About the service:

The Island Residential Home accommodates up to 34 people. At the time of our inspection, 28 people lived at the service. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors.

Rating at last inspection:

The last inspection was carried out on 06 February 2018. The service was rated Requires Improvement.

Why we inspected:

This inspection was brought forward in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service. At the time of the inspection we were aware of incidents being investigated by third parties.

People’s experience of using this service:

The provider did not have effective safeguarding systems in place to protect people from the risk of abuse. Some incidents of abuse had not been appropriately reported to the local authority or relevant persons. Risk assessments did not have all the information staff needed to keep people safe, because risk assessments had not been reviewed and amended as people’s needs changed. This meant staff did not have up to date information to keep people safe.

Staff had not always been recruited safely to ensure they were suitable to work with people. The provider had not carried out sufficient checks to explore staff members' employment history to ensure they were suitable to work around people who needed safeguarding from harm. There were enough staff to support people's needs. The provider did not have a system in place to assess if staffing levels met people’s needs. The provider had recognised this and had asked the manager to develop this tool.

Medicines were not always managed safely. Medicines were stored at safe temperatures in monitored clinical rooms and medicines fridges. However, one medicine fridge contained a urine sample which was stored alongside people’s medicines. This was unhygienic and there was a risk that medicines could become contaminated. Medicines had gone missing in the service. Some people’s care plans contained body maps for staff to record where medicine patches were applied. These were not always completed. This meant that staff could not be assured that the site of application was rotated to prevent irritation to people’s skin.

The service was clean and we saw staff used protective equipment such as gloves and aprons. The flooring in one area of the service was damaged which prevented this from being effectively cleaned. We reported this to the provider.

People were not protected from harm because the provider had not been analysing accidents and incidents to look at causes or trends. This meant lessons could not be learnt from these events to reduce the same thing happening to others.

People were supported to receive meals which met their dietary requirements. People told us they liked the home cooked food. Staff had good relationships with healthcare professionals to ensure that people saw them when required. When people had been unwell or their needs had changed referrals had been made to relevant health professionals. However, records evidenced that some referrals had not taken place in a timely manner. Records of healthcare professional visits were not always documented, and instructions left were not always actioned.

Capacity assessments were inconsistent and did not always follow the Mental Capacity Act 2005. Some assessments made were not decision specific. People with capacity to consent to decisions about their care had not always signed consent forms. We made a recommendation about this.

The layout of the building met people's needs. The service had dementia friendly signage to help people find their bedrooms, bathroom or toilet and the lounge.

Assessments of people's needs had taken place after people had moved to the service

The inspection took place on 06 February 2018. The inspection was unannounced.

At the previous comprehensive inspection on 05 June 2017 the service was rated Requires improvement overall and inadequate in the safe domain. The provider had breached Regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The provider had failed to meet the requirements of the Mental Capacity Act 2005. The provider had failed to ensure that medicines were suitably stored, administered and recorded. The provider had failed to asses and mitigate risks to people's safety effectively. The provider had failed to operate effective systems and processes to monitor the quality of the service. The provider had not deployed sufficient numbers of staff to meet people's needs. We asked the provider to make improvements to meet Regulations 11 and 18 and we served the provider a warning notice and told them to meet Regulations 12 and 17 by 11 August 2017.

The provider sent us an action plan which stated they would meet Regulation 11 and 18 by 30 September 2017. The registered manager continued to send a monthly update to evidence what actions they were taking to monitor and improve the service.

We carried out a focused inspection on 29 August 2017 to check that the provider had met Regulations 12, 18 and 17. We found they had met the warning notice for Regulation 17 and the requirement action for Regulation 18. Many improvements had been made in relation to meeting Regulation 12, however further improvements were still required to ensure people’s topical medicines were administered as prescribed.

The Island Residential 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 service was not registered to provide nursing care. Any nursing care was provided by community nurses.

At the time of our inspection, 34 people lived at the service. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors.

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.

At this inspection, people and their relatives told us they received safe, effective, caring, responsive care and that the service was well led.

At this inspection, we found that the registered persons had not met Regulations 11 and 18 as stated in their action plan. However, further improvements were required to meet Regulations 12 and 17. We found a new breach of Regulation 19.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Further improvements were required to ensure quality monitoring systems were effective to enable the provider to assess, monitor and improve the quality and safety of the service.

People's care plans detailed most of their care and support needs. Care plans had been reviewed and updated regularly. Two people’s care plans did not give staff clear information on how to meet all of their support needs. We made a recommendation about this.

Risk assessments were in place to mitigate the risk of harm to most people and staff. These had been updated when people’s needs had changed. Risk assessments did not have all the information staff needed to keep people safe. One p

The inspection was carried out on 29 August 2017. The inspection was unannounced.

The Island Residential offers accommodation and long term care and support to up to 34 people. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors. There were 28 people living at the home on the day of our inspection.

The registered manager of the service had left. 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. The new manager assisted us during the inspection. They were in the process of applying to become the registered manager. The new manager is referred to as ‘the manager’ in our report.

At the last comprehensive inspection, the service was rated requires improvement overall and inadequate in the 'Safe' domain.

We carried out an unannounced comprehensive inspection of this service on 05 June 2017. Two continuous breaches of legal requirements were found in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two other breaches were found in relation to Regulation 11 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served the provider warning notices in relation to Regulation 12 and Regulation 17 and asked them to meet the legal requirements by 11 August 2017.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulations 11 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider told us they would meet these two regulations by 30 September 2017.

We undertook this focused inspection to check that the provider had met the warning notices. We checked to see if the service was safe and well led. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Island Residential Home on our website at www.cqc.org.uk.

At this inspection, we received positive feedback from people and staff.

Medicines practice had improved. However further improvements were required to ensure that topical medicines were appropriately administered and recorded. Protocols were not in place for all ‘as and when required’ medicines. Medicines were stored effectively in a temperature controlled environment. This evidenced the provider had complied with their warning notice, however topical records needed to be improved.

Risks to people’s safety and welfare had been managed to make sure they were protected from harm. Risk assessments had been reviewed and updated when people’s needs changed. People with diabetes were appropriately supported by staff to monitor their blood sugar levels and relevant action was taken when people’s blood sugar levels were high. This evidenced the provider had complied with their warning notice.

There were suitable numbers of staff deployed on shift to keep people safe. Effective recruitment procedures were in place to ensure that potential staff were of good character and had the skills and experience needed to carry out their roles before they were employed.

Systems to monitor the quality of the service were embedded. Audits picked up a number of issues and concerns which the management team had worked through. Audit tools were continuously updated to ensure that they captured the full picture of what was happening in the home. This evidenced the provider had complied with

The inspection was carried out on 05 June 2017. The inspection was unannounced.

The Island Residential offers accommodation and long term care and support to up to 34 people. Previously the provider had provided care and support for up to 38 people; they had made changes to their registration to reduce the numbers. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors. There were 31 people living at the home on the day of our inspection.

The home had a registered manager. 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. The registered manager was not present during the inspection. The provider had employed a new manager; they were planning to apply to become the registered manager. The new manager is referred to as the manager in our report.

At our previous inspection on 29 November and 01 December 2016 we found breaches of Regulations 9, 11, 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as ‘Requires improvement’ overall and ‘inadequate’ in safe. As the provider had been rated inadequate in safe for two consecutive inspections, we placed the provider into special measures. We issued three warning notices in relation to Regulation 9, Regulation 12 and Regulation 17. We asked the provider to meet Regulation 9 and 17 by 17 February 2017. We asked the provider to meet Regulation 12 by 20 January 2017. We also asked the provider to take action in relation to Regulation 11 and Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We received an action plan on 14 February 2017 which stated that the provider planned to be compliant with Regulation 19 by 28 February 2017 and Regulation 11 by 10 March 2017. The provider had met a number of regulations as they had planned to. However, at this inspection we found two repeated breaches of Regulations and a new breach of Regulation.

At this inspection, we received positive feedback from people and their relatives. They told us that people received safe, effective, caring and responsive care.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights. However, care plans and documentation did not evidence that the MCA had been followed. MCA assessments contained conflicting information.

Medicines were not well managed. Medicines had not been recorded appropriately. There had been inconsistent monitoring of temperatures of areas where medicines were stored. Medicines had not always been given following the manufacturers guidelines.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm. Risk assessments had not always been reviewed and updated when people’s needs changed.

There were not always enough staff deployed on shift to keep people safe. At peak times such as meal times, more staff were required to keep people safe.

Systems to monitor the quality of the service were embedded. Audits picked up a number of issues and concerns which the management team had worked through. However, the audits had not picked up issues which were breaches of Regulations found during the inspection.

Effective recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience ne

The inspection was carried out on 29 November and 01 December 2016. Our inspection was unannounced.

The Island Residential offers accommodation and long term care and support to up to 38 people. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There is a passenger lift for access between floors. There were 33 people living at the home on the day of our inspection.

The home had a registered manager. 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 our previous inspection on 05 and 07 April 2016 we found breaches of Regulations 9, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as ‘Requires improvement’ overall and ‘inadequate’ in safe. We asked the provider to take action to meet the regulations.

We received an action plan on 06 July 2016 which stated that the provider had met some of the regulations already and planned to be compliant with the Regulations by 30 July 2016. However the provider had not met the regulations as they had planned to. At this inspection we found a number of repeated breaches of Regulations.

At this inspection we received positive feedback from people and their relatives. They told us the people received safe, effective, caring and responsive care.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights. Care plans and documentation did not evidence that the MCA had been followed.

People’s weights had not consistently monitored to ensure people remained in good health.

The home was in the process of being decorated, some bedrooms on the ground floor had already been completed. The majority of other bedrooms and communal areas in the home were yet to be started. These rooms were shabby and in need of repair. The flooring in a number of the bedrooms upstairs was rippled and uneven. We made a recommendation about this.

Some areas in the upstairs of the home smelt of stale urine. We made a recommendation about this. The rest of the home was clean and smelt fresh.

Topical medicines administered were not adequately recorded to ensure that people received them in a safe and effective manner. We made a recommendation about this.

Improvements had been made to the training staff had received. However not all staff had received training relevant to their roles. Some staff had not received regular supervision. We made a recommendation about this.

The decoration of the home did not follow good practice guidelines for supporting people who live with dementia. We made a recommendation about this.

People’s view and experiences were sought during meetings and through quality assurance surveys. Relatives were also encouraged to feedback through surveys. The provider had not always acted on feedback given in a timely manner. We made a recommendation about this.

People’s care plans were not complete and were not updated to ensure that their care and support needs were clear and their preferences were known.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always accurate and complete.

People were en

The unannounced inspection was carried out on 05 and 07 April 2016.

The Island Residential Home provides accommodation and personal care for up to 38 people. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There is a passenger lift for access between floors. There were 33 people living at the home on the day of our inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The provider of the service had recently changed their legal entity. The change meant that this was the first inspection for the new provider. However the home had been inspected before. We inspected the home on 13 August 2015.

When we last inspected the home we found breaches of Regulation 17 and Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made recommendations about recruitment records and maintaining a list of staff signatures who are trained to administer medicines. We asked the provider to take action in relation to Regulation 17 and Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we received positive feedback from people, relatives and health and social care professionals.

People were not protected from abuse or the risk of abuse. The manager and staff were aware of their roles and responsibilities in relation to safeguarding people; however, safeguarding incidents had not always been appropriately reported to the local authority and CQC.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm.

Recruitment practices were not always safe, gaps in employment history had not always been explored.

Staff had not all received training relevant to their roles. Some staff had not received regular supervision.

People’s care plans had not been reviewed and updated to ensure that their care and support needs were clear and their preferences were known.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had not picked up the concerns about recruitment records, risk, infection control, training, supervision, care plans and activities.

People’s view and experiences were sought during meetings and through quality assurance surveys. Relatives were also encouraged to feedback through surveys. The provider had not always acted on feedback given in a timely manner.

Some people were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible. However, people with higher care needs and those people receiving their care in bed did not have the same opportunities.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights. Care plans and documentation did not evidence that the MCA had been followed in cases. We made a recommendation about this.

People were supported and helped to maintain their health and to access health services when they needed them. However advice and guidance about meeting people’s health care needs had not always been added to people’s care plans to detail their needs had changed. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care