About the service: Harry Sotnick House is a 'care home with nursing'. People in care homes receive accommodation and 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. Harry Sotnick House can accommodate up to 92 people living with dementia and physical frailty. There were 38 people at the home when we inspected.

People’s experience of using this service:

• In April 2018 a new provider took over the running of Harry Sotnick House.

• Improvements had taken place at the service and the managers were creating a culture to support the delivery of high-quality, person-centred care. Multiple governance systems had been introduced and had led to positive outcomes for people. However, further time was needed to fully embed some of the processes in order to ensure records reflected clear assessment of risk and lessons learned following incidents.

• Medicines were managed safely and people were supported by effective staff who understood their responsibility to keep people safe.

• People’s involvement in activities had greatly improved and they were provided with opportunities to access the community by staff who were keen to do this.

• People were mostly treated with kindness and respect by staff who understood the importance of supporting people to make their own decisions and of the importance of maintaining privacy and dignity.

• There were enough staff to meet people’s needs and the provider was actively working to recruit registered nurses.

• People were supported by staff who felt valued and listened to and who felt the training opportunities for them were good.

• The management team were open and transparent. They understood the regulatory responsibility and were working hard to provide an effective service to people. No one had any complaints and felt the management team were open, approachable and supportive. Everyone was confident the provider would take the necessary actions to address any concerns promptly. Feedback about the management team demonstrated they listened and took any feedback as an opportunity to make improvements for people.

Rating at last inspection: A focused inspection carried out in August 2018, following concerns, rated this service as Requires Improvement. (Report published September 2018).

Why we inspected: This was the first comprehensive inspection of this service since the change in provider in April 2018 and was to ensure the provider was meeting the requirements of the legislation.

Follow up: There is no required follow up to this inspection. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

This inspection took place on 6 and 7 August 2018 and was unannounced.

This was the first inspection of the service following a change of provider in April 2018.

We undertook a focused inspection following receipt of concerning information. The team inspected the service against two of the five questions we ask about services: is the service safe and well led. This is because the service was not meeting some legal requirements under the Health and Social Act 2008 (Regulated Activities) 2014. This report only covers our findings in relation to these key questions.

Harry Sotnick House is a ‘care home with nursing’. People in care homes receive accommodation and 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 Sotnick House can accommodate up to 92 people living with dementia and physical frailty. There were 45 people at the home when we inspected.

There was 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.

People told us they felt safe living at the home. Staff understood their responsibilities to protect people from abuse and referrals had been made to the local authority when incidents or allegations occurred.

Where concerns had been raised and errors found, improvements had been made in the management of people’s medicines. Actions had been taken to address medicine errors made by agency nursing staff, however the lack of permanent nursing staff and continued reliance on agency staff had led to issues with medicines. Supervisions and daily audits had been implemented to improve the management of people’s medicines in the home.

Some risk assessments and management plans to minimise the risk of people falling were not always completed or sufficiently detailed. However, actions identified in risk management plans were followed by staff.

Permanent and experienced staff were knowledgeable about the risks associated with people’s care. However, the information available to new and unfamiliar staff such as handover notes and care plans were not sufficiently detailed or consistent to guide staff on how to support people safely.

Staff assessed, managed and reduced risks to people’s safety at the service and in the community. There were sufficient staff on duty to meet people’s needs.

People were safeguarded from avoidable harm. Staff adhered to safeguarding adult’s procedures and reported any concerns to their manager and the local authority.

Staff protected people from the risk of infection and followed procedures to prevent and control the spread of infections.

Equipment used to support people’s needs, such as hoists and bed rails was checked and maintained to ensure they were safe for people. The premises were safely managed by maintenance staff. Protective equipment was in place such as fire safety equipment and the arrangements for the safe evacuation of people in an emergency was robust.

Sufficient staff were available to meet people’s needs. The provider told us there had been changes to the number of permanent staff on duty and the more effective shift management and allocation of staff. However, people and their relatives told us they did not think there were always enough staff available.

The provider told us about the recent staffing changes they had made and were confident these would achieve improvements for people. These included recruitments to all vacant care posts and improved allocation of staff on duty, daily call bell audits to investigate and address poor response times. Further time was required to embed these changes into practice and ensure sufficient staff were available to