We carried out an unannounced inspection on 21 March 2018.

Crowley Care Homes Ltd - St Anne's 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.

Crowley Care Homes Ltd - St Anne's care home accommodates up to 19 people in one adapted building. The home supports people who require nursing and personal care; some of whom may be living with dementia.

This is the third time we have inspected this provider. We previously inspected the home in February 2016 and rated it as 'Requires improvement'. We identified two breaches under the Health and Social Care Act and issued the provider with a fixed penalty notice because they had failed to notify us of the deaths of people using the service. This is an expected requirement for all providers. Following this inspection, we carried out a further inspection in May 2017 and rated the provider as ‘Requires improvement for the second time. In this inspection we identified a further five breaches under the Health and Social Care Act and issued a further two fixed penalty notices because the provider had failed to display their rating within the home and on the provider’s website as they are legally required to do. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions for safe, responsive and well-led to at least a rating of good.

At this inspection we found that the service had made some improvements and five breaches identified in the last two inspections had been addressed. We did however find a continued breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 because there was a continued lack of provider oversight of the service which meant that the service was unable to maintain care standards. This was because there was a lack of accountability when audits were undertaken which meant that the registered manager did not identify when the standards in the home were in breach of regulations and the provider had not identified this failing.

We also found that the cleanliness of the home did not meet with the expected standards and there was therefore a new breach identified under Regulation 15: Premises and equipment.

The service had 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. The registered manager did not have a robust auditing process which could ensure that processes were being followed by staff and that the service provided was fit for purpose.

Cleanliness and infection control procedures were not always followed which meant that people were left at risk of acquired infection.

Staffing levels were sufficient to provide the level of care required to keep people safe from avoidable harm. There was also a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people using the service. Staff demonstrated a good understanding of their roles and responsibilities and regular checks were undertaken to help ensure on-going competency of care staff.

The provider and staff followed the local authority policy and guidance when dealing with safeguarding people from harm and demonstrated a good understanding of safeguarding issues. 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.

Confidentiality was respected and independence was promoted. People were support

This inspection visit took place on 24 May 2017. The visit was unannounced.

The service provides accommodation and care for up to 20 people. At the time of our inspection there were 19 people living at the home.

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.

Medicines were not always managed safely and guidance to staff on the administration of ‘as required’ (PRN) medicine was not always in place.

There were not always enough skilled and qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded, although the causes of these had not been analysed to allow the provider to identify preventative actions which could be taken to reduce the number of occurrences.

Staff received training to ensure that they had the necessary skills to care for the people who lived at the home, and were supported by way of supervisions and appraisals.

People’s needs had been assessed when they moved into the home and they and their relatives had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People were happy and felt safe living at the home but said that they did not always have enough support with activities to keep themselves occupied during the day. They had a choice of food and drink with snacks and fruit available throughout the day.

Staff were caring and friendly. They knew the people they cared for well. They protected people’s dignity, treated them with respect and encouraged them to maintain their independence. Staff understood the need for confidentiality.

Information was available to people about how they could make a complaint. People were assisted to access healthcare services to maintain their health and well-being. Staff worked with healthcare professionals and people’s relatives to ensure that the care provided to people best met their needs.

The provider had not submitted notifications to the Care Quality Commission (CQC) as required by law. Neither had they displayed the rating of ‘requires improvement’ given at the last inspection carried out by CQC. The manager completed regular audits of the service to check on quality but there was a lack of evidence of Provider oversight. People were asked for their views but the information provided was not consistently used to make improvements to the service.

We found that the provider was not meeting some legal regulations. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on the 24 January 2016 and was unannounced. During our last inspection in December 2013 the service was found to be compliant with our standards.

Crowley Care Homes Ltd- St Annes Care Home is a residential service providing care and support to older people in central Luton. They provide long-term care and short-term respite care to up to 20 people. At the time of our inspection there were 18 people using the service.

The service had a manager who was not registered by the Care Quality Commission (CQC) yet, although our records confirmed that their application had been received. 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 & Social Care Act and associated regulations about how the service is run.

People were kept safe from risk of harm and supported by staff who understood their needs and maintained their health and well-being. They had enough to eat and drink and were provided with a varied and balanced diet which took into account their individual preferences and choices. The service worked closely with healthcare professionals to ensure that people’s healthcare needs were assessed and met. People were provided opportunities to provide feedback on their care and were supported to maintain relationships with friends and family. The service provided some activities to people, but there was no activity co-ordinator in post at the time of our inspection and people were not always stimulated with a full programme of activities throughout the day.

Staff received training which was relevant to their role and enabled them to provide person-centred and effective care. People were cared for by staff who were knowledgeable, caring and compassionate. There were enough staff on duty to keep people safe and people were positive about the consistency of support they received and the attitude of those who supported them. Staff were provided with supervisions and performance reviews, and attended regular team meetings to enable them to contribute to the planning and development of the service. Staff understood the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLs) and how they applied to the people using the service.

People, their relatives and staff were complimentary about the management of the service. There was a robust quality assurance system in place which identified any improvements needed in the service and took action to resolve them. Medicines were administered safely, and risk assessments were detailed and supported staff to keep people safe from any risk of harm.

Details of people’s support needs, likes and dislikes and social histories were included in their care plans, and daily notes showed that people’s daily routines and tasks were carried out efficiently. However, care plans did not always contain consistent and relevant information, and the review process did not always lead to appropriate changes being made. The provider had not submitted notifications when there had been a death in the service.

During our inspection we found that the provider was in breach of two regulations of the Health and Social Act (2008). You can see what action we’ve asked the provider to take at the end of the report.

During our inspection of St Annes Care Home, we used a number of different methods to help us understand the experiences of people using the service. This was because some of the people using the service had complex needs, which meant they were not able to talk with us about their experiences. In addition we spoke with three of the 16 people using the service and a relative of a person using the service. People told us they were happy with the care and support they received from staff.

We saw that each person received an assessment of their care needs, including any risks associated with their care provision. Records showed that people and their families had been involved in the development of their care plans.

People's nutritional requirements were assessed and managed in line with their needs, and these were reviewed on a regular basis. We found that people living in the home received their prescribed medication when they needed it and in a way that suited them.

We found the premises to be maintained to ensure the home remained safe for people using the service, staff and visitors. However some areas of the home required redecoration. We were told and we saw that this had already commenced.

There was an effective complaints system in place and comments and complaints people made were responded to appropriately.

The people who were living at St Anne’s care home when we visited on 25 May 2012, had varied levels of verbal communication, however they were all able to demonstrate through speech, facial expressions and gestures that they were satisfied with the care and support they received. One person said ‘’It is very nice here’’.

Friends, relatives and visiting professionals told us that staff at St Anne’s were ‘‘excellent, nothing is too much trouble’’ and that they ‘’always do their best for people’’.