This inspection took place on the 12 October 2017 and was unannounced.

During our last inspection on 25 October 2016 we found the provider to be in breach with regulation 17 of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This breach was in relation to keeping accurate and contemporaneous records and good governance.

We rated the service during our inspection on 25 October 2016 overall requires improvement.

During this inspection we found that the provider had taken appropriate actions to address this breach. For example we found that records were of good standard and provided detailed information in relation to the care provided to people who used the service. We saw that the provider had improved their quality assurance monitoring systems, which was found to be effective in addressing shortfalls and improving the quality for care for people who used the service.

Karuna 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. Karuna Manor is registered to provide accommodation for up to 60 people who require nursing or personal care. Some of the people using the service may be living with dementia. During the day of our inspection 47 people were using the service. People receiving care at Karuna Manor were mostly from an Asian background.

Care and support are provided over three floors. On the ground floor were people who required residential care, on the first floor lived people who required nursing care and on the second floor lived people who had dementia care needs. The home had its own cinema, shop, beauty salon and massage and complementary therapy room in the basement. People had access to these facilities, however therapy sessions and hairdressing were not included in the overall fees and people were required to contribute additionally to them if they wished to receive these services.

Since July 2017 a new manager had been registered with the Care Quality Commission (CQC). 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 found some very good features at Karuna Manor. People lived in a purpose built environment which aimed to maximise people’s comfort, cultural background, and choice as well as people’s health and social care needs. People had access to culturally appropriate TV channels. The building was dementia friendly. The whole home had full internet access and the building was tailored around people’s independence, but without compromising their safety and security. For example, the home had CCTV in all communal areas and door alarms when people accessed the balconies Activities offered were flexible and responsive to people’s needs and the home found creative ways to engage people in activities. Consideration was given to people’s cultural, religious and medical needs when offering and providing activities.

All the people we spoke with told us they felt safe. Relatives and staff said they felt people were kept safe and cared for. We saw that the provider had processes and systems in place to keep people safe and protected from the risk of harm. Staff knew how to report any allegations of abuse and showed confidence in the senior leadership that it would be dealt with. People’s needs were individually assessed. We saw from care records that there were measures to reduce identified risks. We found there were enough staff deployed to meet peoples identified needs because the provider ensured that staffing levels were based on people’s dependency levels. People that required support with the

We undertook an unannounced inspection on 25 October 2016 of Karuna Manor. Karuna Manor is a care home registered to provide accommodation for people who require nursing or personal care. They are registered to provide care for a maximum of 60 people who may be living with dementia. There were 29 people using the service at the time of our inspection.

There was no registered manager in post. 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. The registered manager had resigned since the last inspection and an interim manager was managing the home until a permanent manager was appointed.

At our previous inspection of 19 May 2016, we found the provider failed to maintain an accurate, complete and contemporaneous record in respect of the care and treatment provided to people using the service, people were not adequately protected from the risks of unsafe medicines, and management and quality assurance systems and processes in place were not robust enough to assess, monitor and improve the quality and safety of the services being provided to people.

This meant the provider was in breach of two regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection the provider sent us an action plan setting out the actions they would take to meet the regulation. During this inspection we found action had been taken to meet one of the regulations. Records showed appropriate arrangements were in place in relation to the management and administration of medicines. However we still found issues with record keeping and audit processes were not robust enough to facilitate improvement in the quality of care being provided.

People’s care plans were person-centred, specific to people’s needs and detailed the support people needed in various areas of their care. However, some areas were poorly written so very difficult to read. Staff were not completing daily monitoring charts accurately and these were not being checked and countersigned by a nurse or senior member of staff to ensure the needs of people were being met.

Some audits were conducted. However, they were limited to checks being undertaken. There was no effective evaluation of the quality of service being provided to people and action plans in place to enable improvement.

There was a lack of leadership in the home and poor communication with people and relatives. Unit managers for each floor were being appointed to address this.

Since the last inspection the registered manager had resigned and a number of care workers had also left. During this inspection we found the provider had taken action to reduce the use of agency staff by employing more permanent staff to ensure consistency in people’s care.

People and relatives of people using the service told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People's care needs and potential risks to them were assessed. Risk assessments had been carried out and staff were aware of potential risks to people.

Staff were caring and knowledgeable regarding the individual choices and preferences of people. Records showed that staff had received training to enable then to carry out their roles.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Depr

This inspection took place on 19 May 2016 and was unannounced. Karuna Manor is a care home registered to provide accommodation for people who require nursing or personal care. They are registered to provide care for a maximum of 60 people who may be living with dementia. There were 21 people using the service at the time of our inspection. This was the first inspection for Karuna Manor since their registration in March 2015.

There was a registered manager in post at the time of our inspection. 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.

On the day of the inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff.

Relatives of people who used the service and care professionals we spoke with told us that they were confident that people were safe in the home.

People were not adequately protected from the risks of unsafe medicines management. Medicines records were not kept up to date so we could not be certain that people were adequately protected from the risks of unsafe medicines management. We found a breach of Regulations in respect of this.

On the day of the inspection staff were not rushed and were able to complete their tasks. However, feedback from people, relatives and staff indicated that at times, there were not enough staff in the home to care and support people safely. This could risk people receiving inconsistent and inappropriate care.

Systems and processes were in place to help protect people from the risk of harm and staff demonstrated that they were aware of these. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

People's care needs and potential risks to them were assessed. However there was limited information about the moving and handling needs of people using the service and the safety of bed rails in the home. We discussed this with he registered manager who told us he would ensure all the bed rails were checked and appropriate training would be provided to staff. He also told us risk moving and handling risk assessments for people would be reviewed.

Staff prepared appropriate care plans to ensure that people received safe and appropriate care. Their healthcare needs were closely monitored and attended to. Staff were caring and knowledgeable regarding the individual choices and preferences of people.

There were records of essential inspections and maintenance carried out at the home. The service had an infection control policy and measures were in place for infection control.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes.

People told us that they received care, support and treatment when they required it. Care plans were reviewed monthly by staff and were updated when people's needs changed. However, there were some gaps and inconsistency in the monitoring of people’s care on a daily basis.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary