This comprehensive inspection took place on 13 and 14 November 2018; the first day of the inspection was unannounced.

Towneley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Towneley House is registered to provide accommodation and personal care for up to 22 older people; there were 21 people living in the home at the time of the inspection. The home is situated in a residential area in Burnley near to Towneley Park. Accommodation is provided over three flours in 12 single bedrooms and four shared bedrooms; 13 of the bedrooms have an en-suite facility and all upper floors are accessible via stair lifts. Communal space is provided in two lounges, a dining room and a conservatory.

The service was managed by a registered manager. 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. The registered manager was not present on either day of the inspection. We therefore had to contact them after the inspection to request additional information from them; this was received within the requested timescale.

At our last inspection in February 2017 the service was rated as requires improvement. This was because we found there was a continuing breach of the regulation in relation to record keeping. There was also a continuing breach of the regulation which requires providers to notify the commission of important events which occur in the home. We therefore issued a fixed penalty notice in relation to this breach of regulation. In addition, we found further shortfalls in the maintenance of one person's bedroom, the implementation of the Mental Capacity Act (MCA) 2005 and the recruitment of new staff. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations.

During this inspection, we found improvements had been made in relation the submission of required notifications, the implementation of the MCA and the recruitment of staff. However, we identified five breaches in regulations. These related to the way medicines were managed in the home, the lack of risk assessments and care plans for one person and the measures in place to ensure people’s dignity and privacy were protected. There was also a lack of robust governance systems to monitor the quality and safety of the service. This has led to the service again being rated as required improvement. This is the fourth consecutive time the service has been rated as required improvement since May 2015. You can see what action we told the provider to take at the back of the full version of the report.

The provider had a quality assurance system in place which included the completion of audits relating to care plans, medicines, the environment and infection control. However, these had not been effective enough to identify the shortfalls we found during this inspection.

Although systems were in place for the safe handling of medicines, we found arrangements for the administration of prescribed topical creams needed to be improved. In addition, improvements were needed to ensure all medicines were stored safely to prevent misuse. Staff had not followed the correct procedure to authorise the covert administration of medicines for one person in their best interests (i.e. in food or drink when the person was unaware), although at the time of the inspection medicines were not being administered in this way.

We looked at the care records for four people and found one person did not have any care plans or risk assessments

We carried out an inspection of Towneley House on 14 and 16 February 2017. The first day was unannounced.

Towneley House is registered to provide accommodation and personal care for up to 22 older people. It specialises in providing care for people living with a dementia. The home is situated in a residential area in Burnley near to Towneley Park. Accommodation is provided in 13 single bedrooms and three shared bedrooms, 13 of the bedrooms have an ensuite facility. Communal space is provided in two lounges, one dining room and a conservatory.

The service was managed by a registered manager. 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 our last comprehensive inspection on 8 and 9 October 2015, we found the provider was not meeting two regulations. We therefore asked the provider to make improvements to the maintenance of records and ensure statutory notifications were submitted to commission without delay. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations.

During this inspection, we found there were continuing shortfalls in respect to record keeping and the provider had not notified the commission of three events in the home. We received the notifications following the inspection. We also found further shortfalls in the maintenance of one person’s bedroom, the implementation of the Mental Capacity Act 2005 and the recruitment of new staff. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. Whilst some risks had been assessed and documented, we found the assessments had not always been updated in line with changing needs. Similarly, we found people’s care plans had not always been kept up to date. This is important to ensure staff have accurate information about people’s current needs.

People's medicines were managed appropriately and according to the records seen people received their medicines as prescribed by health care professionals.

Whilst there was a system in place to record accidents and incidents, we saw an analysis had not been carried out in order to identify any patterns and trends.

We saw the communal areas of the home had been decorated and maintained to satisfactory standard. However, we found one person’s bedroom was in an unacceptable condition which compromised their safety and right to dignity. This situation had not been identified by the provider. We also noted staff had not been instructed on how to close a window in another person’s bedroom which had resulted in the person experiencing discomfort.

At the time of the inspection, there were sufficient staff on duty to meet people’s needs, however, we found shortfalls in the recruitment of new staff and noted essential checks had not always been carried out.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training. Since the last inspection, the registered manager had ensured all staff received regular supervision. All staff had the opportunity to attend meetings and provide feedback on the service. Staff spoken with told us they were well supported and had full confidence in the registered manager.

We found appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority. However, we noted there was no evidence to indicate people’s mental capacity to make their own decisions had been assessed and recorded in line the requirements of the Mental Capacity A

We carried out this inspection to follow up progress on compliance actions identified at our last inspection on 16 September 2013. The provider sent us an action plan and stated the service would be compliant by 31 January 2014. On this inspection we found the necessary improvements had been made.

People spoken with were satisfied with the service provided, one person told us, “I like it here” and another person said “It’s very nice”.

People’s care and support was planned and delivered in accordance with their needs. Since our last visit people’s care plans had been updated to provide staff with more detailed information on people’s healthcare needs.

There were suitable arrangements in place for the management of medication. Staff designated to administer medication had received appropriate training and their competence had been tested to ensure they could handle medicines in line with the home’s policies and procedures.

People told us they were happy living in the home and they were satisfied with the care and support provided. One person told us, “It’s very good and the staff are nice” and another person commented, “I’m happy here and have no worries”.

People had an individual plan of care which was supported by various assessments and daily care records. However, we found information in the plans was limited and did not always provide staff with guidance about how best to meet people’s needs.

Whilst there were suitable policies and procedures in place to manage medication, we found some improvements were needed in respect of the management of medication.

Staff were provided with appropriate training opportunities and were invited to attend regular meetings.

There were systems in place to monitor the quality of the service, which included seeking the views of people living in the home.

During our last inspection of the service on 3 April 2012, we found issues resulting in non compliance with outcome 7 (Safeguarding people who use services from abuse), outcome 12 (Requirements relating to workers) and outcome 16 (Assessing and monitoring the quality of service provision). We therefore carried out this inspection to check the progress made to achieve compliance.

On this inspection, the provider was compliant in all outcomes assessed. We noted staff had completed additional training on managing challenging behaviour and risk management plans had been devised for one person with the potential to display behaviour which challenged others and the service. As a result of the application of the plans, the person’s behaviour had stabilised and were more settled in the home.

The recruitment and selection procedures for new staff had been revised and we found all checks had been carried out on new employees in line with legal requirements.

A series of audits had been introduced to monitor and evaluate the quality of the service and action plans had been devised to address any shortfalls. People spoken with told us they were satisfied with the service provided.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. People were involved wherever possible in the care planning process and their views were sought about how the care was provided.

People’s needs were assessed and care was planned and delivered in line with people’s needs. We saw that each person had a care plan which had been reviewed at least once a month. The plans contained information and guidance for staff about how best to meet people’s needs. One person told us, “I am looked after and the staff are good” and another person said, “Everything is going well, I’m happy here”.

The staff had received training on safeguarding vulnerable adults; however, we noted from looking at one person’s records that one member of staff had responded inappropriately to one person’s behaviour. The provider assured us this incident would be investigated.

Work was ongoing on the premises and this was due to be completed as scheduled in the summer of 2012. Appropriate arrangements were in place for routine maintenance and repairs. People were satisfied with their rooms which they could personalise with their own belongings.

We found from looking at staff files, not all checks had been collated during the recruitment procedure. These are important so the provider can be assured all information provided by applicants is accurate and staff are suitable to work with vulnerable adults.

Whilst the provider had developed a system of audits these had not been implemented at the time of our visit. We also found the results from satisfaction questionnaires had not been collated and analysed. This meant the overall quality of the service and outcomes for people living in the home had not been fully assessed or monitored.

People told us they were happy living in the home and they were able to express their views and opinions about the level and type of care they were provided. One person said “I’m happy living here and I feel well looked after” and another person commented, “It’s very homely”. People spoken with felt they were well cared for and the staff respected their rights to privacy and dignity.

Visitors were welcome in the home at any time and people said they were supported to maintain good contact with their family and friends. Relatives spoken with were very satisfied with the quality of care provided and felt that their family members were looked after in a caring and sensitive manner.

People made complimentary comments about the food and said the staff and the cook were aware of their likes and dislikes, so they were could plan the meals around everyone’s preferences.

People said they enjoyed participating in the activities, particularly the twice weekly trips out of the home. On the day of the visit several people enjoyed a day trip to Fleetwood and people were looking forward to a forthcoming two week holiday to Spain.

We carried out an inspection of Towneley House on 8 and 9 September 2015. The first day of the inspection was unannounced.

Towneley House is registered to provide accommodation and personal care for up to 22 older people. It specialises in providing care for people living with a dementia. The home is situated in a residential area in Burnley near to Towneley Park. Accommodation is provided in 13 single bedrooms and three shared bedrooms, 13 of the bedrooms have an ensuite facility. Communal space is provided in two lounges, one dining room and a conservatory.

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. However, the registered manager was due to leave the home the week following the inspection and was not present during our visit. The provider was planning to take full responsibility for the day to day management of the home until a new manager could be appointed.

We last inspected this home on 13 and 14 April 2015 and found the service was meeting the regulations in force at that time. However, we made three recommendations in respect of the development of cleaning schedules and quality monitoring systems as well as the implementation of the Mental Capacity Act 2005.

During this inspection we found progress had been made in respect of the recommendations. However, we found there were two breaches of the regulations related to people’s care plans and the notification of incidents. You can see what action we told the provider to take at the back of the full version of the report. We also made a recommendation in respect of on going staff supervision.

People told us they felt safe and were well cared for in the home. Staff knew about safeguarding procedures and we saw concerns had been dealt with appropriately, which helped to keep people safe. However, the provider had not notified us of two incidents in the home and an allegation of abuse in line with the current regulations. We received the notifications following the inspection.

As Towneley House is registered as a care home, CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate applications had been had been made to the Local Authority for a DoLS. Staff had completed relevant training and had access to appropriate policies and procedures relating to DoLS.

Staff had been trained to handle medication and records seen gave detailed information about people’s medication requirements. Records and audits were in place which ensured people received their medication in a safe manner.

A robust recruitment procedure was followed. Staff had completed relevant training for their role and told us they were well supported by the management team. However, we found the staff had not received a recorded supervision for many months.

Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food.

People had opportunities to participate in a variety of activities and we observed staff actively interacting with people throughout our visit. All people spoken with told us the staff were caring and kind. We saw that staff were respectful and made sure people’s privacy and dignity were maintained. People and a relative spoke positively about the home and the care they or their family member received.

Each person had an individual care plan and risks to their health and well-being had been assessed. However, we noted two people’s plans and risk assessments had not been updated to reflect their current needs.

All people, their relatives and staff spoken with had confidence in the provider and felt the home was well managed. We found there were systems in place to assess and monitor the quality of the service, which included feedback from people living in the home.