The inspection of Turner Home took place on 11, 13 September and 1 October 2018; the first day of the inspection was unannounced.

Turner Home 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.

Turner Home is registered to provide nursing care and accommodation for up to 59 people; in an original Victorian building and in a more recently added annexe. At the time of our inspection 45 people were living at the home.

The home had 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 this inspection the registered manager has been absent from the service and had been since August 2017.

During our inspection in January 2018 the trustees of the service appointed a general manager who took on the role as the nominated individual. The nominated individual is responsible for supervising the management of the regulated activity provided. Since that inspection the acting manager was in the process of applying to become registered with the CQC.

At our inspection in August 2016 the service was rated overall ‘requires improvement’. There were breaches of regulation 9 (person-centred care) and regulation 18 (staffing). This was because people were not receiving person centred care that reflected their preferences as to what time they wanted to be supported to get up out of bed; and there were not sufficient numbers of staff on duty at night to make sure that they could meet peoples care needs.

At our inspection in January 2018 the quality of the service had deteriorated. We found breaches of regulation 9, 10, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found there had been breaches of regulation 14 and 18 of Care Quality Commission (Registration) regulations 2009, as there had been a failure to notify the Commission of notifiable events. We issued the provider with a warning notice because there had been a continued breach of Regulation 9.

At this inspection there was a continued breach of Regulation 12 and a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because the service had not ensured that medication was always stored safely and appropriately and the service had not consistently applied robust recruitment checks on the suitability of all applicants.

However, at this inspection we saw that in many other areas there had been significant improvements in the quality of the care and support provided to people.

Improvements had been made in the way that care planning ensured that the service met people’s needs and reflected their preferences. More information had been obtained about people’s preferences and other person-centred details; this information had been used to increase engagement with people in a way that was meaningful to them. This included information on choices and decisions people made, including the details of who a person would like to be involved in any future best interest decisions. The showed service was provided in line with the principles of the Mental Capacity Act (2005).

The home’s activity room had been refurbished and now looked interesting and inviting. Also, a previously underused room had been turned into a cinema room. The service had employed three activity co-ordinators; the times they worked were staggered so that people were able to also do things into the evening time.

There was an increase in the amount and quality of activities people got involved with both inside and o

The inspection of Turner Home took place on 25 and 30 January and 8 February 2018, the inspection was unannounced.

Turner Home 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.

Turner Home is registered to provide nursing care and accommodation for up to 59 people; in an original Victorian building and in a more recently added annexe. At the time of our inspection 48 people were living at the home.

The home had 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. During our inspection we became aware that the registered manager had been absent from the service since August 2017. The registered manager was also the nominated individual for the service. The nominated individual is responsible for supervising the management of the regulated activity provided.

There was an acting manager at the home and an acting deputy manager. During our inspection the trustees of the service appointed a general manager to support the management of the home.

At our previous inspection in August 2016 the service was rated overall ‘requires improvement’. There were breaches of regulation 9 (person-centred care) and regulation 18 (staffing). This was because people were not receiving person centred care that reflected their preferences as to what time they wanted to be supported to get up out of bed; and there were not sufficient numbers of staff on duty at night to make sure that they could meet peoples care needs.

At this inspection we found breaches of regulation 9, 10, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found there had been breaches of regulation 14 and 18 of Care Quality Commission (Registration) regulations 2009, as there had been a failure to notify the Commission of notifiable events.

We observed times when staff did not protect people’s dignity or privacy, showed a lack of respect or were overly focused on the task at hand and not the person and any impact their actions may have. We also saw a lack of dignity in how people’s daily notes and records were written.

We saw in people’s care files that there was insufficient information on risk assessments and they had not always been updated to reflect current risks. Some risk assessments were missing background information which would be needed to assess a risk and at times a necessary risk assessment was not in place.

The service provided was not in line with the principles of the Mental Capacity Act (2005). People’s consent had not always been sought for the support they received. Care planning often did not demonstrate how decisions had been made in people’s best interests. People’s care plans lacked sufficient guidance for staff and did not give information on people’s history, lifestyle choices and preferences.

The acting manager and deputy manager were unable to show us the system for reporting, reviewing and learning from incidents and how this information was used to inform the risk assessment process.

The administration and recording of medication was not always safe. The nursing staff did not have protected time when administering medication and they experienced distractions. Some administration records and the stocks and balances of some medication had not been consistently recorded; at times it had been recorded and the figures were inaccurate. This made it impossible to work out if the stocks were correct and therefore to be assured that the correct medication had been given to people. Audits of the med

The inspection took place on the 9 and 10 August 2016 and was unannounced. The Turner Home is registered to provide accommodation for 59 people who require nursing or personal care. There were 52 people living at the home at the time of this inspection. The building is split into two units. A newer annex where 42 people lived and the original building where 10 people lived.

We went to The Turner Home at 6:00 am as the CQC had received concerning information regarding people being got up out of bed by the night staff from 5:30 am.

The manager was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run. The registered manager was not available for this inspection, we spent time with two senior nursing staff and the deputy manager.

At this inspection we found breaches relating to people not being provided with person centred care as people were being got up very early and moved into the main lounge areas by the night staff. The staffing levels at night were not at all times adequate to meet the care of the 52 people. Also people were not receiving activities for stimulation during the daytime to support their wellbeing. You can see what action we told the provider to take at the back of the full version of the report.

People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided had been checked. Where people had lost weight this was recognised with appropriate action taken to meet the person’s nutritional needs.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that care plans and risk assessment monthly reviews records were all up to date in the six files we looked at however there was not a lot of information recorded by staff that reflected the changes of people’s health in the monthly reviews.

People were not having enough person centred activities provided by the service to promote their wellbeing.

People told us they felt safe with staff. The deputy manager had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required. However two recent incidents that had occurred in The Turner Home had been reported to the local authority but not to the CQC.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

We found that medicines were managed safely and records confirmed that people received the medication prescribed by their doctor.

The staffing levels were seen to be adequate on the day shifts however the staffing levels at night fluctuated from six to four staff which was not adequate at times to support people, meet their needs and undertake the tasks required. Day staff did not have time to provided activities or one to one stimulus to promote people’s wellbeing.

The home used safe systems for recruiting new staff. These included using DBS checks and annual self-disclosure checks made with the manager. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home. Senior sta

During our visit we spoke with five people who used the service and six staff. We looked at the care records of six people who used the service to see how their needs should be met. We also looked at staff rotas and information on complaints.

We observed that there was good rapport and interaction between the people who used the service and staff. People who used the service told us that they received the appropriate care and support that they needed. They also told us they had choices in what they wanted to do such as when to get up, meals and activities.

Some people who used the service had limited verbal communication but could communicate in a number of other ways. They were supported by staff who knew the appropriate way to communicate with them when decisions needed to be made about their care and welfare.

All residents had an individual care record. One person told us, "They are very good (the Staff) nothing is any bother for them".

There were enough qualified and skilled staff on duty to meet the needs of the people who used the service. People told us they had no concerns about the staff and had no complaints about the care home.

We saw evidence that the Turner Home had acted on recommendations in the previous inspection report regarding work that was needed to ensure that any risks of receiving care or treatment that was inappropriate or unsafe were identified and acted upon in a timely manner.

People using the service told us they liked the staff and that staff had always been polite and respectful towards them. They said staff had talked to them about their care and treatment and had always gained their permission before providing them with intimate care and support such as with bathing and showering.

People told us they had been well cared for by staff at the home and that staff had supported them to attend appointments such as with their GP, chiropodist and at hospital. People knew about their care plan and said they thought staff knew their needs well. People said they had enjoyed organised trips out with staff and others said they had enjoyed getting out and about locally on their own.

People told us they knew how to complain and would do if they needed to. They said they knew they would be listened to and were confident that their complaint would be properly dealt with.

People using the service and a person's relative told us they had had no concerns about the way people had been treated. They told us they would report an incident of abuse right away.

People said staff were good at their jobs and they felt confident in their care. They said they thought staff were well trained and properly supervised.

People told us that the manager had regularly approached them and had asked how things had been and if they had any concerns or other comments about the service they received.