This inspection took place on 19 and 20 July 2018 and was unannounced.

Littlebourne House is a ‘care home’. 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 care provided, and both were looked at during this inspection. Littlebourne House accommodates up to 64 people across two separate units, each of which have separate adapted facilities. People living at the service may be living with dementia and were able to spend time in either the main house or the King William unit. There were 60 people living at the service at the time of the inspection.

There was no registered manager in post. The previous registered manager had left in May 2018. There was a management team in place including a manager who was going to apply to be registered. 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.

The registered manager and other senior care staff had left the service in May 2018. The provider had not put a plan in place to check that their roles and responsibilities were being completed by other staff. This included the management of medicines, completing care plans and assessing potential risks for new people who moved into the service. There were no care plans, risk assessments and guidance for staff for people who had moved into the service since May 2018. This put people at risk of not receiving consistently safe, effective and person centred care.

People’s needs had not been consistently assessed before they moved into the service. When an assessment had been completed, this had not been put on the electronic care plan system for staff to access. People’s needs were not consistently assessed using recognised tools and following current guidelines.

Audits were completed on the quality of the service but these had not been effective in identifying the shortfalls found at the inspection. When shortfalls had been identified action had not been taken to rectify the shortfalls. Medicines audits had identified shortfalls, these same shortfalls were found at the inspection, people’s medicines were not being managed safely.

There were sufficient staff on duty to meet people’s needs, who had been recruited safely. Staff received one to one supervision to discuss their role and development. Staff received training appropriate to their role. We observed putting their training into practice including infection control, staff wore gloves and aprons when appropriate.

Staff knew how to recognise and report abuse to keep people safe. The manager had reported safeguarding concerns to the local authority when required. Accidents and incidents were analysed for patterns and trends, action was taken and lessons learnt to reduce the risk of them happening again.

People told us that staff were kind and caring while supporting them to be as independent as possible. We observed staff promote people’s dignity and respect their decisions. People had access to a variety of activities. People’s end of life wishes were recorded and staff supported people to be comfortable at the end of their lives.

People and relatives told us they knew how to complain. Any complaints received were investigated in line with the provider’s policy. The complaints policy was not available in formats such as pictorial, this was an area for improvement.

People were supported to remain healthy. Staff encouraged people to be as active as possible including dancing and exercise. People were supported to eat a balanced diet and people had a choice of meals. Staff monitored people’s health and when changes occurred people were referred to healthcare professionals such as the GP or dieticia