About the service: Randolph House Care Home is a residential home registered to provide accommodation and personal care for up to 70 older people, including those who are living with dementia. At the time of the inspection there were 38 people using the service.

People’s experience of using this service: Records in relation to the safe administration of medicines were not always completed and people did not always receive their medicines as prescribed.

The systems and processes used to monitor and deliver improvements required embedding further to ensure improvements would continue.

Relatives told us their family member was safe. Risks to people were assessed and how to reduce risks and respond to possible harm were recorded. Staff followed infection prevention and control guidance when supporting people.

The service had skilled and experienced staff and staffing levels were measured against a dependency tool. At times during the inspection there did not seem to be enough staff on duty to meet people’s needs and staff seemed rushed for example at lunchtime. Staff received appropriate training and support to enable them to perform their roles effectively. Safe recruitment processes were in place and followed.

Staff involved healthcare professionals to ensure people's health care needs were met. People received support with eating and drinking, when required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff gained people's consent before providing personal care and support.

Relatives said and information in people’s satisfaction surveys confirmed staff were kind and caring. The staff described how individual people preferred their care and support delivered and the importance of treating people with dignity and respect. Care plans showed people were involved in their care and they contained details for staff to provide effective care and support. The manager said these records were currently being reviewed to ensure they were up to date.

People, relatives and staff had the opportunity to provide feedback about the service. Information was provided so people knew who to speak with if they had concerns. There was a system in place to respond to any complaints.

The provider worked in partnership with other services to support people’s care and quality of life.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection: Requires Improvement (report published 27 March 2018

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor this service and inspect in line with our re-inspection schedule or sooner if we receive information of concern.

Randolph House Care Home 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.

Randolph House Care Home accommodates 70 people across two separate units, Poppy and Primrose, each of which have separate adapted facilities. Poppy Unit provides residential care support and Primrose Unit specialises in providing care to people living with dementia. At the time of our inspection there were 43 people using the service.

We undertook this unannounced inspection on 25 and 29 January 2018. The last inspection took place on 21and 22 February 2017 and the service was rated ‘Requires Improvement.’ Issues were identified in relation to the deployment of staff, standards of hygiene and governance systems.

The service had a registered manager. A registered manager is a person who has registered with the 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. Following the inspection, we were informed the registered manager had resigned and left the service and the provider had appointed an experienced interim manager to oversee the service, until a new manager could be recruited.

The provider's systems to assess, monitor and improve the quality of the service provided had not been effective in identifying and addressing all the issues highlighted during our inspection or consistently driving improvements in line with their own action plans. Examples included shortfalls in care plans, supplementary and consent records, topical medicines and training in behaviour that challenged the service.

There was inconsistency with the application of mental capacity legislation. This had led to one person potentially being deprived of their liberty unlawfully, as staff had not recognised they met the criteria for a Deprivation of Liberty Safeguard. Some people had assessments of capacity and records of best interest decisions when restrictions were in place, but this was not consistent throughout the service. One person was subject to low level physical interventions, which had not been agreed or assessed as being in their best interest. However, we found staff had a good understanding of the need to gain consent from people prior to carrying out care tasks.

You can see what action we told the provider to take at the back of the full version of the report.

The management of medicines was safe with the exception of the recording and administration of some topical medicines. The regional manager took action during the inspection to ensure staff administered these as prescribed.

Improvements had been made to the staff supervision and appraisal programmes. There were staff meetings which enabled them to receive information and express their views. Although staff completed a thorough induction and range of essential training, we found gaps in the training to meet the needs of people who used the service, including the management of behaviour that challenged the service. We have made a recommendation about staff training on the subject of the needs of older people.

People received the support they required to maintain adequate nutrition. People told us there was a choice of food and it was of good quality. We found staff were not always responsive when people had a poor fluid intake. We spoke with the regional manager about this during the inspection and they took immediate action to improve the monitoring of people’s intake and the recording of follow up action taken by staff.

The quality and range of activities had improved since the previous inspection. Feedback from people who used the service and relatives was positive about the

This inspection was undertaken on 11 and 14 November 2016 and was unannounced. This was the first inspection of this service under this registered provider. The inspection was brought forward because concerns had been raised with us about the nursing care and staffing levels provided at the service.

Randolph House is registered with the Care Quality Commission (CQC) to provide accommodation for up to 70 people who require nursing or personal care. The service can provide support to people who are living with dementia. There are three separate units within the service, Bluebell providing nursing care with 11 beds, Poppy unit providing residential care for 23 people and Primrose unit providing elderly mentally infirm care for up to 17 people. Bluebell unit is in the process of closing.

This service has a registered manager in place. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff understood how to protect people from harm and abuse. They knew how to report abuse and told us they would report issues to the registered manager and the local authority, or directly to the Care Quality Commission.

Staffing levels within the service were increased during the inspection process. We observed that the staff were very busy and they told us they were under pressure. Staff reported to us they felt the senior staff needed to work more closely with the care staff. Staff meetings were not held regularly and this was a concern voiced by staff working at the service. These issues were discussed with the registered provider and registered manager. Immediately action was taken to increase the staffing levels on the dementia unit. The management team agreed to undertake regular staff meetings and monitor how staff worked together to improve team work and communication at the service, at every level.

Environmental issues and concerns found regarding the services food hygiene records and cleanliness of the Bain Marie’s found during the first day of our inspection were rectified immediately.

The care records for people on the nursing unit were basic. Staff we spoke with and relevant health care professionals confirmed that people were receiving the nursing care they currently required. The nursing records were being reviewed and updated as people were moved from the nursing unit. People’s care records on the other units were personalised, detailed, person centred and reflected their full and current needs.

Staff understood people’s needs and they were aware of risks present to their health and wellbeing. Staff placed their emphasis on providing care and support to people.

Training was provided for staff in a variety of subjects to maintain and develop their skills. Induction training needed to be reviewed to make sure staff had understood what they had learnt. Staff supervision was in place; however appraisals had not been undertaken and we saw they had been scheduled. These helped to support the staff and develop their skills. The senior management team were looking at how to develop better teamwork at the service.

People’s food and fluid intake was monitored, However, one relative raised concerns about the monitoring of their relations fluid intake with us. The registered manager was looking into this. People were prompted or assisted with meals and drinks by patient, attentive staff who understood people’s dietary needs and preferences.

People’s privacy and dignity was respected by staff. People made choices and decisions about how they wished to live their lives, where this was possible. Staff supported people to make choices about their daily lives.

Staff contacted health care professionals to discuss people’s changing needs and