We conducted an unannounced inspection at Connect House on 11, 12 and 13 September 2018. Connect 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.

Connect House is situated in Basford, Nottingham and is operated by Medina Connect Limited. Connect House work closely with staff employed by CityCare partnership and Nottingham University Hospitals, to provide a service where people are enabled to access expert support from a range of specialist health professionals. It is a fast-paced service with multiple admissions and discharges each week. The service accommodates 56 people across two distinct units, Heritage and Garden.

Heritage Unit is comprised of 23 short-term beds providing a reablement service, to people who have recently been discharged from hospital, to help them regain their independence. A range of health professionals including physiotherapists, occupational therapists and nurses support this. There are also five people who are long term residents in Heritage. During our inspection there were 25 people in Heritage Unit.

Garden Unit provides nursing care. 12 beds in Garden Unit are ‘Discharge to assess’ beds, which are for people who no longer require a hospital bed, but still require an enhanced level of healthcare. A further six beds in Garden Unit are dedicated to the care and rehabilitation of people who have experienced a stroke and the remaining 10 beds, are for people who require long term nursing care. Garden Unit is staffed by nurses and health care assistants who are supported by a range of visiting clinicians including GP's, consultants and specialist nurse practitioners. During our inspection there were 26 people staying in Garden Unit.

This was the second time we had inspected the service since its registration in September 2017. At our last inspection in February 2018 we found significant concerns across a range of areas, including; safety, staffing, recruitment, hydration and nutrition, consent and choice and leadership and governance. We acted to impose conditions on the registration of the provider and the service was rated as inadequate. At this inspection we found many improvements had been made and some further work was underway to ensure compliance with the legal regulations. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in place at the time of our 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.

During this inspection we found there had been some improvements to the safety of the service, but further work was needed. Action had not always been taken after incidents to reduce the risk of the same thing happening again. There were not always enough staff to meet people’s needs, people told us this resulted in delays to their care and support. There were occasions were people did not receive their medicines as prescribed. Medicines were not always stored safely or hygienically. People told us they felt safe and there were systems in place to protect people from abuse. Improvements had been made to risk management processes and, overall, we found risks associated with people’s care and support were managed safely. The home was clean and hygienic.

There was a risk people may not be provided with enough to eat and drink. Food and fluid records had not been completed to demonstrate people had been offered adequate amounts of food and drink. Further work was needed to ensure people’s rights under the Mental Capacity A

We conducted an unannounced inspection at Connect House on 5 and 6 February 2018. Connect 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.

Connect House is situated in Basford, Nottingham and is operated by Medina Connect Limited. Connect House work closely with staff employed in CityCare partnership and Nottingham University Hospitals, to provide a service where people are enabled to access expert support from a range of specialist health professionals. It is a fast-paced service with multiple admissions and discharges each week. The service accommodates 56 people across two distinct units, Heritage Suite and Garden Suite.

Heritage Suite is comprised of 24 short-term beds providing a reablement service, to people who have recently been discharged from hospital, to help them regain their independence. A range of health professionals including physiotherapists, occupational therapists and nurses support this. There are also four long-term bedrooms in Heritage. During our inspection there were 25 people staying in Heritage Suite.

Garden Suite provides nursing care. 17 beds in Garden Suite are ‘Discharge to assess’ beds, which are for people who no longer require a hospital bed, but still require an enhanced level of healthcare. A further six beds in Garden Suite are dedicated to the care and rehabilitation of people who have experienced a stroke and the remaining five beds, are for people who require long term nursing care. Garden Suite is staffed by nurses and health care assistants who are supported by a range of visiting clinicians including GP's, consultants and specialist nurse practitioners. During our inspection there were 20 people staying in Garden Suite.

This was the first time we had inspected the service since its registration in September 2017.

There was no registered manager in place at the time of our inspection. The previous registered manager had left Connect House in September 2017. 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. There was a manager in post at the time of our inspection who had been in post for a period of approximately four months. They informed us they would be submitting an application to register with CQC. We will monitor this.

During this inspection, we found the service was not safe. People were not always protected from risks associated their care and support. Risks were not always identified and addressed in a timely manner and this placed people at risk of harm. Measures in place to reduce risks were not consistently used as intended. People did not always receive safe support to move and transfer with the use of mobility equipment and there was not enough equipment available to meet people’s needs.

There were not always enough staff employed to ensure people’s wellbeing and safety, and staff were not deployed effectively. Adequate steps had not been taken to ensure people were protected from staff that may not be fit and safe to support them. There were systems and processes in place to minimise the risk of abuse and incidents were investigated. The service was clean and hygienic.

People were not protected from the risk of poor food and fluid intake, as monitoring systems were not consistently effective. People’s dietary preferences were not always taken into account and mealtimes were not organised effectively. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the se