The inspection took place on the 3 and 4 and 6 July 2018 and was unannounced.

Colebrook Manor is a care home that can accommodate up to 40 people that require nursing or residential care. At the time of the inspection 33 people were living at the 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.

The service had 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.

When we completed our previous inspection on 12 September 2017 we found concerns relating to people’s end of life care recordings. At this time this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this topic area was included under the key question of Responsive. Therefore, for this inspection, we have inspected this key question and also the previous key question of Caring to make sure all areas are inspected to validate the ratings.

During the last comprehensive inspection in September 2017 we found the areas of safe, caring, effective and responsive required improvement and well led was rated as inadequate with breaches of Regulation. We took enforcement action by imposing positive conditions on the provider’s registration. This meant they needed to send us a monthly action plan of the progress of meeting the regulations.

At that inspection we found that people could not be confident that risks to their health and safety had been fully assessed and recorded, or that safe systems were in place to monitor the risks. We also found people's health, safety and well-being may be at risk due to lack of maintenance in some areas of the home at that time. Some aspects of medicine administration were not fully safe. Some staff had not received training on safeguarding procedures People's end of life care was not fully planned with them. Care plans did not fully reflect people's needs or wishes. People were at risk because the provider's systems to monitor the quality of the service were not fully effective and had failed to identify or address areas where improvements were needed. At that time the leadership, governance and culture did not ensure staff had sufficient information to ensure people's needs were fully met and staff were not well supported to enable them to consistently and safely deliver good quality care.

During this inspection the service demonstrated to us that improvements had been made and is no longer rated as inadequate in any of the key questions.

This inspection in July 2018 was a comprehensive inspection that looked at all areas of the service again to check the service had addressed the concerns from September 2017. We found people's care at Colebrook Manor had significantly improved in all areas. The service has been therefore rated as Good in effective, caring and responsive. There remained a rating of Requires Improvement in the responsive and well-led sections of the report. This is due to the need for the provider and house manager to demonstrate they can sustain the positive changes that have been made.

The registered manager and provider had put new systems in place to oversee the running of the service and check its quality. The registered manager and provider had monitoring systems which enabled them to identify good practices and areas of improvement.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff and professionals said the man

This inspection took place on 12 and 14 September 2017 and was unannounced. The service was previously inspected on 27 and 28 October 2015 when we rated the service as ‘Good’ overall. At that inspection we found no breaches of regulation, but we found some aspects of the management of the service required improvement and rated the well- led section as requires improvement.

Colebrook Manor is a care home that can accommodate up to 48 people who require nursing or residential care. There were 39 people receiving care at the time of this inspection. A few weeks before this inspection took place the registered manager resigned. A new manager had been appointed in mid-August 2017 and they had submitted an application to register, but this process had not yet been completed. 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.

This inspection was brought forward because we received some concerns and complaints about the service and we wanted to make sure people were receiving safe care. The concerns related to staffing levels, moving and handling procedures, procedures to be followed after a fall or serious injury, and behaviour and attitude of individual staff members. During this inspection we were assured that the concerns and complaints had been taken seriously by the new manager and their staff team, and actions had been put in place to address them and prevent recurrence. While we found no evidence of people being harmed by poor practice at the time of this inspection, we found a number of concerns which meant there was a risk of harm in the future. The providers had failed to implement robust systems to monitor and improve the quality of the service. They had not been pro-active in identifying issues, or dealing with issues promptly when they arose. This meant concerns and complaints may have been avoided if robust systems had been in place.

People could not be confident their personal care and health needs had been fully assessed, or that the staff had up to date information and knowledge on how to meet their health needs effectively. Before people moved into the home information was received from the local authority or hospital which outlined their needs. This information was used as the basis of a care plan for each person. However, care records were not always updated when people’s needs changed and they were not reviewed on a regular basis in order to ensure that information was reflective of people's current needs.

Risks to people’s health and safety had not been fully assessed, and staff did not have sufficient information to ensure the risks were minimised. People who lived with epilepsy did not have risk assessments detailing how to minimise risks from their condition. Where people were at risk of pressure ulcers, pressure mattresses had been put in place but we found three were incorrectly set. Staff had not been given information on the correct mattress settings, and there were no systems in place to monitor the mattresses. While we found no evidence that people had suffered harm at the time of this inspection due to poor risk assessment systems, there was a risk they may suffer harm in the future.

Systems to monitor the maintenance of the home were not fully effective. The overall appearance of the home was bright, clean and comfortable. A new wing had been opened on the first floor since our last inspection and this area appeared bright, modern, comfortable and spacious. However, there were some maintenance problems in some other areas of the home which may compromise people’s health and safety and affected the appearance of those areas. We also found a number of other maintenance issues around the home which had not been pick

We inspected Revelstoke Care Home due to concerns we had received over the number of staff on duty. We carried out this responsive inspection due to concerns received that the home did not have sufficient staff on duty to keep people safe and care for the people living in the home.

We met seven people who used the service and spoke to them about the number of staff on duty. We met and spoke with the deputy manager and seven staff members who were on duty.

On the day we visited we could not substantiate the concerns which were about staffing levels. We saw there were sufficient staff on duty to support people at their own pace.

The care workers that we saw working with people were kindly and respectful. We spoke with people who received care. They told us that the nurses and care staff supported them well and said "“When I ring the bell they are usually there pretty quickly” and another said, “I don’t have to wait long for help”.

They staff we spoke with told us about the work they carried out at the home. They were passionate about the work they did. One told us "I enjoy working here, even when it is busy it is still nice”. Another told us they worked well as a team and covered some vacant shifts to help out. We saw care workers were well organised.

We considered all the evidence we had gathered under the outcome we inspected.

We considered our inspection findings to answer the question:

• Is the service safe?

This is a summary of what we found-

Is the service safe?

We found sufficient staff on duty to meet people’s needs. We spoke to seven people who used the service and they were all happy with the care provided. They said they were treated with respect and dignity by the staff. There were enough staff on duty to meet the needs of the people who received care at the home and people were able to say they felt safe living at Revelstoke. One staff member said, “I think we have enough staff on duty”.

Revelstoke Lodge was recently acquired a new provider called Blue Mar Ltd. This was their first inspection by the Care Quality Commission (CQC). On the day of our visit there were 23 people living in the home. We spoke with seven people who lived in the home, four relatives and a visiting professional.

We observed that staff spoke with people in a friendly and respectful manner. People told us that they were able to make choices about their day to day lives. People we spoke with told us “we are well looked after.” Another said “I can do whatever I want.”

The care plans we looked at were personal to the individual and gave staff information to follow. This made sure that people received care and support which met their individual needs.

There were suitable safe storage facilities for medication and we observed staff administering medicines competently and safely.

The new provider was keeping people informed of changes taking place and monitoring the service.

The inspection took place on the 27 and 28 October 2015 and was unannounced. The last inspection took place on the 29 and 30 October 2014. At this inspection we were found there were not enough staff to deliver care safely and people who paid for their own care did not have contracts in place. We found both these concerns had been met on this inspection.

Colebrook Manor can accommodate a maximum of 65 people. Care is provided for younger and older adults who may have a physical disability. Nursing and residential care are provided. For people receiving residential care, their nursing needs were met by the community nursing team. There were 24 people living at the service when we visited.

There was a registered manager in place to manage 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 ‘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.

Colebrook Manor was owned and run by Blue Mar Ltd. They run two care homes in England. There was a nominated individual (NI) in place who is accountable at the provider level. There was no evidence of the provider ensuring the quality of the service. We spoke with the nominated individual who explained there had been a need to consolidate the finances of the service. This had been achieved and they were now in a position to facilitate stability and growth of the service.

At our last inspection, we found people who were paying in full or in part for their care did not have terms, conditions and contracts in place. We found terms and contracts had been developed but had not been implemented. We were advised they were to be implemented the week following the inspection.

The registered manager had some audits in place to measure the quality and safety of the service. There were gaps in these such as investigating people’s falls to reduce this risk for others. Water temperatures were being taken to prevent scalding however, there was not a current legionnaire’s check in place to ensure the water outlets were safe. The registered manager considered how to ensure the concerns raised could be addressed.

People and staff felt the registered manager was approachable. They also felt the registered manager had developed a culture which was open and inclusive. People and staff were asked their view of the service and felt they could offer alternative ideas on how the service was run. People’s concerns were addressed early so they could be resolved quickly. The registered manager was looking at how they could use people’s concerns to ensure the service improved for everyone.

People were looked after by staff who treated them with kindness and respect. The atmosphere in the home was happy with plenty of conversation and appropriate humour. Staff spoke highly of the staff and the staff spoke fondly of the people they were looking after. People said their dignity was protected at times of personal care. People said staff would always ask for their consent before starting care. People added that staff respected their decision and would come back later.

People felt safe living at the service. People were protected by staff who could identify abuse and would report their concerns. People and staff felt the registered manager would act on any concerns. Staff would contact the local authority or CQC if action was not taken. There were sufficient staff recruited safely to meet people’s needs. Staff were trained to meet people’s needs.

People were in control of their care and felt staff listened to them. People had their capacity to consent to their care assessed, as required. People had care plans and linked risk assessments in place to meet their needs. We identified some gaps but action was taken to address this through a new care planning process. For example, people on respite did not have care plans in place but this was addressed and started to be implemented on the second day of the inspection.

People’s medicines were administered safely. Staff were following safe infection control policies.

People had their health needs met. People had access to healthcare professionals as required. People also had their nutritional and hydrations needs met. Action was taken when concerns were raised.

People were provided with activities to remain physically, cognitively and socially active. People’s religious needs were met. The service employed an activity coordinator. There was a programme of activities developed with people which was flexible.