We inspected Clann House on 19 and 20 November 2018.The inspection was unannounced. The service is for elderly people, some of whom may have physical disabilities, mental health needs or dementia. Respite care and day care was also provided.

Clann House 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. Clann House accommodated up to 34 people. At the time of the inspection 32 people lived at the home.

The service did not have a registered manager, although the current manager had submitted an application to be registered with the Care Quality Commission. 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, in November 2017, the service was rated as ‘Requires Improvement.’ This was because we had concerns about the management of medicines and because mental capacity assessments were not being completed. The registered persons had not always submitted statutory notifications to the Care Quality Commission when they were required to do so. There were insufficient systems to assess, monitor and improve the quality of the service.

At this inspection we found that satisfactory action had been taken in respect of mental capacity assessments, and we had no evidence to suggest the registered persons did not notify us of relevant events required by law. However, we still had concerns about the operation of the medicines system. We also did not subsequently think audit systems were satisfactory. This was because the systems in place did not identify the problems we found with the medicines system. The registered persons did not take appropriate action to ensure the system worked effectively.

The service was viewed by people we spoke with as very caring. We received positive comments about the service. For example we were told, “They are lovely here and very respectful, “ and “They are very good and very helpful.” Relatives told us, "They are friendly and patient,” and “They are very caring and seem to look after everyone here and are very good to all the families to. They are really, really good.” A staff member told us, “Care is really good. I don’t have any issues, “ Care is amazing, really good,” and “Staff are lovely.”

Everyone we observed looked well cared for. People were clean and well dressed.

The service provided a range of activities. An activities co-ordinator was employed. There were limited external activities available. The service had a vehicle but the rear wheelchair ramp was not working. We have recommended that the registered provider reviews activities provision including current transport arrangements.

People told us they felt safe. For example people told us, “Yes. It is important to feel safe,” “I do and have always done,” and “They do all they can to help us all. They are very good and most kind.” The service had a suitable safeguarding policy, and staff had been appropriately trained to recognise and respond to signs of abuse.

People had suitable risk assessments to ensure any risks of them coming to harm were minimised, and these were regularly reviewed. Health and safety checks on the premises and equipment were carried out appropriately.

There were enough staff on duty to meet people’s needs. Recruitment checks were satisfactory. For example, the registered provider obtained two written references and a Disclosure and Barring check to ensure the person was suitable to work with vulnerable adults.

Staff members received an induction. The registered provider was aware of the Care Certificate. Thi

Clann House provides accommodation and personal care for up to 34 older people who may be living with a dementia. At the time of our inspection there were 24 people living at the service. This inspection took place on 28 October and 4 November 2017. The first day of the inspection was unannounced. This was the first time the service had been inspected since it updated its legal entity.

The service is required to have a registered manager and at the time of our inspection there was no active 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 and associated Regulations about how the service is run. The registered manager had left the organisation in May 2017 but no steps to cancel the registration had been taken. The manager told us they would be applying to be the registered manager and were awaiting preliminary checks to be completed.

People told us they were happy with the care they received and believed it was a safe environment. There were several staff vacancies and agency workers were frequently used to maintain staffing levels. The manager also regularly covered care shifts. This meant they had less time to spend completing managerial duties. We identified gaps in staff training and noted there was no plan for staff supervision in place. Agency workers were required to complete an induction to familiarise themselves with the service. This had not been completed by all the agency staff. Recruitment was on-going and the manager told us they were confident the situation was improving. Recruitment checks were carried out before new staff started work. There was an induction process in place to help ensure staff had the relevant skills and knowledge required for the role.

People received their medicines on time and as prescribed. Staff supported people to access healthcare services such as occupational therapists, GPs, chiropodists and dieticians. Relatives told us staff always kept them informed if their family member was unwell or a doctor was called. Records in respect of the care and support people received were accurate and up to date. Care plans were regularly reviewed.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). DoLS applications had been submitted for some people. There was no evidence any capacity assessments had been completed before submitting the applications. This was not in line with the legislation laid down in the MCA.

The atmosphere was friendly and relaxed. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. During the inspection we frequently saw staff stopping to exchange a few words with people and enquire after their well-being.

Staff knew how to recognise and report the signs of abuse. There was an up to date safeguarding policy in place and information on local reporting procedures was available to staff. Any risks in relation to people’s care and support were identified and recorded. The records guided staff on the actions they should take to protect people from any identified risk. There were systems in place to help ensure staff were kept informed of any changes in people’s needs.

There was a daily choice of menu and people told us they enjoyed their meals. People had access to a varied and healthy diet. When necessary food and fluid records were kept to help ensure people received enough to eat and drink.

People had limited opportunities to take part in organised activities. There was no activity co-ordinator in place at