We carried out this unannounced inspection on 12 and 20 July 2018. At our last inspection in March 2016 we rated this service ‘good’. At this inspection we found several breaches of regulations and have rated this service ‘requires improvement’.

Colin Care 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. The service provides residential home care for four men with mental health needs who may also have an associated brain injury or alcohol dependency. The care home consists of four bedrooms and a communal lounge, dining room and kitchen.

The service did not have a registered manager following the resignation of the manager in December 2017. The provider told us they were advertising to recruit a new manager. A registered manager is a person who has registered with 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 provider was recruiting a manager from the existing staff team and told us they intended to appoint a new manager in August 2018.

At the time of our inspection two key posts were not covered and staffing levels were too low to safely meet people’s needs. Most care workers were part time which meant the service was not able to provide a consistent staff team. Safer recruitment measures were not consistently followed to ensure that care workers were suitable for their roles.

Care workers did not receive regular supervision and lacked training in key areas such as mental health awareness and managing behaviour which may challenge. People did not have personalised plans to manage and de-escalate such behaviour. Risk assessments were in place but were not reviewed regularly or in response to changes in people’s needs. The provider worked with the local authority to review people’s care and manage risks to people.

People told us that they were treated with respect by care workers, but there were limited meaningful activities in place. Keyworking and residents’ meetings were not taking place frequently and consistently and plans lacked clear goals for people to gain independence and engage in meaningful lifestyles. People were safeguarded from abuse. People were supported to make choices about what they ate and people’s nutritional needs were assessed and met.

The building was kept clean and was a pleasant environment. There were systems of health and safety checks to ensure the premises were safe for people who used the service. Medicines were managed and stored safely by care workers who had the competence to do so. There were systems of weekly audits in place to ensure that this continued. However, a lack of consistent management at the service meant there were not robust systems to ensure that other regulations were met and that care plans and risk assessments were kept up to date.

The provider was not meeting requirements to display their ratings of the previous inspection or to notify CQC of serious incidents that had occurred in the service.

We have made a recommendation about how the service manages and records complaints. We found breaches of regulations relating to staffing levels, supervision and training, display of ratings, notifications of serious events and good governance. You can see what action we told the provider to take at the back of the full version of this report.

In response to our inspection feedback, the provider sent us a plan stating how they would address our concerns, which included appointing a new manager. We will carry out a further inspection in due course to ensure these requirements have been met.

We carried out this unannounced inspection on 30 December 2015.

Colin Care Home provides accommodation and personal care for up to four people with mental health needs. Four people were using the service at the time of the inspection. The care home is a detached two-storey property located on a residential road, close to local amenities.

The service has a registered manager in post at the time of the inspection. 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.

People felt safe living at the service. People were protected by the provider’s robust recruitment procedures. The service had enough staff to meet people’s needs and keep them safe. Staff received safeguarding training and understood the procedures to follow should they suspect abuse.

People’s risks were assessed and plans to manage risks were regularly updated.

Medicines were stored safely, administered in line with care plans and recorded correctly. Medicines procedures, records and balances were subject to frequent audits. People were supported to access healthcare services.

Staff received the training, appraisal and supervision they required to meet people’s needs effectively. People’s needs were assessed prior to admission and reviewed with their participation. People’s consent to care and treatment was sought in line with legislation.

People’s dignity and privacy were respected and staff promoted independence through skills teaching. Care plans were detailed and reflected people’s needs and aspirations. People’s views and those of their relatives were actively sought and acted upon. People participated in activities of their own choice. The provider supported people to meet their cultural needs.

The registered manager provided staff with a clear vision of how to deliver care and support to people. The service had an open culture and staff were encouraged to share their ideas for driving up improvements.

The inspection was carried out in order to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

When we last inspected the service in February 2014 we found that it was not safe. We asked for improvements to be made. We found that people were at risk because the provider had not made sufficient checks in relation to the suitability of job applicants.

In February 2014 we found that people were at risk of receiving care from staff who did not have the skills to meet their needs. On this inspection we saw records which confirmed that the provider had ensured that all staff had received the training they required to support people safely.

In February 2014 we found that people were at risk of not receiving their medicines safely as prescribed. The provider had not assessed the competency of staff to safely support people with their medicines before they undertook this task on their own. On this visit we saw records confirming that all staff in the service had received training in the safe administration of medicines and an assessment report had been completed in relation to their competence in this area. Records showed that staff had supported people to receive all their medicines correctly at the right time of day. People received their medicines safely as prescribed.

At this inspection we confirmed that the provider had improved staff recruitment arrangements and all the required checks on staff had been undertaken before they started work. People were protected from the risk of receiving care from unsuitable staff. People told us that they trusted the staff and felt safe. People and their relatives told us there were sufficient staff on duty to meet people’s needs. People received a consistent and safe level of support.

We saw evidence that the provider had undertaken the appropriate checks in relation to managing risks to people's health and safety. For example, audits were carried out on various aspects of the service, including stocks of medication, fire safety arrangements and the maintenance of the building.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). We confirmed that the service met legal requirements in relation to DoLS and there were no unauthorised deprivations of people's liberty.

Is the service effective?

People's needs had been assessed and they had an individual support plan which set out how the service supported them. People told us they received their support in the way they wished. Support plans promoted people's independence by specifying what tasks they could carry out independently. People received their support in accordance with these plans. The service had ensured people had seen a range of health care professionals for specialist care and treatment.

People told us that staff were skilled and knew how to care for them well. The provider had ensured staff had received relevant training in topics such as supporting people with mental health needs and managing challenging behaviour.

Is the service caring?

People were supported by kind and attentive staff. A person's relative said, “I visit [my relative] regularly and know all the staff. They are friendly and treat people well.” Staff knew about people's individual background, interests and preferences and used this information when communicating with people and offering support.

Is the service responsive?

People told us they were asked how they would like to be supported. A relative who acted on behalf of a person who uses the service said they were fully involved in planning the person's support so that it reflected their interests and preferences. People using the service told us that they were asked about their views and these were taken into account in relation to the delivery of their support.

People went out of the service to a range of activities of their choice and followed their own interests. People were supported to retain links with their family. A person's relative told us, "I come here often and the staff always make me welcome and tell me what has been happening."

Is the service well-led?

The current manager of the home has been in post since 16 May 2014 and is not yet registered with the Care Quality Commission. Staff, people who use the service and relatives who act on their behalf told us that the manager communicated well with them and they had confidence in him. Improvements had been made in relation to record keeping and staff recruitment. Staff had received appropriate training and support. The provider had worked in cooperation with the local authority to analyse incidents and to identify improvements to the service.

We carried out this inspection in response to a number of concerns that were expressed to the Care Quality Commission (CQC). We also wanted to determine if the provider had taken action to rectify issues found at the previous inspection carried out in October 2013. At the time of this inspection there was no registered manager in post.

At our previous inspection we found staffing levels were not adequate, staff did not receive supervision and dispensing and recording of medicines was not satisfactory. On this visit we found staffing levels had been revised and staff were receiving supervision. Medication recording had improved however new staff were not assessed for their competency before being allowed to dispense medication.

We reviewed the recruitment process for four new staff. We found that there were a considerable number of gaps in the documentation required, including a failure to obtain a criminal records check for any of the new staff.

Staff were required to care for people who suffered from seizures however we found that new staff were left on their own on some shifts without having received training or guidance in caring for people who may have a seizure.

We were informed that people using the service were not consulted about bedroom allocation; that they were not provided with good quality food; that the home was inadequately heated and that their money was used to top up house funds. We spoke to two of the people using the service. They did not express any concerns, and said they were 'OK' with their allocated bedroom.

We carried out this inspection after receiving concerns about the care that was being provided. We reviewed medication and staff levels, staff support and staff recruitment. At the time of our inspection the provider did not have a registered manager in post.

We found that staff recruitment was being carried out appropriately. Staff received regular training however they were not being provided with regular supervision or the reassurance and support they required in specific stressful situations and when working alone.

We found that there were not always a sufficient number of staff on duty to support the needs of the people using the service.

We found a number of errors in medicine administration, including unsigned records, procedures not being followed, and staff using blister packs inappropriately (blister packs are pre-sealed pill boxes).

This inspection was carried out to assess the action the provider had taken to become compliant with the regulations and meet the requirements that were made following our inspection in April 2013.

We previously found that not all care and treatment was planned and delivered in a way that ensured people's safety and welfare. On this visit we found that the provider has taken appropriate action and that care plans were being regularly reviewed and updated, and that keyworking sessions were now being carried out monthly.

At our inspection in April 2013, we had found that people who use the service were not protected from the risk of abuse. On this visit we found that staff had undergone training and that they had current policies and procedures in place to refer to.

We found that improvements had been made with regard to infection control. Staff now had procedures to refer to and were supplied with an adequate amount of cleaning materials.

Changes had been made to the staff rota. We had previously found that there were not enough staff on duty to meet the needs of people using the service. We now saw that the number of staff on duty had been increased at weekends and for several days during the week. Staff training had also been reviewed, and staff had undergone additional training, particularly in epilepsy, which was appropriate to the needs of people using the service.

We found that the provider and staff had improved the quality assurance systems, and that now a range of audits and checks were in place to ensure that the services provided were of good quality and met people’s needs.

We found that people using the service had care plans and risk assessments in place, and that most of these plans had been reviewed within the last six months. Each person was allocated a specific care worker, a keyworker, to lead on their care. Keyworker meetings had been held, but not always every month as stated in the home's policy. Not all health records were being kept up to date. People using the service told us that they enjoyed living at the home, and that they felt the staff team looked after them well.

People told us that they felt safe in the service. Staff told us that they had training in safeguarding every year, however we found that there were some gaps in this training.

We found that the home was clean but that staff sometimes ran out of cleaning materials, and not all of them had received training in infection control.

We looked at staffing levels and found that particularly at weekends there were not enough staff on duty to meet the needs of the people using the service. We also found that staff were not receiving regular supervision, and that some staff had not undergone all of the expected training.

The provider did not 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; or to regularly assess and monitor the quality of service that people received. People were unaware of the complaints process.

There were four people living at Colin Care Home when we inspected the service on 14 September 2012.

Two of the residents were out in the community: one at a day centre and the other at a counselling appointment.

We observed how the other residents were being supported and one of the residents shared his experiences of the service with us, which were positive. He told us he felt supported by the staff team and his life had improved since he had come to live at Colin Care Home.

We observed positive and supportive interactions between the staff and the residents. People were treated with dignity and respect.