About the service: Scorton Care Village provides both nursing and residential care across two buildings for up to 114 people, some of whom maybe living with dementia. Elizabeth Swale House provides residential care for up to 54 people. We did not visit this part of the service at this inspection. Archery Bower House provides nursing care for up to 60 people. When we inspected 29 people lived in this part of the service.

People’s experience of using this service: The provider did not have sufficient oversight of the service to ensure people received a safe, high quality service. Where they introduced new medication systems, they did not ensure appropriate training, coaching and monitoring occurred to check they were implemented safely. This had led to people being at risk of not receiving their medicines as prescribed.

Although staff knew people and their preferences very well, the records to guide staff on how to support people safely and monitor their progress were not always up to date or in place.

Where accidents or incidents occurred the management team did not ensure they investigated and understood where lessons could be learned to prevent future occurrences.

Staff and the management team demonstrated they were committed to people’s wellbeing and understood that their records are used to evidence how they keep people safe and deliver high quality care. A new registered manager had been in post since December 2018 and had already started to implement changes to improve safety and quality.

The provider reflected on the concerns raised prior to the inspection and our findings. They advised us after our inspection that they had implemented a series of changes to their systems and approach to governance. They told us this would achieve improvements.

We observed people were supported well, with kindness and compassion by all staff. There was enough staff on duty to provide timely support to people when they needed it.

Improvements had been made to the environment as part of a refurbishment programme which was ongoing at the time of our inspection.

A full description of our findings can be found in the sections below.

Why we inspected: We received concerns in relation to the management of medicines and people’s nursing care needs. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Scorton Care Village on our website at www.cqc.org.uk.

Rating at last inspection: Requires improvement (Published 5 October 2018). The service remains rated requires improvement. This is the second consecutive time the rating has been requires improvement.

Enforcement: The provider continued to be in breach of a regulation because the governance of the service had not improved. You can see what action we told the provider to take at the back of the full version of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider, local authority and clinical commissioning group to monitor progress. If any concerning information is received we may inspect sooner.

We inspected Scorton Care Village on 3, 6 and 13 August 2018. The inspection was unannounced on the first day and we told the provider we would be visiting on subsequent days. The provider was newly registered in December 2017. This is the first time we have inspected the service since the new provider took charge.

Scorton Care Village 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.

Scorton Care Village is registered to provide both nursing and residential care across two buildings for a maximum of 114 people some of whom maybe living with dementia. Elizabeth Swale House provided residential care for up to 54 people. 29 people lived there when we inspected. Archery Bower House provided nursing care for up to 60 people. 30 people lived there when we inspected.

Each ‘House’ had their own 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.

When the provider had taken over the management of the service they had immediately initiated an improvement programme to recruit more permanent employees and reduce the reliance on agency workers. This had been successful and a positive impact on people’s experience of care were reported. All recruitment of staff had been completed in a safe way.

Archery Bower House had increased the number of people supported by more than double since December 2017. Resources for activities, Housekeeping and care workers had not increased at the same pace. This meant people were at risk of not receiving support in a timely way. The provider immediately made plans to change the staffing resources following inspection.

A refurbishment plan was in place and this included better resources to make the garden areas more welcoming, replace flooring and to make the environment more dementia friendly when it was decorated based on good practice.

Records reflected that health and safety checks were carried out on the equipment and environment. However, day, day-to-day hazards were not always recognised such as cleanliness and trip hazards. Plans were put in place following the inspection to prevent the likelihood of those happening again.

A new system to manage medicines was in place and this had improved medicines safety. Better care plans were needed to ensure staff worked in a consistent way where people displayed anxiety or distress. We have issued a recommendation in relation to this.

Where accidents or incidents occurred, we saw records did not always reflect the work completed to reduce the likelihood of future occurrences. Care plans were not always reviewed following an incident. We recommended that the provider review the document format to include all the requirements to robustly report and manage incidents.

Staff were very knowledgeable about people’s care needs and the interventions they needed to keep people safe. However, care plans were not always reviewed to ensure they reflected people’s current needs or record the interventions they made, such as wound management. This meant people were at risk of receiving poor care.

The checks undertaken by the registered managers and provider had not picked up on all the areas we highlighted for improvement during the inspection. This meant the systems were not effective enough to ensure quality and safety. The provider told us they were committed to ensuring further development would happen following the inspection. They sent us examples of the improvements they had made following our visit and this gave us confidence they understood the work re