John Masefield House 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. John Masefield House is run by Leonard Cheshire Disability. The home provides support and nursing care for up to 22 physically disabled adults. The home has large communal living areas in the lounges, dining room and activities area. There are extensive gardens which are accessible to the people living in the home.

At our last inspection on 19, 20 and 22 September 2017 we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations (2014). These related to risks to people not being managed safely. People were not protected against the risk associated with choking and aspiration and pressure damage. Medicines were not always stored securely. People were not always supported in line with the principles of the Mental Capacity Act 2005 (MCA). People at a risk of malnutrition were not always supported appropriately. Staff did not always follow recommendations and guidance from healthcare professionals. Records relating to people’s care were not always up to date or accurate, The provider did not have effective systems in place to monitor the quality of service. As a result of our findings we took enforcement action and issued a warning notice.

We also found one breach of Regulation 18 of the Health and Social Care Act 2008 (Registration) Regulations (2014). The registered manager had not always notified CQC of reportable events. Services that provide health and social care to people are required to inform CQC of important events that happen in the service.

At this inspection we found the service had made significant improvements to address these concerns.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people's needs and followed guidance to keep them safe. People received their medicines as prescribed. Records confirmed where people needed support with their medicines, they were supported by staff that had been appropriately trained.

The manager and staff understood the MCA and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

Records relating to people’s care were accurate and complete. The service was embedding systems to assess the quality of the service provided. The manager and provider was able to identify how these new systems would support them in identifying and learning from the audits it would produce. This would promote people's safety and quality of life.

Staff spoke positively about the support they received from the manager. Staff had access to effective supervision. People told us and staffing rotas confirmed there were sufficient staff to meet people's needs. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with the staff who had a caring approach to their work. People’s views, opinions and feedback were sought prior to changes within the service.

People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

There was not a registered manager 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 told us they were safe.

This inspection took place on 19, 20 and 22 September 2017. It was an unannounced inspection.

John Masefield House is registered to provide accommodation for up to 22 people who require nursing care. At the time of the inspection there were 22 people with physical disabilities living at 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.

We last carried out an unannounced inspection of John Masefield House in March 2016. Following our inspection in March 2016 we published a report in which we rated the service as good service. However during this inspection we found evidence that the safety and oversight of the service had declined in that, risks associated with peoples care and wellbeing were not always managed safely.

People were not protected against the risk of choking, aspiration and pressure damage. People who were unable to access their call bells were not always supported effectively and in line with their care plans.

Staff gave a varied response when speaking about the registered manager . Relatives we spoke with told us there had been a noticeable deterioration in the positive atmosphere of the service. Peoples views and thoughts were not considered before changes were implemented within the service.

The provider did not have an effective system in place to monitor the quality of service. The registered manager had not always notified CQC of reportable events. Staff did not feel supported by the provider.

Medicines were not always stored securely. There was not an effective system in place to ensure that medicines were stored at in line with the manufacturer’s guidance. Equipment relating to peoples care and the day to day running of the service was not always maintained in line with manufacturer’s guidance.

Staff did not always follow recommendations and guidance made by healthcare professionals. People were not always supported effectively and in line with their support plans. Records relating to peoples care were not always up to date or accurate.

People's nutritional needs were met and they were given choices. However People at a risk of malnutrition were not always supported appropriately.

The service did not always support people in line with the principles of the Mental Capacity Act (2005). The service did not always follow the correct procedures when depriving people of their liberty.

There were sufficient staff to meet people's needs. Staff were not rushed in their duties and had time to chat with people.

Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. People had access to activities which included range of activities of their choosing. Staff clearly understood the likes and dislikes of the people they were caring for.

The overall rating for this service is 'Inadequate' and the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel their provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalate

This inspection took place on 31 March 2016. It was an unannounced inspection.

John Masefield House is registered to provide accommodation for up to 22 older people who require nursing care. At the time of the inspection there were 22 people with physical disabilities living at the service.

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.

People told us they were safe. People were supported by staff who could explain what constitutes abuse and what to do in the event of suspecting abuse. Staff had completed safeguarding training and understood their responsibilities. The service sought people’s views and opinions and acted upon them.

People received their medicines as prescribed. Staff administering medicines checked each person’s identity and explained what was happening before giving people their medicine. Relatives told us the service was responsive and well managed.

Where risks to people had been identified risk assessments were in place and action had been taken to reduce the risks. Staff were aware of people’s needs and followed guidance to keep them safe.

There were sufficient staff to meet people’s needs. Staff were not rushed in their duties and had time to chat with people. Throughout the inspection there was a calm atmosphere and staff responded promptly to people who needed support. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood the Mental Capacity Act (MCA) and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

People and received person centred care. People were cared for by a service that understood the importance of getting to know the people they supported. There was a clear focus on the importance of knowing people’s histories.

Relatives told us they were confident they would be listened to and action would be taken if they raised a concern. We saw complaints were dealt with in a compassionate and timely fashion.

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery.

The service had systems to assess the quality of the service provided. Learning from audits took place which promoted people’s safety and quality of life.

At our last inspection we found that care and treatment was not always planned and delivered in a way that ensured people’s safety and welfare. Care plans we looked at did not specifically detail the requirements of the care that staff needed to provide. Appropriate and adequate risk assessments were not always in place. We told the provider to take action, they submitted an action plan to us and told us the date by which the actions would be completed.

On the day of our inspection we met with the registered manager of the service, they told us about the actions that had been taken to improve. We spoke with four people who used the service. We spoke with six care staff, one senior care staff member and two nurses. We observed staff interacting with people during the course of the inspection. We looked at the care records of six people who used the service.

On the day of our visit there were 21 people using the service. We spoke with nine people who used the service and looked at five people’s care files. We spoke with the manager, seven care workers and reviewed four staff files. We also reviewed other documents made available to us by the manager. We considered the five questions we always ask: Is the service caring? Is the service safe? Is the service responsive? Is the service effective? Is the service well led? This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

People who used the service felt cared for, one person told us, “the staff are brilliant, they make the difficult times bearable”. People we spoke with also felt their dignity was respected. One person told us, “I feel very respected, when I need support they [care workers] go at my pace and always cover me up, they are lovely”. We also observed caring and compassionate interactions between people and care workers throughout the day.

We found that people were supported to engage in activities that were important to them and offered opportunities to keep up their hobbies, such as crafts as well as pursue their cultural interests. Care files we looked at were person centred and captured people’s personal preferences and wishes.

Is the service safe?

People who used the service felt safe and care workers understood the signs of abuse and where to report their concerns.

We found that people may be at risk of harm as care plans were not always supported by adequate and appropriate risk assessments and did not always provide specific details regarding peoples care needs.

At our last inspection in October 2013 we found that the provider was not meeting the standard for cleanliness and infection control. We were satisfied at this inspection that the standard is now being met and that effective systems were in place to reduce the risk and spread of infection, and that the provider planned to further develop and embed these.

Is the service responsive?

People who used the service, their representatives and care staff were asked for their views about their care and treatment and they were acted on. Meetings for people who use the service were held to ensure that issues were raised and responded to.

The provider took account of complaints and comments to improve the service. We saw the complaints policy and reviewed a recent complaint around the cleanliness of the service and the care a person received. We saw that this was responding to on the same day and the complainant was invited in for a meeting.

Is the service effective?

People who used the service felt their care and treatment provided them with a good quality of life. One person told us, “of course I would rather be at home, but this is the next best thing. I am encouraged to do things I enjoy and feel more confident to move around by myself”.

People’s needs had been assessed before they moved into the home. Care files confirmed people’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. When people raised concerns the service responded by making changes where necessary.

Is the service well led?

People we spoke with felt the manager was interested in maintaining high standards. One person told us, “[the manager] is very good; [the manager] is interested in what we want and communicates [their] plans very well”. Care workers felt supported and they were offered development opportunities. One care worker told us, “I get the support I need and I have been given some great chances to develop my skills”.

The manager was new in post and had identified areas of improvement. A new care staff structure had been introduced to ensure all care staff got the support they needed, but also to ensure quality assurance and governance systems were in place. Team leaders and Care supervisors were newly appointed to ensure improvement across the service. We saw from team meetings that plans were being communicated and that an open and fair culture was being promoted.

During our visit to John Masefield we met with the registered manager. We spoke with four people living at the home, with a relative and with four members care workers.

Consent was sought from people before care or treatment was delivered. One person said "they [the staff] always ask before doing any care".

People were happy with the care they received. A person told us "they really do a good job and are kind. They [staff] are good about privacy and dignity".

Some guidance on reducing the risk and spread of infection was not being followed. A risk assessment for legionnaire’s disease had not been carried out and water temperatures were not always recorded properly.

Appropriate checks had been carried out before staff and volunteers were allowed to start work.

People’s views were sought and acted upon. Some people had commented that food at the home was bland. They were going to visit another home with a good reputation for food quality to get ideas for improvement.

On the day of inspection we met with the deputy manager and briefly with the manager. The deputy manager told us the home had been affected by staff shortages in the last eight months due to ill health and staff leaving. One of the staff with key responsibility for health and safety had been on leave and another training coordinator had left the organisation. The deputy told us about her cover for the managers leave. She explained how their responsibilities had been reprioritised so people living in the home received a consistent level of care. The home covered the absences with existing staff or regular bank staff.

People were well cared for and were involved in decisions about their care. People we spoke with told us how staff respected their privacy and others told us how much they enjoyed the activities and the day trips the home organised.

We saw staff were well trained and supported in their roles. The deputy manager told us about the appraisal and supervision processes. Staff told us that they had supervision, appraisals and training appropriate to their role.

People were protected from the risk of abuse. Staff had received safeguarding training and knew how to recognise and report suspected abuse.

The provider and manager had a system in place for monitoring the quality of service, which was not always effectively implemented. People we spoke with told us they had not regularly been asked for their feedback.