Acomb Court provides residential and nursing care for up to 76 older persons, some of whom are living with dementia. At the time of our inspection there were 75 people living in the home.

This inspection took place on 26 and 28 July 2017 and was unannounced. The last inspection we carried out at this service was in November 2015 when we found the provider was meeting all of the regulations that we inspected and we rated the service as good.

A new registered manager was in post and the service had been taken over by a new care provider. We were told that communication about the transition to the new provider had been good. Our records showed the new manager had been formally registered with the Care Quality Commission (CQC) since June 2017. A registered manager is a person who has registered with the 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.

We checked the management of medicines and found safe procedures were in place for the ordering, receipt, storage and administration of medicines. Staff received regular training and competency checks to administer medicines.

The premises were clean and well maintained. Procedures to prevent the spread of infection were followed and a number of checks to the safety of the premises and equipment were carried out. Individual risks to people were assessed and plans were in place to mitigate these. Accidents and incidents were monitored by the registered manager to check for patterns or trends.

There were suitable numbers of staff on duty during the inspection and staff records we checked found recruitment processes helped to protect people from abuse as appropriate checks on applicants were carried out. Staff had received training in the safeguarding of vulnerable adults and knew how to report concerns of a safeguarding nature.

People were generally 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. We found one example of where people’s rights and choices had not been supported due to the understanding of staff and training was provided to address this issue. We made a recommendation that the registered manager monitors practice in this area to ensure training is embedded in practice.

Staff received regular training, supervision and appraisals, and new staff completed an induction into the service.

The nutritional needs of people were supported. Assessments were carried out and action taken in the event of people at risk of malnutrition. People had access to a range of health professionals including GP, dietitian, and other healthcare professionals as required.

Staff were polite and caring towards people. We received positive feedback about the manner of staff from people, relatives and visiting professionals.

Care plans were in the process of being transferred to the standard documentation of the new provider. We found some care plans lacked detail and these were mainly the older style records. The registered manager had recognised this issue and had developed a plan to ensure all care plans were reviewed and updated while being transferred to new documentation. The newer style plans we read contained satisfactory information.

There were mixed views about the availability and suitability of activities. Some people told us they were happy with the activities available while others felt they had reduced. The activities coordinator was absent at the time of the inspection and we received confirmation that activities staff were back on duty following our inspection. We have made a recommendation that the provider monitors satisfaction with activities in light of the mixed feedback we received.

The registered manager carried out a

We spoke with people about the care and support they received from this service. People told us they were happy with the care and support they received. One person said, "I am happy here." Another person said, "People are very kind."

We found people's care and support needs were appropriately assessed and their care was planned. They received care safely and to an appropriate standard. One person told us, "I get the help I need." Care plans were regularly updated and contained clear information about individuals' care. People or their relatives had been involved.

People were cared for in a clean and hygienic environment and we found the service had appropriate measures in place to monitor and manage infection control.

We found people were cared for by staff who were trained and supported to deliver care and treatment safely and to an appropriate standard.

People's personal records were accurate, fit for purpose and held securely. Staff records were kept in an appropriate form.

People told us what it was like to live at this home and described how they were treated well by staff and their involvement in making choices about their care. People and their relatives told us they had confidence in the service. Comments included, "It is a good place to live", "Very clean", "I am in everyday and have been happy with what I see", "Staff are helpful and polite" and "I have had no worries."

We saw how people were treated by staff and their involvement in making choices about their care and support. We saw staff provided care and support which respected people's dignity and privacy. We saw people could receive medical and specialist attention if they needed it and were helped to fulfil their social needs within the service and community.

People told us what it was like to live at this home and described how they were

treated by staff and their involvement in making choices about their care. They

also told us about the quality and choice of food and drink available. This was

because this inspection was part of a themed inspection programme to assess

whether older people living in care homes are treated with dignity and respect

and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional.

Due to their needs, most people could not clearly tell us about night time routines, or how their choice for retiring and getting up was supported. The people we spoke with told us they were happy with the care and support offered. The people living here appeared relaxed and to get on well with the staff.

The views of the people who used the service were not obtained on this inspection.

Acomb Court provides residential and nursing care for up to 76 older persons, some of whom are living with dementia. At the time of our inspection there were 63 people in receipt of care from the service.

This inspection took place on 10 and 11 June 2015 and was unannounced.

The last inspection we carried out at this service was in November 2014 when we found the provider was not meeting all of the regulations that we inspected. These included; care and welfare of people who used the service; assessing and monitoring the quality of service provision; safeguarding people from abuse and improper treatment; dignity and respect; safe care and treatment (in respect of medicines management) and good governance (in respect of records). The provider was issued with two warning notices and they submitted action plans linked to the remaining four breaches of regulations, stating how and by when they would meet the requirements of the law. Overall we had rated the service as inadequate and the provider’s request to review that rating is on-going.

At this inspection we found improvements had been made in all of the regulations that had previously been breached.

A registered manager is required under this service’s registration with the Care Quality Commission (CQC). There was a new registered manager in post at the time of this inspection who had been registered with the Commission since May 2015. 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.

People told us they felt safe and comfortable living at Acomb Court. Staff were aware of the provider’s safeguarding policies and procedures and said they would not hesitate to raise matters of a safeguarding nature with the registered manager. Records showed that the registered manager had referred incidents to the safeguarding team within the local authority for investigation in line with her responsibilities.

Risks that people were exposed to in their daily lives had been assessed and these were reviewed regularly. Where amendments were needed to risk assessments or care plans, these had been actioned. Environmental risks within the home had been assessed and measures put in place to protect the health and wellbeing of people, staff and visitors. Health and safety checks such as those related to the servicing of equipment were carried out regularly.

The management of medicines was safe and medication audits were effective. Where minor issues with medicines had been identified these were rectified promptly. Staffing levels were sufficient to meet people’s needs and staff had been vetted through the provider’s recruitment procedures to ensure they were both of suitable character, and mentally and physically fit, to work with vulnerable adults. Staff were trained in key areas such as infection control and safeguarding. In addition, staff had received training in areas specific to the needs of the people they supported, such as training in challenging behaviour and falls prevention. Staff told us they felt supported by the newly appointed registered manager and they received regular supervision and appraisal which demonstrated this.

The Mental Capacity Act 2005 (MCA) and the principles of the best interests decision making process were appropriately applied. Where people’s families held a lasting power of attorney related to health and welfare decisions, copies of the documentation issued to prove this, had been obtained by the provider. Deprivation of Liberty Safeguards (DoLS) had been considered and applications submitted to the local authority safeguarding team for consideration.

People’s general healthcare needs were met and where there were concerns about people’s health and welfare, healthcare professionals such as psychiatrists were contacted for input into people’s care. The food available within the service was healthy and wholesome. People told us they enjoyed the food that they received. Their nutritional needs were met and they were assisted to maintain their food and fluid intake if necessary.

Our observations confirmed people experienced care, treatment and support that protected and promoted their privacy and dignity. Staff engaged with people in a kind, caring and compassionate manner and people told us they enjoyed a positive relationship with staff. We saw improvements to the effectiveness with which staff delivered care particularly to those people living with some form of dementia or cognitive impairment. People’s relatives and external healthcare professionals linked to the service gave us feedback which supported this.

Staff were aware of people’s individual needs. People told us that they were supported to engage in activities within the home if they wished to but it was their choice. Choice was promoted and we heard staff asking people throughout our visit what their wishes were. People were encouraged to be as independent as possible, although staff were available for support at the same time.

Care records overall were well maintained. A small number of daily notes had not been fully updated and we received assurances from the registered manager that this would be addressed with staff.

The home had undergone an extensive refurbishment since our last visit and the environment of the upper floor had been redecorated and accessorised with the needs of people living with dementia or some form of cognitive impairment in mind. For example, there were tactile objects for people to engage with and signage to aid orientation.

The provider gathered feedback about the service from people, their relatives and staff via meetings and surveys. There was a complaints policy and procedure in place and records showed that complaints were handled appropriately and documentation retained.

Quality assurance systems were in place and these were used to monitor care delivery and the overall operation of the service. For example, audits related to medicines management and health and safety within the building were carried out regularly. Checks on the building and equipment used in care delivery were undertaken within the recommended time frames.

The provider had a staff reward scheme in place where staff could enjoy discounts with large organisations and a bi-annual recognition awards ceremony was held, where staff could be nominated by colleagues, people and visitors for their attitude and good practice.

We noted many positive changes within the service since our last inspection. People, relatives, staff and healthcare professionals linked with the service all said that they welcomed these changes.