Rating at last inspection: Inadequate (Report published on 15 August 2018).

About the service: Comfort House is a residential care home that provided personal care for up to 42 people. At the time of the inspection, 32 people were living at the service.

People’s experience of using this service:

¿ People and their relatives were positive about the service and the improvements made since we last inspected. The registered manager and staff had updated many procedures for the benefit of people receiving care and support. We need to ensure this is maintained over a longer period of time.

¿ People's needs were assessed before moving into the service. Tailored care plans with associated risk assessments were also put in place to keep people safe and ensure their needs were met how they wanted.

¿ Safeguarding systems and processes were in place, including staff training and reporting of concerns appropriately. People told us they were safe and relatives confirmed this.

¿ Accidents and incidents were recorded and reported correctly. The registered manager analysed incidents to minimise the risk of them happening again and looked for any trends forming.

¿ There were enough safely recruited, trained and supported staff working at the service and this was monitored by the registered manager. The registered manager had booked further training to take place and we have made a recommendation regarding training in pressure damage (skin care).

¿ Medicines were generally managed well. We did find some recording issues, which were addressed immediately.

¿ People’s dietary needs were met, but we had mixed views on the food prepared. The registered manager had this in hand already.

¿ 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.

¿ The service was clean, tidy and homely.

¿ Activities were occurring and had greatly improved and measures were in place to maintain this.

¿ The registered manager led the team with an open and honest approach. They were kind and caring as were the rest of the staff team.

¿ Complaints had been dealt with effectively, but some outcomes had not always been documented, this was to be addressed.

¿ The registered manager was very visible within the service and knew people and visitors well. Audits and checks were completed to ensure quality was monitored and continually improved upon. Links with the local community had improved.

For more details, please see the full report below and which is also on the CQC website at www.cqc.org.uk.

Why we inspected: The inspection was a planned inspection based on the previous rating. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Comfort House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection 35 people with physical and mental health related conditions were using the service.

This unannounced comprehensive inspection took place on 3,4, and 5 July 2018. This meant that the provider, staff nor people who used the service knew we would be arriving.

At the last fully comprehensive inspection in September 2017, we identified two breaches of regulations which related to safe care and treatment and the governance of the service. Following the last inspection, we asked them to do an action as to how they were going to meet the regulations. We found whilst some improvements had been made, the service remained in breach of both regulations and during the inspection further issues were found.

There was no registered manager in place at the service. A deputy manager from another service had been in post a few weeks and managed the service daily as the previous manager had resigned very recently and the current deputy manager was not available. The temporary deputy manager had applied to become the manager of the service and it was confirmed during the inspection that they would be taking on this role and applying to register with the Care Quality Commission (CQC) in due course.

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.

The provider indicated in action plans that the management team at Comfort House carried out daily, weekly and monthly checks of the quality and safety of the service and were confident that issues had been or were being addressed. We did not find adequate evidence to corroborate these checks had consistently taken place or were completed robustly enough to identify the continued issues we highlighted during this inspection.

We found some irregularities with people’s finances within the service. At the time of the inspection, an internal audit was underway and police were investigating. We will monitor this and follow up in due course.

Record keeping had deteriorated throughout the service since our last inspection. The lack of accurate and thorough details recorded within care records meant that neither we nor the provider could ascertain if issues had been correctly identified and followed up properly with the necessary action. We found accidents had not always been recorded fully and people’s care records lacked the detail required to ensure they received safe care and treatment that met their needs.

Care plans reviewed were either not in place, up to date or were incomplete. There were also gaps in risk assessments. Monitoring of food and fluid intake was not always robust, with records not fully accurate. This meant that important information may have been missed and this put people at risk of harm through not receiving the appropriate care and support. Care records did contain person centred information, but further work was required to ensure people’s individuality was fully captured.

Medicines were not always managed safely. There were concerns relating to the ordering, administration, records and staff competencies.

Staff continued to be safely recruited. However, we found there was not enough staff, mainly relating to the upper levels of the service. We monitored call bells and found in some cases excessive amounts of time passed before they were responded to, for example over 15 minutes, more in some cases. We overheard one person being told not to use the bell. This was reported to the management of the servi

The unannounced inspection took place on 4, 6 and 8 September 2017. We last inspected Comfort House in June 2015 when we found the service was in breach of Regulation 18 in relation to staff not receiving adequate supervision and yearly appraisals.

At this inspection, although all appraisals were not yet complete, the new manager had made improvements to ensure that staff received appropriate support and had planned to have the remaining appraisals completed in the near future. Staff had received supervision sessions to allow them the opportunity to discuss a variety of issues and development opportunities.

Comfort House provides residential care for up to 42 people, some of whom are living with dementia. At the time of our inspection there were 38 people living at the service.

The service had a manager in post who had applied to become the registered manager and was awaiting a decision. 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 received their medicines in a timely manner, however we found areas of concerns which needed to be addressed. We found thickeners which had been left in an unlocked room which posed a risk to people. Thickeners are usually powders added to foods and liquids to bring them to the right consistency/texture for people with swallowing difficulties. We also found medicines security, storage of unwanted medicines and staff not using information they had available regarding ‘as required’ medicines was of concern.

We found that moving and handling procedures were not always being carried out correctly which posed a risk of harm to people.

Maintenance of the home was undertaken, although recent lift failures had resulted in one person (unharmed) being trapped in the lift. We have been given reassurances that the lift was in the process of having some major repairs completed.

Staff were aware of their personal responsibilities to report any incidents of potential or actual abuse to the manager.

People told us there were enough staff at the service to support them and we confirmed this through viewing records, however, the use of agency staff had impacted on the day to day support given. The provider had recently recruited more care staff and they were due to take up their posts in the coming weeks.

We found call bells were sometimes slow to be answered. Call bell monitoring was difficult to undertake, because the system did not allow monitoring reports to be completed. The provider told us they were about to install new software to address this.

We found emergency procedures, including fire safety were monitored and staff knew what to do in an emergency. Accidents and incidents were recorded and monitored to identify any trends. The premises was not always as clean as it should have been. The manager confirmed after our feedback that they took action to rectify this, including deep cleaning, contact with infection control specialists in the area and appointing a new infection control lead.

We received mixed views from people on the quality of the food available. We found that kitchen staff did not have all the information they should have regarding people’s dietary needs. However, from observations people still managed to be provided with suitable diets appropriate to their needs. The manager dealt with this issue immediately.

We found staff were adequately trained. They received induction and supervision. Appraisals were being completed and there was a plan in place to ensure all staff received one this year. The provider followed safe recruitment procedures in order to ensure that staff employed were suitable to work with vulnerable adults. We noticed the provider had recently audited staff

We spoke with approximately half the people living in the home. All the comments we received were positive.

Typical comments included, “It’s very good, here. It’s ideal, and the staff are very good, all of them”;

“I’m happy with the place”;

“We are definitely treated with respect. There’s nothing I don’t like about the home”.

No one had any complaints to make, but we were told that people would tell the staff or the manager if they were unhappy about anything.

Relatives were equally positive about the home. Comments included, “It’s the best move my mum has made, coming here”;

“All the staff are fine. They really make the effort”;

“I’ve never seen anything of concern, here”

Visiting professionals said the staff were very caring and helpful.

People we spoke with told us they were happy and settled in the home. They told us that they were well cared for, and that staff listen to them and respond to their needs.

This inspection took place on 23 and 24 June 2015. The first day of the inspection was unannounced.

We last inspected this service in October 2013. At that inspection we found the service was meeting all its legal requirements.

Comfort House is a care home for older people, some of whom may have a dementia related condition. It does not provide nursing care. It has 41 beds and had 32 people living there at the time of this inspection.

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.

People told us they felt safe and secure in the home, and said they had no concerns regarding their safety. Risks to people were assessed and managed appropriately.

Staff were fully aware of their responsibilities for safeguarding vulnerable people from abuse and had been given the necessary training to recognise and report any potential abuse. Where there was any suspicion that a person had been harmed, this was reported immediately to the proper authorities.

Staffing levels were sufficient to allow people’s needs to be met promptly and attentively. New staff were carefully vetted to make sure they posed no risk to vulnerable people.

People received their medicines from experienced staff trained in the safe administration of medicine.

Accidents and other incidents were studied to see if lessons could be learned and the environment made safer.

Staff received regular training in all the areas required to protect people’s health and safety, and to meet their diverse needs. People told us staff had the skills and knowledge they needed to give them their care safely and in the ways they preferred.

People had a nutritious diet with a good degree of choice. Any special dietary needs were assessed and met. People said they enjoyed their meals.

People’s healthcare needs were monitored closely and routinely met.

Staff communicated effectively with people to ensure their views were heard and acted upon.

People said the staff encouraged them to be as independent as possible and make their own decisions about how they lived their lives. Where it was assessed a person lacked the mental capacity to make informed decisions, the service worked jointly with their families and involved professionals to make sure their rights under the Mental Capacity Act 2005 were upheld.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place and the registered manager was familiar with the processes involved in the application for a DoLS. At the time of the inspection two people living in the home were subject to a deprivation of liberty safeguard.

People and their relatives spoke very highly of the staff team. They told us they were always treated with respect and affection by the staff team, and felt they were listened to. We saw staff demonstrated a positive, person-centred approach to people’s care, and took time to treat them as individuals.

People said they were treated with consideration at all times, and their privacy and dignity were protected. They were involved in the assessment of their needs and their views and preferences regarding how their care should be given were taken seriously and incorporated into their care plans.

A good variety of social activities were available, and people told us they enjoyed a stimulating environment, with plenty of things going on.

People told us they had no complaints, but were sure they would be listened to if they raised any concerns.

There was an open and positive atmosphere in the home. People, their relatives and staff all said they were treated with respect by the registered manager. They said they felt listened to and were able to contribute to the development of the service.

Feedback from visiting professionals was very positive.

Effective systems were in place to check the quality of the service and identify where improvements were necessary. We noted significant improvements had taken place in areas such as activities and catering services.

Staff members had not consistently been given the necessary support to carry out their work effectively, because they had not always been given supervision and appraisal of their work by the management team. This was a breach of Regulation 18 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.