This inspection took place on 13 and 14 June 2018 and was unannounced.

Spencer House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under on contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Spencer House accommodates up to 25 people in one adapted building. At the time of the inspection 22 people were living at the service.

We last inspected Spencer House in March 2017, when two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations were identified. We issued requirement notices relating to safe care and treatment and good governance. The provider had not maintained the building to the required standards and issues relating to unsafe management of medicines. The provider had failed to monitor and improve the quality of the service and maintain accurate and complete records.

At our last inspection, the service was rated ‘Requires Improvement’. We asked the provider to complete an action plan to show how they would meet the regulatory requirements. At this inspection improvements had been made, however, there was a continued breach of Regulation 17, Good Governance. This is therefore the second consecutive time the service has been rated ‘Requires Improvement’.

The registered manager had left their post in May 2018. An acting manager had joined the service at the beginning of June 2018 and had started their registration with Care Quality Commission (CQC). A registered manager is a person who is registered with the CQC to manager the service. Like registered providers, they are ‘registered persons’. Registered persons have a 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 last inspection in March 2017, the provider employed a registered manager. They had entrusted the registered manager with maintaining, monitoring and improving the quality of the service. The provider was present at the service regularly but had not maintained oversight of the service. The provider had not identified the shortfalls found at this inspection.

Checks and audits had not been completed on the quality of the service being provided. Accidents and incidents had not been analysed to identify any patterns or trends to learn lessons and stop them happening again.

Potential risks to people’s health and welfare such as diabetes, had not been consistently assessed and staff did not have detailed guidance to mitigate the risks. However, staff knew how to support people to reduce risks and described how they supported people living with diabetes. Each person had a care plan that contained details about their choices and preferences, but some information contained in the care plans was contradictory. However, people told us that staff supported them in the way they preferred.

The acting manager had completed an audit on all aspects of the service the week before this inspection and had identified all the shortfalls the inspection found. The acting manager had put an action plan in place and had started to rectify the shortfalls.

The acting manager understood their responsibilities to keep people safe. Staff explained how they would raise any concerns they had and were confident that the acting manager would act appropriately.

There were sufficient staff on duty, who had been recruited safely. Staff received training appropriate to their role, new staff completed an induction programme. Staff told us they felt supported by the provider and had regular supervisions to discuss their training and development.

People received their medicines safely and on time. Staff monitored people’s health and reported any changes to the GP and other healthcare professionals. Staff followed the guidance given to keep people as healthy as possible. People were encouraged and supported to live

The inspection visit was carried out on 28 March 2017 and was unannounced.

Spencer House provides care for up to 25 older people some of whom maybe living with dementia. At the time of the inspection 22 people were living at the service. Spencer house offers residential accommodation over three floors, has two dining rooms and two lounges, there is a stair lift to access the first and second floors. Spencer House is situated in the village of Birchington, there is a secure garden at the rear of the premises.

The service does not have 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 requirements in the Health and Social Care Act and associated Regulations about how the service is run. There was a manager in post who was not present on the day of the inspection. During the inspection we were supported by the provider.

People told us that they felt safe living at the service, however, the provider had not consistently completed checks on the environment to ensure people remained safe. The environmental risk assessments were not up to date. Water temperatures had not been checked to ensure that they were at a safe level to reduce the risk of scalding. There were no personal emergency evacuation plans (PEEP) for each person, to inform staff about how to evacuate people safely. Staff and people had not taken part in a fire drill, there was a risk that they would not know how to leave the building safely.

People told us that they received their medicines when they needed them. However, medicines were not consistently recorded and managed safely. There were audits and quality assurance systems in place, but these had not been completed consistently. Audits had identified shortfalls, but, the provider had not taken action to rectify the shortfalls. Feedback from people, staff and relatives had not been analysed and used to improve the quality of the service.

The provider had not maintained complete and accurate records; safety certificates were not available at the time of the inspection. After the inspection copies of the safety certificates were provided.

People were protected from the risks of abuse and avoidable harm. Risks to people were assessed and there was guidance for staff on how to reduce risks. Staff were confident that any concerns raised would be investigated to ensure people were safe. They knew about the whistle blowing policy and, if required, to report concerns to agencies outside of the service. There were systems in place to record and receipt any monies spent which were regularly audited.

Accidents and incidents had been analysed to identify trends and patterns. Action plans and risk assessments had been put in place to reduce the risk of them happening again.

Recruitment processes were followed to make sure staff employed were of good character. There were sufficient staff on duty, and contingency plans to cover a shortage of staff in an emergency.

People received effective care from staff who had the knowledge and skills to carry out their roles. The provider had identified that some training needed to be refreshed and training had been booked to address the shortfalls. . Staff were knowledgeable, able to tell us and we observed how they put their training into practice.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The provider understood their responsibilities in relation to DoLS. The requirements of the Mental Capacity Act 2005 (MCA) had been met. Staff understood the importance of giving people choices and gaining consent.

People were offered a choice of healthy meals which people told us they enjoyed. Staff monitored people’s weight to make sure they remained as healthy as possible. People were referred to specialist healt