We inspected this service on 8 November 2018. This inspection was unannounced.

A comprehensive inspection took place during December 2016 and the overall rating awarded was ‘Good.’ We carried out a further inspection on 14 August 2017 concentrating on two areas ‘safe’ and ‘well-led due to concerns received.’ However, the overall rating for the service awarded following this inspection changed to ‘Requires Improvement’. The provider was not meeting one of the regulations that we checked and was in breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following the last inspection, we asked the provider to take action to make improvements to promote people's safety and to improve systems and processes to monitor the quality of the service. The provider submitted an action plan outlining their plan for improvements.

At this inspection we found that the provider had made improvements and were now meeting fundamental care standards, resulting in a rating of ‘Good.’

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

Perth House is situated in the Chaddesden area of Derby and is owned by Derby City Council. Perth House is registered to provide personal care and accommodation for up to 39 older people and younger adults. The service has intermediate care beds for people who need further therapy or treatment following a hospital admission and social care beds for people who are being assessed and supported prior to returning home or to another care service. At the time of our inspection there were 20 people using the service.

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 told us they felt safe with the care provided by staff. Staff we spoke with understood their responsibility in protecting people from the risk of harm. Staff told us they had received training and an induction that had helped them to understand and support people.

People were supported with their medicines in a safe way. Staff were available to support people when they required it.

Recruitment procedures were thorough to ensure prospective staff were suitable to care and support people at Perth House.

Risks were managed according to individual need and we saw staff support people safely and appropriately with transfers.

People were protected by the provider's infection control procedures, which helped to maintain a clean and hygienic environment.

People were supported to have maximum choice and control of their lives. Staff were aware of the importance of seeking consent from people and demonstrated an understanding of the Mental Capacity Act 2005.

People were supported to maintain their health and well-being and had access to healthcare professionals such as GP's when required. People were supported with their dietary needs.

People were cared for by staff who were kind and caring. Staff respected people's privacy and dignity. People were supported with their independence by staff. Visitors were welcomed at Perth House.

The provider’s complaints policy and procedure were accessible to people who used the service and their representatives. People knew how to make a complaint and felt the provider would take action to address any concerns.

People received a service which was well-led. The service monitored the quality of the service people received, where shortfalls were identified actions were taken to improve. People were asked for their views about t

Perth House is situated in the Chaddesden area of Derby and is owned by Derby City Council. Perth House is registered to provide personal care and accommodation for up to 39 older people and younger adults. The service has intermediate care beds for people who need further therapy or treatment following a hospital admission and social care beds for people who are being assessed and supported prior to returning home or to another care service. At the time of our inspection there were 18 people using the service.

This inspection took place on 14 August 2017 and was unannounced. At our previous inspection on 30 December 2016 and 6 January 2017 the provider was meeting all the regulations we checked and we rated the service as Good.

This inspection was focused following concerns received about medicines management at the service. The inspection only covered two of the key questions, safe and well-led. This report covers our findings in relation to the identified concerns. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the ‘all reports’ link for Perth House on our website at www.cqc.org.uk

There was 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.

We found that the provider's quality assurance systems had not picked up the issues we identified at this inspection visit. This demonstrated that the management systems were not always effective in recognising areas which required improvements.

Risk assessments were not always in place to ensure people received safe care. Not all risks to people’s health and safety were identified and action put into place to reduce them.

The provider had procedures in place for the management of medicines, to ensure people were receiving their medicines as prescribed. However we found that medicines audits were not clearly documented, which did not make it easy to identify if there were any shortfalls.

People and relatives told us that there were enough staff to support them. However a couple of staff felt that staffing levels were not adequate on the early shifts as it was the busiest time of day.

People and relatives we spoke with felt people were safe at Perth House. The provider had taken steps to protect people from harm. Staff had an understanding of potential abuse and their responsibility in keeping people safe. Recruitment procedures ensured suitable staff were employed to work with people who used the service.

People told us they were happy with the care they received and felt their concerns would be listened too. Staff told us they enjoyed working for the provider and they felt supported.

People were encouraged to share their opinions about the quality of the service to enable the provider to make improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection began unannounced on 30 December 2016. We returned announced on 6 January 2017 to complete the inspection.

Perth House is situated in the Chaddesden area of Derby and is owned by Derby City Council. Perth House is registered to provide personal care and accommodation for up to 39 older people and younger adults.

The service caters for people who need short-term care following a stay in hospital. The service has 16 intermediate care beds for people who need further therapy or treatment and 16 social care beds for people who are being assessed and supported prior to returning home or to another care service. At the time of our inspection there were 36 people using the service.

The service has a registered manager. This 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 ethos of the service centred on reablement and supporting people to be as independent as possible. Staff focused on encouraging people to do things for themselves. Records showed that people’s well-being improved during their stay at Perth House and in most cases they returned to their own homes.

People told us they thought Perth House was well-staffed and there were enough staff on duty to meet people’s needs in a calm and unhurried manner. Staff had time to talk with people, answer their questions, and provide them with reassurance. Staff were safely recruited to ensure they were suitable to work with the people using the service.

Staff were trained in safeguarding (protecting people who use care services from abuse) and knew what to do if they had concerns about a person’s well-being. When people were admitted to the service staff identified any areas where they might be at risk and put measures in place to minimise these. For example people at risk of falls might be given walking aids and have staff supervise them when they moved about the service.

All the people we spoke with made many positive comments about the food served. Most of the food served was homemade and people had a choice of dishes at each meal. Staff had a good understanding of the varied nutritional needs of the people using the service. People were encouraged to eat with others in the dining rooms making meals a social event, although people could choose to eat in their rooms if they wished.

Staff worked closely with other health and social care professionals to ensure people’s needs were met. The range of expert treatment and care available at Perth House meant people had the support they needed to regain their health, confidence and independence. Staff met regularly with health care professionals to assess, plan and review people’s care and support.

Staff told us their goal was to get people back to their previous level of function or better so they were able to return to their own homes. The service’s multidisciplinary approach and joint working with other health and social care professionals made this possible as the majority if not all of people’s needs could be assessed and met at Perth House.

People told us the staff were caring and kind. Due to the nature of the service, with people only there for a limited time, staff needed to be able to build positive caring relationship with people quickly. We saw that staff were able to do this using good interpersonal skills and a warm professional approach that gave people confidence.

Activities were available at the service for people who wanted them. These included bingo, quizzes, crafts, reminiscence, dominoes and reading material. A hairdresser came to the service once a week and people told us they were pleased about this.

There was a friendly and inclusive atmosphere at the service. All the people and relatives we spoke with said the staff were

This inspection was carried out by one inspector. We met and spoke with eight people who lived at Perth House. There were 11 people receiving residential care. An intermediate care service was also based at Perth House. The intermediate care service provide short term support for people who required care as an alternative to being admitted to hospital or for people discharged from hospital who needed support to enable them to return to their own home. Perth House also provided a day centre for people to attend on one or more days per week. No one was attending the day centre when we inspected. We spoke with two relatives who were visiting when we inspected. We also looked at care plans and other records relating to the management of the service. We spoke with the manager, the nurse in charge of the intermediate care service and three care staff working at the service. We spoke with a healthcare professional who was visiting several people at Perth House.

We last inspected this service on 13 August 2013. At the last inspection we found the service did not have effective procedures in place to manage medicines safely. At this inspection we found the provider had addressed the issues raised in the previous inspection. A summary of what we found is set out below.

Is the service safe?

We spoke with a relative who told us they, “Had no concerns about the standards of care.” They said, “If anything happens they get in touch with you right away. It’s reassuring so I am not surprised if I come and see a bruise.”

The service investigated accidents and incidents and identified the actions required to improve the safety of people using the service. The manager told us they had made a safeguarding referral recently because someone had gone missing from the home. An investigation had been carried out and actions put in place to reduce the risk of a similar incident occurring again.

Is the service effective?

One person who used the service told us, “I go to the day centre three days a week and really enjoy it. It’s nice to meet other people. I get tired of sitting in the same place it’s nice to have a change.”

Is the service responsive?

One person who used the service told us, “I go to bed when I like. I like to go early and listen to the radio. I enjoy company during the day but I prefer my own company in the evenings.”

On the day of our inspection someone was concerned about their relative. We observed care staff reassure the person and they agreed to contact local health services for advice.

A relative told us, “Care staff noticed something and contacted the GP quickly. They took [them] to the GP surgery and had it seen to right away.” They said, “Anything I have raised has been seen to.”

Is the service caring?

We spoke with three people who used the service whilst they were waiting for tea. They told us, “Staff are pretty good. They treat us well. We can’t grumble.” One person told us, “it’s marvellous what they have done to improve things. I am looking forward to sitting in the new conservatory when the furniture arrives.” One person told us, “The staff are very nice and work really hard.

Is the service well led?

The provider had developed a quality assurance process which consisted of audits and checks designed to identify and manage the risks to people‘s health and welfare. The service had also obtained feedback from people who used the service, relatives and staff.

Care staff were supported with training and supervision from their manager. We saw the manager discussed people’s knowledge about supporting people, for example with dementia, as part of care staff supervision meetings.

There were 28 people living at the service at the time of our inspection visit. We spoke with six people at the service, six staff, one visiting health professional and one visitor.

People using the service told us they were happy with the care they received from the staff team. Comments included “if you cannot be at home, there is no better place to be than Perth House”, “we feel safe here, the staff are lovely” and “you have only got to ask for something and the staff are there straight away.”

We saw that people's needs were assessed, and care plans were in place. This meant they received support in a way that met their needs.

Most people told us they enjoyed their meals. People also said that they received enough to eat and drink.

The provider did not have effective procedures in place to manage medicines safely, which did not ensure people received medicines in a safe way.

Staff worked well together as a team, and felt supported by the management team.

People, who use the service, told us they had no complaints about the service and felt safe at Perth House.

In this report the name of a registered manager, Mr Kevin Jowett, appears. He was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this report.

People confirmed that staff treated them respectfully and ensured their dignity and privacy was maintained. Comments included, “staff seem very polite and friendly.” And “staff are lovely, I have a laugh and a joke with them, they don’t invade my space but they are always around if I need them.”

People using the service said they were happy with the support they received from the staff team. Comments included, “I was a bit worried about coming into a care home, but so far it’s been fine. The staff are nice and I feel quite comfortable here now.”

People confirmed that staff recognised when they were unwell and required treatment, and responded to their needs. One person told us, “if you’re ill, the staff call the doctor out. “