The inspection took place on 9 October 2018 and was unannounced.

The inspection was brought forward as we had been made aware of safeguarding issues communicated to us directly and received from the local safeguarding authority. Our inspection does not examine specific incidents and safeguarding allegations. However, we used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection.

At our last comprehensive inspection on 5 and 6 October 2017 the overall rating of the service was, 'Requires Improvement'. This summary rating was the result of us rating the key question's 'safe', 'effective', 'caring', 'responsive' and well-led as, 'Requires Improvement'. At our last inspection we found breaches of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that care and treatment was provided safely. Staff were not always deployed to meet people's care and support needs. Staff did not receive supervision and appraisal necessary to enable them to carry out their duties. Consent to treatment was not always obtained from people. Where people were unable to give consent because they lacked capacity, staff did not act in accordance with the Mental Capacity 2005 Act. People were not involved in the assessment of their needs and preferences. Care and treatment was not designed to make sure it met peoples’ needs. Systems were not effective in monitoring and managing risks. Records relating to the care and treatment of people were not kept securely.

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 to at least good. At this inspection we found significant improvements had been made and maintained, resulting in the overall rating of the service changed to, 'Good'.

At this inspection we have rated the key question 'well led' as 'Requires Improvement'. We found although there were significant improvements in the care planning, further work was still needed to ensure they were accurate and fully completed. We also found that the new systems introduced since the last inspection required more time to be embedded and sustained. Although necessary provision had been made to ensure that medicines were managed safely, we found due to the technology being used, medication was delayed. The provider had identified this themselves through their quality monitoring processes. This had impacted how relatives felt their loved one’s needs were being met. We have recommended the registered provider ensures care records and information relating to people's care is contemporaneous.

Fulford Care and Nursing Home is registered to provide nursing care and residential care for up to 74 people with a range of care needs, including frailty of old age, specific health conditions and people living in the early stages of dementia. At the time of our inspection, 67 people were accommodated at the home. Fulford Care and Nursing Home is divided into five areas, over three floors. The five areas are called Magnus and Harold, on the ground floor. First floor: Godwin and Edmund. Second floor: William. The floors are accessible by a lift and stairway.

Fulford Care and Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Since the last inspection, the registered manager had left employment and another registered manager was in post. A registered manager is a person who has registered with the 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 Soci

The inspection took place on 5 and 6 October 2017 and was unannounced.

This inspection was the first inspection since a change of provider in December 2016. The inspection was planned because we had been made aware of a number of safeguarding issues communicated to us directly and received from the local safeguarding authority. Our inspection does not examine specific incidents and safeguarding allegations. However, we used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection.

Fulford Care and Nursing Home is registered to provide nursing care and residential care for up to 74 people with a range of care needs, including frailty of old age, specific health conditions and people living in the early stages of dementia. At the time of our inspection, 50 people were accommodated at the home. Fulford Care and Nursing Home is divided into four units, Magnus, Harold, Edmund and Godwine. Communal facilities include the main lounge on the ground floor and a smaller lounge on the first floor. There is a large dining room located in a converted barn and a ground floor conservatory. All rooms have profiling beds and are en-suite. People have access to gardens surrounding the home.

A registered manager was in post. 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’s risks were not identified, assessed or managed safely. Risk assessments provided incomplete information about people’s risks and insufficient information and guidance for staff on how to mitigate risks. Daily records in relation to completion of fluid intake or repositioning charts for people, had not always been completed fully. Personal emergency evacuation plans were not in place for everyone living at the home. Some aspects of medicines management were unsafe. The medicines trolley was left unlocked and/or unattended when medicines were administered to people. Medicine profiles for people were out of date, although staff were in the process of taking new photos of people.

Staff were not deployed in such a way as to ensure people’s needs were met promptly. Many people were still in bed or sat in their rooms in their nightwear at 11am awaiting personal care. A medicines round which had begun at 8.30am was not completed until 11.15am. There was mixed feedback about the staffing levels, with some relatives and staff expressing concern about the high usage of agency staff.

Staff had not received regular supervision meetings or appraisals of their work. Competency assessments for nursing staff had been completed in some cases, but information was scant and did not cover all clinical competencies. Staff completed a survey in July 2017 which indicated they were unhappy with the level of support they received at that time.

Assessments of people’s capacity, in line with the legal requirements of the Mental Capacity Act 2005 (MCA), had not always been completed. Some people had been deemed to lack capacity, but had no capacity assessments in place to corroborate this. People’s consent to care and treatment had not been formally recorded, nor was it clear how people’s particular communication needs had been assessed or were met.

There was no evidence to confirm that people and/or their relatives were involved in planning and reviewing their care. Care plans did not always provide detailed information about people’s care needs or have social histories that staff could access. Staff and management acknowledged that care plans did not always contain updated information about people or that they were reviewed regularly. Care staff told us that they