortfall we noted was that the system used to recruit staff was not robust. We also found that quality checks had not been completed in the right way to identify and quickly resolve problems in the running of the service.

After our inspection of 27 April 2016 the registered person wrote to us to say what improvements they intended to make in order to meet the legal requirements in relation to the breaches. They said that all of the problems we noted would be addressed so that people consistently received safe care. The registered person said that all of the necessary improvements would be completed by 31 June 2016.

This report only covers our findings in relation to the action taken by the registered person to meet the breaches of legal requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Mrs Christine Lyte on our website at www.cqc.org.uk

At this inspection, we found that the registered person had introduced most of the improvements that were necessary to ensure that people safely and reliably benefited from receiving safe care. This meant that the relevant legal requirements had been met. However, a small number of further improvements still needed to be made to ensure that the service continued to reliably care for people in the right way.

This was an unannounced inspection carried out on 27 April 2016.

Caythorpe Residential Home provides accommodation for up to 14 people who need personal care. The service provides care for older people some of whom live with dementia. There were 14 people living in the service at the time of our inspection.

The provider of the service was a sole trader. This meant that the person who was the sole trader acted as both the provider of the service and the registered manager. In this report we refer to this person as being, ‘the registered person’. Registered persons have a 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 three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not consistently managed safely, risks to health and safety were not robustly addressed, recruitment checks had not been correctly completed and quality checks had not been effective. You can see what action we told the registered person to take at the end of the full version of this report.

There was insufficient evidence to show that there were robust arrangements to safeguard people from abuse including financial mistreatment. There were enough staff on duty. Although people had received all of the healthcare assistance they needed, the arrangements to support them to eat and drink enough were not robust.

The registered person and staff were following the Mental Capacity Act 2005 (MCA) by supporting people to make decisions for themselves and when this was not possible by ensuring that decisions were taken in their best interests. However, the Care Quality Commission is also required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards (DoLS) under the MCA and to report on what we find. These safeguards are designed to protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this the registered person had not promptly taken all of the necessary steps to ensure that people’s legal rights were protected.

Although people were treated with kindness and compassion arrangements in the service did not fully promote people’s right to privacy. In addition, confidential information was not kept securely.

Although people had been consulted about and received most of the practical assistance they needed, the arrangements to support people who could become distressed were not sufficient. People had not been fully assisted to meet their spiritual needs and some people were not satisfied with how often they were supported to pursue their interests and hobbies. There was insufficient information to show how well the registered person would investigate and resolve complaints.

Although people had been consulted about the development of the service there was no evidence to show what had been done to implement suggested improvements. Although there was good team work and staff were supported to speak out if they had any concerns, people who lived in the service had not benefited from the registered person acting upon good practice guidance.

We carried out an unannounced comprehensive inspection of this service on 17 February 2015 and found that there were three breaches of legal requirements. The service was not consistently safe. This was because the registered person had not ensured that at all times there were sufficient numbers of staff available to meet people’s needs for care. In addition to this, the service was not consistently well led. This was because the registered person did not operate reliable systems to monitor the quality of the service provided so that any shortfalls could quickly be corrected. We also noted that the registered person had not always notified us about significant events that had occurred in the service that the law says we need to be told about.

We completed an unannounced focused inspection carried out on 24 July 2015. This inspection was undertaken to make sure that improvements had been made and that the breach of legal requirements had been addressed.

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 Caythorpe Residential Home on our website at www.cqc.org.uk.

Caythorpe Residential Home provides accommodation for up to 14 people who need personal care. The service provides care for older people some of whom live with dementia.

There were 14 people living in the service at the time of our inspection.

There was a registered manager who was also registered as being the provider 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 a ‘registered person’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In this report we refer to the registered manager as being ‘the registered person’.

At this inspection we found that the registered person had followed their action plan that they had told us would be completed by 31 May 2015. This action plan had enabled the registered person to meet legal requirements.

We found that the registered person had reviewed the way staff completed their work at busy times of the day and had extended the provision for additional staff to be on duty when necessary. This had been done to ensure that people’s care needs could be promptly met. These care needs included making sure that people with reduced mobility were helped to avoid having falls and near misses. In addition, we noted that the increased flexibility in staffing arrangements had better enabled people who mostly received care in their bedroom to have the attention they needed.

We also found that the registered person had regularly completed more robust quality checks including determining how many staff needed to be on duty. These checks also involved evaluating particular parts of the care that people received to ensure that it met their needs and wishes. This measure included making sure that some people received extra assistance to eat and drink enough. Other new checks had focused on ensuring that people were supported to express their individuality and to pursue their interests.

We noted that quality checks had also been completed to assure the adequacy of the accommodation including making sure that people enjoyed a suitable level of fire safety protection. However, further improvements were still needed. This was because the checks had not resulted in action being taken to address some of the defects in the accommodation we noted during our previous inspection.

We found that the registered person had notified us about any significant events that had occurred in the service. This had assisted us to determine if the service was responding to people’s needs in an effective way.

Together, the improvements that had been made had strengthened the registered person’s ability to ensure that people received safe and consistent care that met their needs.

Caythorpe Residential Home provides accommodation for up to 14 people who need personal care. The service provides care for older people, some of whom live with dementia.

There were 14 people living in the service at the time of our inspection.

This was an unannounced inspection carried out on 17 February 2015. There was a registered manager who was also registered as being the provider 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 a ‘registered person’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. In this report we refer to the registered manager as being ‘the registered person’.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection one person was being deprived of their liberty and records showed that this was being done in a lawful way.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not always enough staff to ensure that people promptly received all of the care they needed. In addition, the registered person had not protected people against the risks of inappropriate or unsafe care by regularly assessing and monitoring the quality of the service provided. We also found a breach of the Care Quality Commission (Registration) Regulations 2009. This was because the registered person had not notified us about all incidents that had affected the wellbeing of people who lived in the service. You can see what action we told the registered person to take at the back of the full version of this report.

There were not always enough staff on duty to ensure that people promptly received all of the care they needed. The registered person had not notified the Disclosure and Barring Service that a former member of staff might need to be barred from working in health and social care provision. Some of the arrangements in place to protect people from risks to their health and safety were not robust. Staff knew how to recognise and report any concerns so that people were kept safe from harm. People’s medicines were safely managed. Background checks had been completed before new staff were appointed.

People had not been consistently helped to eat and drink enough to stay well. Staff had been supported to assist people in the right way including people who lived with dementia and who could become distressed. Staff had ensured that people had received all of the healthcare assistance they needed. People’s rights were protected because the Mental Capacity Act 2005 Code of Practice and the Deprivation of Liberty Safeguards were followed when decisions were made on their behalf.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy and promoted their dignity. Staff managed private information about people in a confidential way.

People had not been fully consulted about all of the care they wanted to receive. They had not been assisted to obtain the services of a hairstylist.  People were not always offered the opportunity to pursue their interests and hobbies. People had received all of the practical assistance they needed including people who lived with dementia and who had special communication needs. In addition, people had been supported to celebrate diversity by fulfilling their spiritual needs. There was a system for handling and resolving complaints.

Quality checks had not been consistently effective. People had not been fully consulted about the development of the service. The registered person had not developed extensive links with the local community. People had not benefited from staff being involved in local and national good practice initiatives. The service was run in an open and inclusive way that encouraged staff to speak out if they had any concerns.

This visit was carried out to check the provider had complied with the actions we had set following our last visit. In order to do this we checked a number of bedrooms and staircases and discussed the improvements with the manager.

We found the provider had complied with the actions we set. People who used the service were protected against the risks of unsafe or unsuitable premises.

During this inspection there were fourteen people using the service as well as three people on a day-care basis. We spoke with two people who used the service and relatives of four people who were unable to express their own views. We spoke with one person who used the service on a day-care basis along with two care staff, activities co-ordinator, maintenance person and the registered manager.

We looked at service information, records and carried out a tour of the building.

One of the people who used the service (and their spouse) told us they were happy with the care and support provided. They told us they felt safe, knew how to raise any concerns they might have and that staff treated them with respect.

Relatives we spoke with said they were consulted with regards to their relative’s care. One relative told us “Staff always keep me up to date with my family member’s care and discuss things with me.”

The staff we spoke with were aware of the individual needs of people who used the service. One staff member told us, “I always read people’s care plans to read about their life history and their interests.”

People told us they felt safe in the building. One relative told us, “It’s a nice building, they (provider) do the best they can with it.” However we saw that toilet facilities within some bedrooms did not ensure people's right to privacy and dignity.

The records we looked at were accurate and relevant to the management of the service.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not always able to tell us their experiences. These methods included observation and speaking to relatives of people using the service.

Of those people using the service we did speak with, one told us, “Obviously I would rather be at my own home but the staff here do a wonderful job”

Another person said “I am very happy here and would not go anywhere else.”

We spoke with four members of staff who all said Caythorpe Residential Home was a good place to work. One said “I’ve been here 8 years now. It's very homely. A good place to work and to live."