This unannounced comprehensive inspection of Philiphaugh Manor took place on the 17 November 2016.

A previous comprehensive inspection of this service was completed in September 2015. This inspection found that the service required improvement in all five of our key question areas and identified breaches of the regulations.

In April 2016 we completed a focused inspection to check required improvements had been made. The focused inspection found significant improvements had been made in most areas but further improvements were required as the service remained in breach regulations in relation to risk management and the display of inspection reports.

Philiphaugh Manor is a detached building located within its own grounds, that provides accommodation and personal care for up to 30 people who do not require nursing care. On the day of this inspection 27 people were using the service. Some people were living with dementia.

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 service has a registered manager in post, however at the time of our inspection the registered manager had been away from work for some time. The provider had appointed an acting manager to provide appropriate leadership and ensure the staff team were adequately supported during the registered manager’s absence. The acting manager had previously been registered at another service and had been providing the additional management support at Philiphaugh Manor since our previous comprehensive inspection.

People said they felt safe Philiphaugh Manor and their comments included, “I feel safe because nothing is too much trouble for the staff” and “There’s nothing to worry about living here.”

The service was fully staffed and records showed that the service was now consistently staffed at safe levels. Since our previous inspection the provider had reviewed staffing levels and taken action to enable care staff to spend more time with people providing care and support.

People told us staff responded promptly to their requests for support and relatives commented, “When I visit there always seems to be enough staff on duty.” In addition staff told us positive changes had been made to how they worked each day. A new system had been introduced where staff were allocated to support named people each morning. Staff reported that these changes combined with the increased staffing level meant they now had more time to spend with people. Their comments included, “There is loads more care staff”, “the kitchen porters have helped a lot because you have time to sit and talk to the clients now” and “The allocation means you can spend a lot more time with people. Time to chat while shaving and things like that. It is very positive.”

During both previous inspections we found accidents and incidents were not always documented or investigated. At this inspection records showed that necessary accident or incident forms had been completed for all significant events recorded within people’s daily care notes. The acting manager had completed monthly audits of these records and taken appropriate action to manage any areas of identified increased risk.

Risk assessment documents now provided staff with detailed guidance on how to protect people from identified areas of increased risk. People’s care plans had been regularly updated and staff told us these documents had significantly improved over the last year.

The service had systems in place to ensure staff were sufficiently skilled to meet people’s care needs. Records showed all staff completed formal induction training and systems had been introduced to ensure all staff now received regular training updates. One recently recruited staff m

We carried out this focused unannounced inspection of Philiphaugh Manor on 7 and 8 April 2016. At this visit we checked what action the provider had taken in relation to concerns raised during our last inspection in September 2015. At that time we found breaches of legal requirements. We issued five requirement notices and told the provider to take action to address the breaches of regulation.

This report only covers our findings in relation to topics of concern identified during our previous inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Philiphaugh Manor on our website at www.cqc.org.uk.

Philiphaugh Manor provides accommodation and personal care for up to 30 people who do not require nursing care. At the time of this inspection there were 22 people living at the service. Some people were living with dementia.

The service is a detached house located within its own gardens. At our previous inspection we found that people were only being accommodated on the ground floor as the first floor rooms were in the process of being redecorated. At this inspection we found that these works had been completed, areas of damaged carpet identified during our previous inspection had been replaced and rooms on the first floor were now occupied.

At this inspection we found that the service was being led by the registered manager who worked in the service on a full time basis. 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. Since our pervious inspection the provider had supplied additional managerial support to the service. The provider’s area manager had visited the service. Their care planning and training lead were now working within the service three days a week. Staff reported that morale had improved and told us; “It is better now the registered manager is back”, “It really has changed. It is better” and, “The atmosphere is much, much better, absolutely without a doubt.” Team meetings had been held regularly, staff had received appropriate supervision and annual performance appraisals were due to be reintroduced.

In September 2015, we found the service was short staffed and staff had been working an excessive number of hours with insufficient rest periods. During this inspection we found that seven additional staff had been appointed and staff were no longer working excessive hours. The service staff rota had been redesigned and we found on our unannounced arrival at the service that the correct number of staff were available to meet people’s care needs. Staff told us, “There are four of us on all the time” and, “The hours are much better. I don’t feel exhausted the way I was.”

However, a number of staff reported on going issues during periods of staff sickness or leave. Staff told us they had been unable to book time off for holidays and the registered manager’s attempts to recruit bank staff to provide additional cover during periods of staff sickness or holiday had so far been unsuccessful.

During our previous inspection we found there were was a lack of systems for the recording of incidents and accidents that had occurred. At this inspection we found new systems had been introduced but not used to record details of a number of significant incidents that had occurred within the service.

At this inspection we again found that risk assessments within people’s care plans did not provide staff with accurate information on how to protect individuals from identified areas of risk.

Significant improvements had been made since our last inspection to ensure that staff training needs had been met and staff told us, “There is a lot more training coming our way.” Induction tra

This unannounced inspection took place on 22 and 24 September 2015. The service was purchased by the current provider in the summer of 2014 and has not been inspected since this change of ownership.

Philiphaugh Manor provides accommodation and personal care for up to 30 people who do not require nursing care. At the time of this inspection there were 19 people living at the service. Some people were living with dementia.

The service uses a detached house located within it’s own gardens. Accommodation is available on two floors. At the time of our inspection only the ground floor rooms were in use as the first floor area was in the process of being refurbished.

The service had a registered manager. However, the registered manager had not been present in the service for an extended period and the provider had formally notified us of this period of absence. 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 and associated Regulations about how the service is run.

People told us they felt safe and comfortable at Philiphaugh Manor. People’s comments included; “I have continuous care day and night. If I need anything else I just use my call bell and they come running” and, “they care for me, nothing is too much trouble.” While staff told us; “We put the clients before ourselves, so they are safe” and, “the residents are all lovely and I give 100% to look after them.”

We found the service was short staffed, with only two of the planned four carers on duty at the beginning of our inspection. Staff told us they were tired and reported that they found the service’s 13 hour shifts difficult. The service’s staff roster showed some staff had worked excessive numbers of hours with insufficient rest periods. The provider recognised that staff rosters were inappropriate and took immediate action to address this area of concern. By the second day of our inspection a new staff roster had been introduced and staff told us the new roster was an improvement.

Staff cared for the people they supported and understood their individual care needs. People living in the service appeared comfortable, appropriately dressed and well cared for. Staff reacted promptly to call bells and other requests for support throughout our inspection.

Where staff identified concerns about individuals well-being they took prompt appropriate action to ensure the person’s care needs were met. People regularly received visits from external health and social care professionals and staff routinely sought guidance from professionals to ensure people’s needs were met.

Recruitment procedures were safe. However, new members of staff had not received formal induction training before providing care and the service had failed to ensure staff training needs were met. The provider had recognised this failure and at the time of inspection was in the process of making arrangements for the provision of additional staff training.

Staff and managers were not clear on the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. We identified that some individuals had care plans that were potentially restrictive, and the service had not applied for the appropriate authorisations.

The service provided tasty home cooked meals and people told us; “It’s better food than I used to eat at home.” We noted however, that menu choices were limited as there was only one hot option available at lunch time.

People’s care plans did not provide staff with enough specific guidance to enable them to meet people’s care needs. Care plans contained numerous general phrases many of which were inaccurate. We discussed these inaccuracies with the provider who told us the service’s care plans had recently been reviewed and updated by staff who did not know the people who used the service well.

Staff told us they did not think there were enough activities for people to do at Philiphaugh Manor. Staff comments included; “I think activities should be done every day but we just don’t have the time”. The provider told us they valued activities within the service and were currently advertising for a full time activities coordinator.

The registered manager had been away for an extended period before the inspection. The provider had notified the commission of the extended period of absence but had failed to make appropriate arrangements for the management of the service. The provider had made arrangements for a deputy manager from another service to provide management support. However, this support had not happened and staff told us; “We could have done with more support while the registered manager was away”.

During the registered manager’s absence the relationship between the staff team and the provider had declined. Regular staff meetings had not occurred and information about significant changes to staff terms and conditions had not been effectively communicated to the staff team. Staff described how recent high workloads and changes to their pay and conditions had impacted on their morale.

In response to our initial feedback provided at the end of our first inspection day immediate action was taken to address some of our concerns. In addition the registered manager returned to the service on the second inspection day and intended to begin a phased return to work during the week following our inspection.

We identified breaches of The Health and Social care Act 2008 (Regulated Activity) Regulations 2014. You can see what action we told the provider to take to address these breaches at the back of the full version of the report.