This unannounced inspection took place on 18 April 2017.

Scaleford Care Home is situated in a residential area of the Marsh in Lancaster and overlooks the River Lune. Bedrooms are situated over two floors. A stair lift is available to assist people with limited mobility to gain access to the upper floor. There are three lounge areas and a dining room. At the front of the home there is a decking area and maintained gardens. At the time of the inspection visit there were thirteen people residing at the home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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.

We last carried out a comprehensive inspection of Scaleford Care Home on 07, 08 and 11 January 2016. At the inspection visit we identified no breaches to Regulation but made two recommendations. We asked the provider to review administration of medicines to ensure they consistently reflected good practice guidelines. Also, we asked them to review staff training to ensure there were no gaps in staff training.

At this inspection visit carried out in April 2017, we found the recommendations made had been acted upon. Suitable arrangements were in place for managing and administering medicines. Good practice guidelines were followed when administering medicines. The registered manager had a training and development plan for all staff. We saw evidence staff were provided with relevant training to enable them to carry out their role. When gaps in training were identified plans were implemented to ensure staff received the training in a timely manner.

We noted that refurbishment of the home was still in progress. Improvements had been made in a communal living area and dining area of the home. Refurbishment of bedrooms was ongoing and plans were in place for a new laundry area. We noted adaptations had been made within the home to make it more accessible and dementia friendly.

People and relatives told us care was provided to a high standard by a caring staff team. They repeatedly described staff as kind and caring. We observed positive interactions during our inspection visit which evidenced this.

We observed staff responding to people’s needs in a timely manner. Staff were not rushed in carrying out their duties. We observed staff spending time with people who lived at the home. Staff were patient with people.

People told us they felt safe. Staff had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. We saw arrangements were in place to protect people from risk of abuse.

The service ensured risk assessments for each person were completed and up to date to address and manage risk. When risks were identified we noted referrals were made to other appropriate agencies in a timely manner to manage the risk and prevent avoidable harm.

We looked at certification and maintenance records and found that premises and equipment were appropriately maintained.

Recruitment procedures were in place to ensure the suitability of staff before they were employed. Staff were provided with training and support at the beginning of their employment to provide them with the relevant skills to provide safe and effective care.

People’s healthcare needs were maintained by the service. We saw evidence of health professional involvement when appropriate.

Care plans were implemented for each person who lived at the home. They included support needs and personal wishes of each person. Plans were reviewed and updated at regular intervals.

We observed meal times at the home. Improvements had been made to the dining area environment to enhance the personal experience at meal times. People were offered a variety of

We considered our inspection findings to answer questions we always ask: -

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

People told us they felt safe and comfortable at the home. One person said, “I feel very safe and comfortable”. Another person explained, “I feel very safe here. They keep an eye on me”.

Our discussions with staff demonstrated they understood the principals of providing care to people in a safe way. Care plans we reviewed showed people’s needs were assessed and monitored. This meant Scaleford protected people from unsafe care because support planning and risk assessment was adequate.

The home had a safeguarding policy and set of procedures in place. Our discussions with staff demonstrated they had a good understanding of how to safeguard people against potential abuse.

We found Scaleford to be clean and tidy. One person said, “It’s clean and tidy here. The staff keep it well-maintained”. We noted some upkeep of the home had been undertaken. Although there was a smell of drains developing during our inspection, the provider assured us this would be addressed.

Due to staff sickness and turnover, we observed over the last six weeks Scaleford had periods of low staffing levels. The home provided care for up to 32 people, some of whom had severe, complex care needs. We were told the provider was trying to recruit new staff. However, this meant people were at risk because they were not always fully monitored.

Is the service effective?

The service had some recorded evidence of formal consent, but this was not evident in all care files we reviewed. Documents and observations showed people were consistently supported to make basic decisions about their care. We noted staff had a good understanding of consent and related principals. One staff member explained, "It’s about your approach with people, taking your time and explaining things properly. You need to understand the resident properly".

Scaleford was not effective in properly applying for Deprivation of Liberty Safeguards (DoLs) for people who lived at the home. Records were limited, unclear and there were no capacity assessments. The provider had not notified the Care Quality Commission (CQC) about these approved applications. This meant people were at risk from unsafe care because the provider had not sufficiently undertaken its responsibilities.

Documents we reviewed showed support plans and risk assessments matched people's assessed needs. This demonstrated people were protected against ineffective care provision because people's needs were appropriately assessed.

Some records we reviewed were task orientated, which was not effective in meeting people’s individual needs. However, we noted the provider was in the process of introducing a new care plan system. A visiting professional told us, “The home have referred to us and engage with us well. It’s hard work because their care has been task orientated, rather than personalised. But they’re beginning to move away from this”.

Is the service caring?

People told us they found staff to be caring and compassionate. One person said, "The staff are caring and friendly. They treat me with respect and dignity". Another person said, “The staff are lovely and caring. They help me keep my independence”.

Our discussions with staff showed they had respect and compassion for the people they supported. One staff member told us, "My approach is about caring for people as if they were my own family”.

Is the service responsive?

During our inspection we found Scaleford worked with the local community mental health team. They were provided with support and guidance to enable them to respond to people’s mental health needs. This showed the service worked with other providers to ensure people were supported appropriately.

Staff had a good understanding of how to meet people’s needs and to provide good levels of care. One staff member told us, “We monitor residents and discuss as a team to make sure they have the right standards of care”.

Is the service well-led?

Scaleford had a range of quality audits in place to monitor service delivery. Appropriate policies and other regular processes underpinned this, such as satisfaction surveys, staff meetings and staff supervision. This meant people were protected against inappropriate support because the manager had systems to check the quality of care.

Care delivery was organised and there were clear lines of responsibility. One person told us, “The manager is great, she runs the home well”. This meant care delivery was adequate and safe because Scaleford was well-led.

At our last inspection in July 2012 we found Scaleford compliant in all the five outcomes we looked at. However, we suggested the management take note of some issues relating to the safety of the premises and how records were kept, in order to maintain compliance in the future. We found on this inspection that these matters had all been addressed. We also saw evidence of continuing refurbishment, a new stair lift and a new central heating system.

On our last visit, we found that the occupancy level was low creating budgetary problems for the home. At this visit we found numbers of residents had improved considerably. We found that resident care remained a high priority, people were well looked after, and both residents and their visitors gave us positive feedback. We found that medication was safely stored and administered. We found the registered manager had a hands on approach to quality assurance, and that both residents and visitors spoke highly of her style and approachability. She also conducted internal audits to ensure standards remained high.

We found a number of minor areas of non compliance where standards had slipped on the day of our inspection. These were resolved immediately after discussion with staff and management. We have not been able to test whether this compliance has been sustained.

People told us they were happy with their care and accommodation at Scaleford Care Home and had no suggestions for improvement. Individual tastes and preferences were catered for.

People using the service told us they were generally very satisfied with the care and support they receive. "I can't imagine living somewhere else"

Some people thought the decoration in their rooms could be better. "I think it's about time they brightened up my room"

Staff were happy with the way they are supported, and felt they worked well together as a team. "We work closely together"

"It's a homely place and we get on well together"

"Some of the residents have been here for a long time and they are such characters, they make the place what it is".

People receive care, treatment and support from the staff team and from other agencies including health and social care. "The staff always come with me when I go for appointments, nothing is too much trouble".

This unannounced inspection took place on 07, 08 and 11 January 2016. We undertook this inspection to assess whether the provider had made improvements to meet the requirements of the regulations.

Scaleford Care Home provides care and support for a maximum of 32 people. At the time of inspection 15 people lived at the home. The home is situated in a residential area of the Marsh in Lancaster and overlooks the River Lune. Bedrooms are situated over two floors and a stair lift is available to assist people with poor mobility to gain access to the upper floor. There are three lounge areas and a dining room.

A registered manager was not in post at the time of the inspection. A registered person is registered with the Care Quality Commission to manage the service. 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 provider had designated a member of staff to be the acting manager, who we were informed was planning to apply to become the registered manager.

The service was last inspected 21, 22, 23, 24, 28 July 2016. The registered provider did not meet the requirements of the regulations during that inspection as multiple breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. Breaches were identified in requirements relating to fit and proper persons employed, safeguarding people from abuse, good governance, supporting staff, safe care and treatment, acting upon complaints and duty of candour.

Continued breaches were also identified to regulations in relating to staffing, consent to care and treatment, infection control, availability and suitability of equipment and management of medicines.

At the inspection in July 2015, the service was placed in special measures by the Care Quality Commission, (CQC.)

During this inspection in January 2016, we found some improvements to meet the fundamental standards had been made. As a result the service has been taken out of special measures. The service will be expected to sustain the improvements and this will be considered in the future inspections.

At this inspection carried out in January 2016, improvements had been made to ensure people who lived at the home were safe. Suitable arrangements had been implemented to protect people from the risk of abuse. Processes were in place to ensure safeguarding alerts were identified, reported and responded to appropriately. Staff understood their responsibilities and how to report safeguarding alerts.

We saw there had been a decrease in the number of reported falls since the previous inspection. Systems had been implemented to monitor and manage falls however these were not always consistently followed by staff.

Suitable arrangements were sometimes in place for administering of medicines. All medicines were stored securely when not in use. Improvements had been made to monitor people who required soluble medicines at mealtimes. Audits of medicines were carried out by the acting manager. Systems had been put in place to ensure creams and ointments were administered correctly. We did however note systems in place for PRN (as and when required) medicines did not reflect current good practice guidelines. We have made a recommendation about this.

Staffing needs had been addressed since the last inspection. A cleaner had been recruited to address all concerns identified in relation to infection control. Systems had been established to ensure the environment was clean and tidy and free from odours. Cleaning staff were aware of their duties and kept records of all cleaning duties. Care staff had been relinquished of all cleaning duties whilst on shift.

The registered provider had taken action to ensure the living premises were fit for purpose and had carried out all remedial works that were identified at the previous inspection. Stained carpets had been cleaned or replaced. Damaged furniture had been removed from rooms and replaced. Rooms not in use had been made secure.

Procedures to lawfully deprive people of their liberty had been considered and applications had been made to the Local Authority. People who lived at the home were free to mobilise throughout the building.

Capacity and consent of all people who lived at the home had been reviewed. We saw evidence best practice guidelines were followed when people were assessed as not have capacity. Advocates had been sought for people without families to assist people with decision making.

We observed staff responding to requests and noted people’s needs were promptly addressed. People who used the service spoke highly of the staff and their attitude. Most staff were patient and respectful to people using the service, although we did identify some interactions which were addressed by the acting manager when we alerted them of our concerns. The acting manager told us they were monitoring that respect and dignity was embedded into all service provision.

Person centred care was provided at all times by staff who knew the people well. Staff knew of people’s likes and dislikes and respected these whilst supporting people. People who lived at the home were encouraged to be involved in how the home was run and were encouraged to make suggestions as to how the service could be improved.

Systems had been implemented to ensure staff were equipped with the necessary skills required to carry out their role. The acting manager had developed a training schedule for all staff members employed at the home and staff told us they had completed some training in the past six months. The acting manager showed us records to demonstrate training had been planned and delivered. However auditing of staff training had not taken place and there were still some training gaps in mandatory training. We have made a recommendation regarding this.

Induction processes for new staff had been developed and implemented. Staff told us supervisions were provided by the acting manager.

People’s nutritional needs were met by the registered provider. People were offered a choice of meals and meals were prepared according to health needs. Support was given in a respectful manner if people required support at meal times.

The registered provider had reviewed their complaints system and had developed a system for staff to come forward and register any concerns they may have. Staff were aware of the system in place and how to complain. The registered provider had started to develop open lines of communication with relatives of people who lived at the home.

Activities were provided during the course of the inspection. There was no structured formal activity plan on a daily basis but we observed staff taking time out and carrying out 1:1 activities with people during the day. We also saw evidence the acting manager had started to increase links with the local community.

The acting manager had started improving paperwork for all documentation relating to people who lived at the home. This had not been fully completed at the time of the inspection. The acting manager had also implemented an auditing system for auditing quality of service provision and tasks completed by staff members. We found however these systems had not been consistently applied and we identified some concerns during the inspection. The acting manager agreed to review their own systems and processes.

Feedback from staff who worked at the home was mixed. There was a general consensus teamwork had improved but we received mixed feedback upon the approach of management in response to handling of all the changes and the morale of the workforce.