This inspection took place on the 3 and 4 April 2018 and was unannounced.

Savernake View 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.

Savernake view is registered to accommodate 64 people in one building across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At time of our inspection 38 people were living there.

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.’

During our last comprehensive inspection in August 2017 we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because medicines were not managed safely and people did not always have access to on-going healthcare that was responsive to their needs. In addition, care plans were not always person centred and did not provide enough detailed guidance for staff on how to meet people's needs and consent to care was not always sought in line with the Mental Capacity Act (2005). We also found that records kept in respect of people using the service, were not always accurately recorded or complete. Internal audits identified shortfalls, but sufficient action was not taken to address these.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. During this inspection we found the provider had met two of the Regulations but two still remained in breach.

Care plans were not consistently person centred and recordings in daily records were not always professional. We found care plans did not contain guidance for staff on managing behaviours which could be challenging to others. Care plans were not reflective of people’s needs and staff did not always follow the most up to date guidance.

People received care from staff who had the right skills and knowledge. Staff had received training in areas such as manual handling, safeguarding, dementia and mental capacity.

Medicines were managed safely, following the service’s introduction of an electronic medicines management system. However, we found shortfalls with the management of people’s topical creams.

The service had improved their relationship with the GP surgery and people now had better access to the GP. Staff told us communication between the home and the GP had improved.

People told us they felt safe living at Savernake View. Staff had a good understanding of protecting people from avoidable harm and said they were confident that any concerns raised would be acted on.

Improvements had been made to gaining people’s consent to care and treatment, and where needed, associated mental capacity assessments had been completed. Where people lacked mental capacity to consent, the registered manager had made applications for Deprivation of Liberty Safeguards.

People told us they liked the food on offer and if they did not like what was on the menu, they would be offered an alternative. There were plenty of drinks and snacks available.

People spoke highly about the care they received. They said staff treated them with kindness and compassion.

Staff felt supported by the management team. There were quality assurance systems in place to monitor the quality of the service people received. People and/or their relatives had opportunities to provide feedback about their care.

We found two repea

Savernake View Care Home provides accommodation which includes nursing and personal care for up to 64 older people, some of who are living with dementia. At the time of our inspection 34 people were using the service. Savernake View is one of Porthaven’s Care Home’s, situated in the Marlborough area.

The inspection took place on the 22 and 23 August 2017 and was unannounced. This was the service’s first rated inspection since being registered with the CQC in August 2016.

The service had 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.

Medicines were not managed safely. We found gaps in the medicines administration records (MAR). Medicines had not been signed as administered and there was nothing documented to indicate that staff had either escalated this for investigation or had undertaken a stock check to ascertain whether they had been administered.

People did not always have access to on-going healthcare that was responsive to their needs. Although people were registered with a local GP practice, the GP did not regularly visit and there was nothing documented to indicate that people’s heath had been regularly reviewed. Staff said that accessing the GP for advice was not easy and that communication was by fax only. This meant there were often delays in seeking GP support.

Care plans were not always person centred and did not provide enough detailed guidance for staff on how to meet people’s needs. Care plans contained risk assessments for areas such as falls, moving and handling, skin integrity and malnutrition. These had been regularly reviewed; however, when risks had been identified the care plans did not always provide staff with enough guidance on how to reduce the risks.

When people had accidents, incidents or near misses these were recorded and monitored to look for developing trends. However, we found that people were not always supported to stay safe.

A significant number of people, relatives, visitors and staff expressed concerns about lack of staff, the use of agency carers/nurses and the impact that this had on the quality of care.

The service did not follow the requirements set out in the Mental Capacity Act 2005 when people lacked the ability to give consent to their care and treatment.

Language used in some of the care plans we looked at was unprofessional and did not demonstrate that staff were respectful of people.

Internal audits had identified shortfalls and action had been taken. However, we found that the action taken was not sufficient to resolve the shortfalls, for example, the safe management of medicines. Records kept in respect of people using the service, were not always accurately recorded or complete.

People told us they felt safe living at Savernake View. Comments included “A nice place to live - a gentle environment to live in. Everyone nice and friendly.”, “I like it here no hassle from anybody.”

People told us that they mostly liked the staff and felt they worked hard to provide a good level of care. Most staff were described as kind, considerate, caring and approachable.

Staff had the knowledge and confidence to identify safeguarding concerns and act on them to protect people. They had access to information and guidance about safeguarding to help them identify abuse and respond appropriately if it occurred.

The service followed safe recruitment practices. Records showed that checks had been made with the Disclosure and Barring Service [criminal records check] to make sure people were suitable to work with vulnerable adults.

People’s preferences including their dislikes and any allergies were recorded and visible in the kitchen. We saw the chef also catered fo