The inspection took place on 24 and 31 October 2018 and was unannounced.

We last inspected the service in February 2018 and found the provider had breached two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These related to the provider not ensuring the principles of the Mental Capacity Act were being followed, and systems and processes used to assess, monitor and improve the safety of the services provided had not identified the concerns we found. We asked the provider to complete an action plan to show what they would do to improve the service.

Dipton Manor 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.

Dipton Manor can accommodate up to 70 people over four separate units. The Derwent and Lintsford units provide support for people requiring residential care. The Bradley unit provides support for people living with dementia and the Pontop unit provides support for people requiring nursing care. At the time of our inspection 58 people were using the service, including 16 who were receiving nursing care. The home was set in its own grounds with an enclosed garden.

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.

The provider had a plan in place to ensure risk assessments and care plans were more personalised which was in the process of being implemented. We found some care records had been re-written to be more personalised. However, some still did contain task orientated information and on occasions did not contain appropriate information. We spoke with staff and found they were supporting people in a personalised manner.

We found some shortfalls in terms of record keeping. Records to provide information for staff in administrating topical medicines and ‘as required’ medicines were not in place for some people. Some food and fluid charts were not always completed and reviewed.

The provider’s quality assurance system had not identified the shortfalls we found in record keeping. This was a breach of Regulation 17 (Good governance) 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.

We found the provider has strengthened Mental Capacity Act 2005 (MCA) and Deprivation of Liberty safeguards (DoLS) training for staff. We found staff had a clearer understanding of the principles of the Act. MCA assessments and best interest records were in place for some people. The registered manager advised all MCA assessments and best interest records were in place before the end of the inspection process.

Recruitment processes were in place with all necessary checks completed before staff commenced employment. Staff received an induction on commencement of their employment. The provider used a dependency tool to ensure staff levels met the needs of the people living in Dipton Manor.

Staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service. Accidents and incidents were recorded and monitored as part of the provider’s audit process.

Health and safety checks had been completed such as gas and electrical safety checks. Equipment used to support people had been checked and/or serviced.

Systems and processes were in place to ensure medicines were available for people. Medicines were m

This inspection took place on 14 and 22 March 2018. The inspection was unannounced. This meant the provider and staff did not know we were coming.

Dipton Manor 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. Dipton Manor can accommodate up to 70 people. At the time of our inspection 63 people were using the service, 14 who were receiving nursing care. Some people residing in the home were living with dementia. The home was set in its own grounds with an enclosed garden.

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.

We visited the home in November and December 2015 and rated the service as ‘Good’. At this inspection we found the service had deteriorated to Requires Improvement.

At this inspection we found that there was a breach of two of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the lack of awareness of the principles of Mental Capacity Act 2005. We found the quality assurance systems failed to identify the concerns found at the inspection.

You can see what action we have taken at the end of this report.

People who were being deprived of their liberty did not always have decision specific best interests meetings recorded in their care records. Staff did not have a clear understanding of how to apply the Mental Capacity Act 2005.

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 service did not support this practice.

Risk assessments were in place for people; however, these were not always reviewed on a regular basis. Some people’s risk assessments were not detailed in order to give guidance for staff on how to mitigate against risk.

Staff supervision and appraisals were not up to date as stipulated in the provider’s policy and procedures.

Staff had not received training in specific topics to meet the needs of the people living at Dipton Manor.

The premises were not suited to people living with dementia, there was a lack of signage for people to be able to orientate around the building.

We made a recommendation about providing a more dementia friendly environment.

The provider did not have a robust quality assurance process in place. Audits and reports lacked detail with no clear direction on how to improve the quality of the service.

People and relatives felt the service was safe. Policies and procedures were in place to keep people safe such as safeguarding, accident and incident policies. Staff had received training in safeguarding and knew how to report concerns.

Staff recruitment procedures were robust and included Disclosure and Barring Service checks and references.

Appropriate arrangements were in place for the safe management and administration of medicines.

People were treated with respect and the staff understood how to provide care in a dignified manner and respected people’s right to privacy. Staff supported and helped to maintain people’s independence. People were encouraged to care for themselves where possible.

The provider did not use a dependency tool to determine levels of staff. This meant we could not be sure that the provider’s system of determining staff levels was robust in order to support people if there was a change in people’s care and support needs. Staff gave mixed views on the staffing levels in the home.

We made a recommendation about the providers approa

The arrangements for supporting people to make decisions about their daily lives and preferences were recorded in their care plans. Each person was supported to take appropriate risks to promote as much independence as possible.

Suitable arrangements were in place for people to take part in activities in line with their needs and preferences.

The relationships between staff and the people who lived there were good and support was provided in a way that promoted and protected their privacy and dignity.

Staff told us they were supported by the provider including training on the principles of care, safe working practices, and around the particular and complex needs of the people who used the service.

The provider had a robust recruitment and selection system in place.

Records were easily accessible, secure and fit for purpose and remained confidential.

The inspection took place on 30 November and 3 December 2015 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We previously inspected Dipton Manor Care Home on 16 September 2013, at which time the service was compliant with all regulatory standards.

Dipton Manor Care Home is a residential home in Dipton providing accommodation and nursing care for up to 71 older people who require nursing and personal care. There were 68 people using the service at the time of our inspection.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service and call bells were answered promptly.

We saw that individual risks were managed through risk assessments and associated care plans in each person’s care file. These risks were reviewed each month. We observed behaviours that could be perceived as challenging supported sensitively.

We found the service had systems in place for ordering, receiving, storing and disposing of medicines. We looked at how the service managed controlled medicines and found that safe storage, administration and recording was maintained.

Safeguarding information such as types of abuse to be mindful of and contact telephone numbers were prominently on display and staff displayed a good knowledge of safeguarding issues.

There were effective pre-employment checks of staff in place and we saw the disciplinary policy was adhered to when a potential safeguarding concern was raised recently.

The service was clean throughout, with a range of infection control measures in place and working effectively.

Staff completed training to meet people’s individual needs in areas such as: catheter care, dementia awareness and PEG feeding (PEG feeding is a way to care for someone who can’t have foods orally). This was in addition to training the provider considered mandatory, such as safeguarding, health and safety, moving and handling, dignity and respect, food hygiene and infection control. When we questioned staff about the practicalities of a range of these areas, they were able to give detailed and informed answers.

Staff also had a good knowledge of people’s likes, dislikes and life histories.

Staff were well supported through formal supervision and appraisal processes as well as ad hoc support when required.

Meals were varied, prepared by kitchen staff passionate about their work and people told us they enjoyed the food. People had choices at each meal as well as being offered alternatives if they did not want the planned meal options. We saw the service had successfully implemented a tool to manage the risk of malnutrition and people requiring specialised diets were supported.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. We found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

We observed a range of dignified and thoughtful interactions during our inspection, with people who used the service and staff sharing jokes; the atmosphere was welcoming and homely. Relatives and external stakeholders unanimously agreed that the service was caring and we saw people’s rights were respected and upheld.

Person-centred care plans were in place and daily notes were comprehensive. Regular reviews ensured relatives and healthcare professionals were involved in ensuring people’s medical, personal, social and nutritional needs were met.

The service had four activity co-ordinators who facilitated a range of group and individual activities. We saw some of these activities during our inspection and evidence that activities were planned on the basis of suggestions made at resident and relative meetings, as well as the ongoing programme of optional group activities.

People’s religious beliefs were respected and encouraged through liaison with the local church and a flexible approach to person-centred care provision.

Staff confirmed they were well supported to pursue their own career progression. All people using the service we spoke with, relatives, staff and external professionals were complimentary about the approachability of the registered manager. Strong community links had been made to ensure the service was part of the community and that people who used the service were able to remain part of their community.