We inspected Finney house on the 13,14 and 15 June 2018. The inspection was unannounced in that the home did not know we were coming to inspect on the first day of the inspection. We returned to the home on the 19 June to provide feedback to the management team and representatives of the company operating the home.

Finney House is a purpose-built care home in the centre of Preston. 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.

The home is registered to support up to 64 people. Due to a restriction on admissions given at the last inspection the home was supporting 25 people. Finney House provides support to people over three floors, with each floor supporting people with different needs. The ground floor focuses on supporting people with residential needs, the middle floor focuses on supporting people with nursing needs and the upper floor supports people living with dementia including some people who also have nursing needs.

At the time of the inspection the top floor still required some work to meet the needs of people living with dementia in order to provide the specialist support to the people living on that floor. CQC has received a notification from the registered provider of a variation to their Statement of Purpose, to include dementia. The provider has given the CQC assurances the top floor will be better adapted to support people living with dementia moving forward which will support this.

Finney House is required to have a registered manager and a registered manager was 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.

At the last inspection in late August and early September 2017 we rated the home inadequate overall and inadequate for all key questions except caring which was found to require improvement. We found 11 breaches to seven of the regulations including registration regulations for the submission of notifications. At this inspection we found the home had a secure and permanent staff team and steps had been taken by staff at the home and the senior leadership to address the concerns from the previous inspection.

Since the last inspection the provider has worked with the Local Authority Quality Improvement Panel. Action plans had been developed by the provider from the findings of the last inspection and Local Authority and Clinical Commissioning Group commissioning contract reviews to drive improvements. The home has reported monthly to this group and met intermittently to update the team on the improvements against the action plan.

At the last inspection we found assessments were not completed when people needed support in certain areas. We also found that when assessments had been completed they were not always implemented.

Since the last inspection new assessments had been developed, including capacity assessments in different formats and choking assessments. However, we found that these had led to inconsistencies across some care plans. When we reviewed the support provided to people, we found records did not include all the information required to for staff to meet people’s needs. Other assessments we looked at were not consistently updated which led to care plans not being informed by the latest and correct information. We have found an ongoing breach in this area.

At the last inspection we raised concerns around the environment on the top floor where people were living with dementia. We recommended the home complete the ‘enhancing a healing environment’ audit developed by the Kings Fund. A

We inspected this service on the 30, 31 August and 1 September 2017. We returned on the 6 September to provide feedback on the inspection findings. The first day of the inspection was unannounced which meant the provider was not expecting us on the date of the inspection.

Finney House is a purpose built care home in the centre of Preston. The home is registered to support up to 64 people with nursing and residential care needs. At the time of the inspection there were 44 people living in the home.

The home is laid out over three floors. The ground floor area supports those with residential needs the middle floor supports people with nursing needs and the top was beginning to support people with nursing needs who were also living with dementia.

Each floor was designed with an open plan lounge and dining area. Long wide corridors were furnished with additional seating and desked areas. These were repositioned during the inspection to provide sight down each corridor making it both easier for staff to view the whole floor but also for people resting in the chairs to have view of more of the home.

The kitchen and laundry facilities were located on the first floor of the home and each floor was accessible by lifts and stairwells.

This was the first inspection of the service since its registration with the commission in October 2016.

At the time of the inspection the home was in the process of registering a new manager to the service. 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.

At this inspection we found the home to be in breach of seven of the Health and Social Care Act (Regulated Activities) Regulations 2014. The home was also found to be in breach of two of the Health and Social Care Act (Registration) regulations 2009. We have also made 13 recommendations based on the findings of the inspection.

We found the high turnover of staff had led to inconsistencies in how the staff delivered the service. Different managers in the home had different styles and priorities and the homes policies and procedures were not embedded. This also had an impact on the quality of the audits undertaken, as the expected standard was not always clear.

The home supported some very poorly people and a high number of people at the end of their life. Staff employed at the service did not have sufficient skills and knowledge to best support these people. Staff were kind and relatives spoke highly of them, but plans of care to support people at the end of their life were often developed too late.

The complexities of those who lived at the home were not supported by enough qualified nursing hours through the night. It was difficult to gauge the days as the senior leadership team were on site both days of the inspection and were supporting staff in the home. They were not on the rota so the hours they provided could not be guaranteed moving forward.

We found the home did not always make referrals to the safeguarding team when people were found to have unidentified injuries including bruises. We also found these injuries were not mapped appropriately through to healing and recovery. We also found that when particular people were seen to have regular bruising, assessments had not been made to identify potential risks and steps were not taken to mitigate them.

There were many people in the home living with varying degrees of dementia. Some applications had been made to the Deprivation of Liberty Safeguarding [DoLS] team to protect these people from unlawful restrictions, but this was not always the case. We saw capacity assessments which should be made prior to the application had not always been made and best interest decisions had not always considered the