About the service: Somerset House Nursing Home is a residential care home registered to provide accommodation and personal care for up to 44 older people, including those who are living with dementia. At the time of the inspection there were 32 people using the service.

People’s experience of using this service: Work was still required to improve the staff and provider's knowledge and practice in key areas such as risk management, care planning and records. All staff needed to understand people’s needs and be skilled to meet them. Systems to check that people were receiving safe and good quality care required further development.

The provider had worked hard since the last inspection to make changes that impacted positively on people's experience of using the service. Most people and their relatives were happy with the care provided and said that things had improved. A relative told is, “The change has been unbelievable, I feel happy going home now, knowing that people are being well cared for.”

Activities were available for people and further improvements were planned to increase these and provide further access to the local community. People were treated with respect and dignity and their independence encouraged and supported. Where people required support at the end of their life, their wishes and beliefs had been sought. 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 received training and assessment of their competency to ensure they had the appropriate skills to meet peoples’ individual needs. A programme of ongoing recruitment was in place to reduce the reliance on agency staff.

The manager and management team were well respected. Most people, their relatives and staff felt confident raising concerns and ideas. All feedback was being used to continuously improve the service.

The manager and provider had developed their ongoing action plan to address the concerns we identified as part of the inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Rating at last inspection: Inadequate (report published January 2019).

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

Enforcement: The provider was in breach of one regulation at this inspection relating to governance of the service. You can see the action we have told the provider to take at the end of the full report.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. The provider will continue providing regular updates to their action plan. If any concerning information is received we may inspect sooner.

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

This inspection took place on the 10 and 11 December 2018. Both days were unannounced.

Somerset House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide nursing, personal care and accommodation for up to 44 older people, including those living with dementia. At the time of our inspection there were 40 people living at the home.

This was the first inspection of the service since the current provider took over in July 2018. We have found multiple breaches in regulation and the overall rating for the service is 'Inadequate'. The service is therefore in 'special measures'.

The inspection was partly prompted by an incident which had a serious impact on a person using the service. This indicated potential concerns about the management of risk in the service and the level of care provided to people. We did not look at the circumstances of the specific incident, as this may be subject to criminal investigation, but we looked at associated risks.

The service is required to have a registered manager in post. 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. At the time of the inspection a manager was in place but had yet to register with CQC.

The service was chaotic and was not well-led. People’s care needs were not being met due to insufficient staffing numbers and unsupported staff. The service was heavily reliant on agency staff and the management team failed to provide any support or leadership to staff members who did not know the people or the service.

Recruitment processes in place were not safe and medicines procedures were not robust.

The management team had completed checks on the quality of care provided. However, a number of these checks had not picked up on the shortfalls identified during the inspection. We found that the management checks focused on paperwork and failed to recognise the lack of care being provided to people.

Staff were not sufficiently trained or supported to enable them to fully understand their role. Staff had not received sufficient training in specialist areas such as behaviours that can be challenging to others, moving and handling and restraint. This meant that staff were not skilled in ensuring that care was provided in a safe and least restrictive way.

People’s nutrition and hydration needs were not being catered for. People did not receive the support they required to eat and drink and their intake was not being monitored effectively. Actions were not taken when people required additional support or a referral to a health care practitioner.

Staff did not have knowledge of people which impacted on their ability to provide person-centred care. Staff were very task focused throughout the inspection which led to people’s care needs being neglected.

Care plans failed to reflect people’s current needs and risks. Poor behaviour management plans placed staff and people at risk within the service. Accidents and incidents were not recorded, reviewed or monitored for trends and reoccurrences. Lessons which could be learned from any incidents were not considered.

The meeting of people’s wider needs could be improved through the provision of more meaningful activities that are monitored and reviewed. We received mixed feedback from people regarding the provision of activities.

Care records demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied. The manager was in the process of submit