This inspection visit took place on 17, 18 and 19 December 2018 and was unannounced.

There was a 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.

Colbury House Nursing and Residential Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Colbury House is registered to provide accommodation and personal care for up to 58 people. At the time of our inspection 49 people were living at the home. The home provides a service for older people, people living with dementia and with a physical disability. Accommodation is provided over two floors, which can be accessed using stairs or passenger lifts.

At our last inspection in December 2017 we found the provider was in breach of three regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of those breaches.

Following our inspection the provider sent us an action plan on 26 January 2018 to tell us about the actions they were going to take to meet these regulations.

During this inspection, we found that insufficient action had been taken to meet the requirements of two regulations the service had breached at the inspection in December 2017.

The provider did not have effective quality monitoring systems in place to ensure on-going compliance with the Regulation's.

The provider had failed to ensure that staff had received appropriate training as necessary to enable them to carry out the duties they are employed to perform.

The provider had a robust and effective recruitment procedure in place that ensured people they employed were of suitable character and background.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment.

Medicines were managed in a safe way.

People, their relatives and staff told us the registered manager was supportive and approachable.

People were supported by staff who knew them well.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives told us they enjoyed the food served which considered peoples individual dietary needs and preferences.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments.

There was a complaints policy and procedure in place. People’s comments and complaints were taken seriously, investigated, and responded to.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We found two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 27, 28 and 30 November 2017 and was unannounced.

The service had a registered 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.

We last inspected this service on 31 October, 1 and 2 November 2016 and found the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of these breaches. Following our inspection the provider sent us an action plan on 29 December 2016 to tell us about the actions they were going to take to meet these regulations.

During this inspection, we found that insufficient action had been taken to meet the requirements of three regulations the service had breached at the inspection in October / November 2016. In addition to this, we found a further two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had failed to ensure that staff had received such appropriate support, training, supervision or appraisal as is necessary to enable them to carry out the duties they are employed to perform.

Where risks to people had been identified, steps to reduce or mitigate these risks had not always been completed placing people at risk of unsafe care.

Whilst there were some systems in place in the home to monitor the quality of the service provided via audits these were not effective at identifying the areas of concern that we found during this inspection.

People received their medicines safely, accurately, and in accordance with the prescriber’s instructions. Medicines were stored safely.

People were protected against abuse because staff understood their responsibility to safeguard people and the action to take if they were concerned about a person's safety. People's rights were protected because staff were aware of their responsibilities under the Mental Capacity Act 2005.

People had access to and were supported with their healthcare needs, including receiving attention from GPs and routine healthcare checks.

People were involved in their day to day care. People’s relatives were invited to participate each time a review of people’s care was planned.

People were comfortable and relaxed in the company of the staff supporting them.

Staff treated people with dignity, respect and kindness. They knew people's needs, likes, interests and preferences. People were supported to maintain relationships with their friends and relatives.

We recommend that the service seek advice and guidance from a reputable

source about supporting people with communication needs or with sensory loss to have access to information in a format they can understand.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and identified a further four breaches. You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on the 31 October, 1st and 2nd November 2016 and was unannounced.

Colbury House provides accommodation for persons who require nursing or personal care for up to 58 people. The home has permanent residents but also provides respite care. At the time of our inspection 44 people were living at the home.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The CQC had not received an application in respect of a registered manager.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider did not return a PIR and a rating’s limiter was applied to the “well led” section of this report which meant they could not achieve a 'good' rating in this domain.

People’s personal emergency evacuation plans and the testing of fire alarm systems were not up to date and we could not be sure that in the event of a fire people would be safe.

Medicines were not stored and administered safely. Medicine administration records were not always completed. Temperatures of refrigerators used to store some medicines were not always recorded.

Staff did not receive regular supervision or appraisals which would have provided them with appropriate support to carry out their roles.

Not all staff had completed training in areas that reflected their job role.

Where people lacked the mental capacity to make decisions the home did not always follow the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

Some risk assessments and care plans were not always person centred and did not ensure that peoples care and treatment was appropriate, met their needs or reflected their preferences.

There were sufficient numbers staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

Individual care records were stored electronically and each member of staff carried a personal data terminal to access and update records accordingly.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People who were able to talk with us said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

People were supported with health care appointments and visits from health care professionals.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Colbury House is registered to provide accommodation and nursing care for up to 58 people, some of whom may be living with dementia. During our inspection we looked at care plans, policies and procedures, training records, staff records, surveys and quality and audits. We spoke with six people using the service and four relatives. We also spoke with the registered manager, deputy manager and four members of the care staff. We gathered evidence against the outcomes we inspected to help answer our five key questions.

• 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?

The service was not safe. We looked at the care plans and risk assessments for four people, who had complex needs. These were inconsistent and did not always describe in sufficient detail how care workers should deliver their care safely and manage identified risks. The needs of some of the people living at Colbury House were not assessed and care and treatment was not always delivered in line with their individual care plan.

Arrangements were in place to deal with foreseeable emergencies. The service maintained a personal emergency evacuation plan for each person and had developed a contingency plan that would ensure that the needs of people who used the service would be met in the event of an incident affecting the safe running of the home.

Care workers we spoke with demonstrated a good understanding of types of abuse people may experience. All care workers we spoke with confirmed they had received training on safeguarding of vulnerable adults. They would not hesitate to report concerns to the manager and stated they were confident any concerns raised would be taken seriously. Care workers knew about the policy and procedures and who to report any concerns to.

The registered manager ensured agency staff were qualified and appropriately registered because the agency provided profiles of staff which included relevant training and registration documentation.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. At the time of our inspection four applications had been submitted and the provider was working with the local authority to ensure further referrals were made proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

Some aspects of the service were not effective. At the time of our inspection the registered manager could only provide evidence of one supervision being completed [the deputy managers] from a staff of 29 over the last 12 months. This meant staff did not received appropriate professional development in respect of supervision and appraisal.

There were arrangements were in place to undertake pre-admission assessments and these considered all aspects of people’s needs. This enabled the service to reach judgements about whether they could effectively meet people’s needs.

A regular visitor to the home from a local out-reach group who had been visiting the home for the past 15 years told us: “I visit and spend time with six to ten people every fortnight. There is always something going on. The activities co-ordinator is very good. I have no concerns at all in relation to the way people are cared for here.

Is the service caring?

The service was caring. We observed two people being supported to eat and drink their lunch in their respective rooms. One person had an eating and drinking care plan which stated care staff were to make sure that they were sitting up when being supported to eat.

One person using the service said: “If all places are like this, they would be doing well. I am really happy here the staff are brilliant with me, it’s much better than it was a year ago”.

Is the service responsive?

The service was responsive. We found risks associated with people’s care had been recognised, assessed and planned for. Risk assessments had been completed in relation to a range of needs such as eating and drinking, moving and handling and managing skin integrity. For example, one person had a risk assessment in relation to their use of the stairs. Another person had a risk assessment to manage their risk of developing infections.

The registered manager responded to complaints in a timely way and took immediate action and included this in the complaints records. All complaints were fully investigated with outcomes and resolutions being relayed back to all parties.This ensured that accurate records were maintained on people's concerns and complaints and the actions that were taken to address them.

Is the service well led?

The service was not well led. Systems were in place to regularly monitor and check water temperatures, nurse call systems, bed rails, security, door closures, and emergency lighting. However records were unclear and did not demonstrate when systems had failed or where issues had arisen. We did not see an audit trail of issues found, reported, and resolved. This meant the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

The sample of care plans we looked at showed that people’s needs were being reviewed monthly.

We visited Colbury House to follow up our inspection visits we made in April and July 2013. During these visits we found that the provider was failing to plan and provide care that was intended to ensure people's welfare and safety, and meet their individual needs. We also had concerns regarding the provider’s recruitment and selection process for care workers and management and that staff had not received appropriate training, professional development, supervision or appraisal. The provider also did not have effective systems in place to ensure quality of care and to manage risks to the health, safety and welfare of people who use the service and others.

At this inspection we found that the provider had taken action to make improvements. There were more robust systems for assessing and monitoring people’s care needs. All care plans were now kept electronically and everyone living at Colbury House had a personalised care record. All care plans we reviewed contained up to date information which reflected the needs of people.

An effective recruitment and selection process was in place to ensure that the people who used the service were safe and their needs were met by care workers who were suitably qualified, skilled and experienced. Appropriate checks were undertaken before care workers began work.

We looked at the training records for 10 care workers and saw that since our previous inspection the provider had introduced an ‘e-learning’ programme for all care workers and nurses. Training records we reviewed showed that care workers were up to date with mandatory training. The manager said there had been a focus on improving training, and this was monitored regularly.

The manager described how regular nurse team meetings and care team meetings had been set up to improve communication within the service and to share learning. For example, there were daily meetings with the deputy manager and nursing staff, as well as shift handover meetings. This meant that issues were communicated effectively.

At our inspection in April 2013 we found that people were not protected from the risks of inadequate nutrition and dehydration. We judged that this had a major impact on people who used the service. As a result of this we issued a warning notice. At this inspection we checked to see that people’s nutritional needs were being met and that they were not at risk of dehydration.

The manager outlined the improvements that had been implemented since the last inspection. For example, previously we had identified that the heated food trolley was not in working order but this had since been replaced. The manager told us that the Speech and Language Therapist (SALT) was visiting once a week and completing two assessments during each visit. We looked at the care plan for one person who had been assessed by the Speech and Language Therapist. That person’s care plan had been updated to reflect that person’s current needs in relation to nutrition and hydration.

At our inspection in April 2013 we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We judged that this had a major impact on people who used the service. As a result of this we issued a warning notice. At this inspection we checked to see that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We looked at a sample of four care records for people who used the service. We saw that people's care records were kept securely in lockable filing cabinets in the nurses’ station. Care plans provided accurate information in relation to the care and treatment provided to those people.

We saw evidence that recruitment procedures had not always been operated effectively. We had concerns about gaps in the recruitment procedure for the manager, who had been in post since 3 June 2013 and also for the deputy manager who commenced employment on the 8 July 2013.

Colbury House is registered to provide accommodation and support for 58 older people who may also be living with dementia. The home provides long stay or short stay nursing care. On the day of our visit 35 people were living at the home. The home is located in a rural area two miles from the town of Totton, Southampton. There is no public transport nearby. The home has two large living rooms, a dining room and a kitchen. People’s private bedrooms are on both the ground and first floors. There is a passenger lift and stair lift to the first floor. The home has a garden to the rear of the premises and a patio area that people are actively encouraged to use.

We undertook an unannounced inspection of Colbury House on 24 and 25 November 2014. This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection on 11 August 2014 had been made.

At the last inspection in August 2014 we asked the provider to take action to ensure that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. To ensure that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard, to have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others who may be at risk. Following our inspection the provider sent us an action plan detailing the improvements they would make. These actions have now been completed.

There was a registered manager 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.

Staff understood the needs of the people and care was provided with kindness and compassion. People, relatives and health and social care professionals told us they were very happy with the care and described the service as excellent. One health care professional said, “I have no concerns at all over the welfare of people living at Colbury House”. People were supported to take part in activities they had chosen. One person said, “I can do whatever I want here. The staff are lovely people and work hard”.

Staff were appropriately trained and skilled to ensure the care delivered to people was safe and effective. They all received a thorough induction when they started work at the home and fully understood their roles and responsibilities.

The registered manager assessed and monitored the quality of care consistently involving people, relatives and professionals. Care plans were reviewed regularly and people’s support was personalised and tailored to their individual needs. Each person and every relative told us they were continually asked for feedback and encouraged to voice their opinions about the quality of care provided.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. People’s freedoms were not unlawfully restricted and staff were knowledgeable about when a DoLS application should be made.

Referrals to health care professionals were made quickly when people became unwell. Each health care professional told us the staff were responsive to people’s changing health needs. One health care professional said, “They (the staff) always contact us if they are unsure or need advice”.

We observed staff talking with people in a friendly and respectful manner. The home had a personalised culture. People told us staff had developed good relationships with them and were attentive to their individual needs. Staff respected people’s privacy and dignity at all times and interacted with people in a caring and professional manner. People who used the service told us they felt staff were always kind and respectful to them.

People told us they were encouraged to raise any concerns about possible abuse. One member of staff said, “The home is managed well. If we have concerns we can speak to the manager or deputy manager about them.