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

Addison Court is a nursing and residential care home registered to provide care for up to 50 people. Facilities for people who used the service were provided over three floors. The second floor was a small unit that cared for people living with a dementia. All of the bedrooms were of single occupancy and had access to en-suite facilities. There was easy access to a private garden with seating available for people during the warmer months. During this inspection there were 39 people using the service.

The service did not have a registered manager in place. 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. An interim manager was currently in place until such time as an appropriate manager was appointed.

We undertook an unannounced focused inspection of Addison Court Care Home on 9 May 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 5 and 6 February 2017 had been made. The team inspected the service against one of the five questions we ask about services: is the service safe? This was because the service was issued with a warning notice [a warning notice specifies the timescale by which the registered person must comply] in relation to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the provider had failed to deploy sufficient numbers of staff to meet the needs of people living at the home. We found the required improvements had been made.

At our comprehensive inspection of 5 and 6 February 2017, we found breaches of legal requirements in relation infection control, premises and equipment, good governance and staffing. We also made recommendations in relation to the management of medicines and activities. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements and by what date. The provider told us they would be compliant by the 24 April 2017.

During this inspection we found improvements had been made; however we found further concerns in relation to medicines. We also found issues with care plans and staffing levels; in particular the high use of agency staff and quality assurance systems failed to identify issues we identified.

All the staff we spoke with confirmed they had received training in safeguarding and knew their responsibilities to report concerns.

Medicines were not always managed safely. Prescribed medicines had not always been administered as directed.

We observed nurse calls alarms were sounding for long periods of time before being answered. We noted a high use of agency staff within the service. We discussed our concerns with the interim manager who told us they had been recruiting and were awaiting recruitment checks to be completed and new staff would be commencing.

All the people we spoke with felt the service was clean and tidy. All the staff we spoke with had completed training in infection control. We saw the service was clean and tidy. We saw staff wearing personal protective equipment as and when necessary.

All the people we spoke with felt that staff members were skilled and knowledgeable. Staff members told us they had received an induction when they commenced employment, although none had undertaken the Care Certificate. We saw a significant amount of online courses were available to staff and some staff had undertaken Diploma’s in Health and Social Care.

We looked at how often staff received supervision and found these were not as regular as specified by policies and procedures. The interim manager had identified this and improvements were noted from

The inspection took place on 9 May 2017 and was unannounced.

Addison Court is a nursing and residential care home registered to provide care for up to 50 people. Facilities for people who used the service were provided over three floors. The second floor was a small unit that cared for people living with a dementia. All of the bedrooms were of single occupancy and had access to ensuite facilities. There was easy access to a private garden with seating available for people during the warmer months.

The service had a registered manager in post. 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.

We carried out an unannounced comprehensive inspection of this service on 5 and 6 February 2017. Breaches of legal requirements were found in relation infection control, premises and equipment, good governance and staffing. We also made recommendations in relation to the management of medicines and activities. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. As there had been a previous breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 in relation to staffing we issued the provider with a warning notice. A warning notice specifies the timescale by which the registered person must comply.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. 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 (Addison Court) on our website at www.cqc.org.uk

All of the staff we spoke with all told us they had no concerns in relation to staffing in the home and all were positive about the changes the provider had made since our last inspection.

We checked duty rotas and staffing analysis to check to the numbers of staff that were available to support people’s individual needs.

The inspection took place on 5 and 6 February 2017. The first day was unannounced.

Addison Court is a nursing and residential care home registered to provide care for up to 50 people. Facilities for people who used the service were provided over three floors. The second floor was a small unit that cared for people living with a dementia. All of the bedrooms were of single occupancy and had access to ensuite facilities. There was easy access to a private garden with seating available for people during the warmer months.

The service had a registered manager in post. 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 the last inspection on 9 October 2015 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing and records. We asked the provider to take action to make improvements and to send us an action plan. The provider complied with our request. During this inspection we found some improvements had been made. However during this inspection we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to infection control, the environment and equipment and good governance. We also made recommendations in relation to the management of medicines and activities.

We also found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 in relation to staffing. You can see what action we told the provider to take at the back of the full version of the report.

We saw medicines were administered safely to people who used the service during our inspection. However we identified concerns relating to the storage of creams and the recording of maximum and minimum room temperatures where medicines were stored.

We saw safe recruitment processes in place. However we identified some concerns relating to the staffing numbers in the home during our inspection.

People who used the service told us they felt safe in the home and there was evidence of risk assessments in place to protect people from harm.

We had concerns relating to the environment, the storage of equipment and cleanliness in a number of areas of the home.

We saw evidence of reviews taking place by health professionals on people’s health and wellbeing where it was required.

All of the staff we spoke with had an understanding of the principles of the MCA and best interest’s decisions. Staff were seen asking for peoples consent before they undertook any care or activity.

Meals provided to people looked appetising and where people required a special meal, this was provided. Staff members’ were observed engaging positively with people who used the service and supported people respectfully in the dining areas of the home.

Staff treated people with dignity and respect. Staff were discreet when discussing care needs and it was clear they were familiar with people’s individual needs, wishes and choices.

Where people who could not make decision for themselves and had no family to support them, information on the use of advocacy service was available to support them, advocacy services was available and information on how to access this was displayed within the home.

Care files reflected people’s individual needs and demonstrated regular reviews had taken place to ensure they reflected people’s current needs. Care plans and risk assessments detailed guidance for staff on how to support people safely and ensure they received care that was tailored to their individual need.

We saw evidence of completed investigation’s when dealing with complaints. Staff understood their responsibilities when dealing with a complaint and

We carried out an unannounced inspection on the 16th December 2014.

Addison Court is registered to provide care for up to 50 people. The home was providing care for people with nursing and personal care needs, including people living with a dementia. The registration requirements for the provider stated the home should have a registered manager in place. We were told the registered manager had recently left the home and there was an interim manager in post. On the day of our inspection the interim manager was supported by the operation director. It is a regulatory responsibility for registered providers to inform the Care Quality Commission of a home that has no registered manager for longer than 28 days. The interim manager told us they would submit a notification to inform the commission that the location would be without a registered manager for longer than 28 days.

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 person responsible for the day to day running of the home on the day our inspection was an interim manager.

We saw evidence of safeguarding investigations taking place in the home; however we had been made aware of a number of safeguarding investigations that had taken place that the home had not notified CQC about. The interim manager informed us this will be a priority in the home. Staff were aware of the signs of abuse and the actions they would take if they suspected abuse was taking place. The Mental Capacity Act 2005 (MCA 2005) sets out actions to be taken to support people to make their own decisions wherever possible. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty in their own best interests. Staff we spoke with were able to demonstrate an understanding of the MCA and DoLS and all staff were able to confirm what actions they would take to protect people who could be at risk of their liberty being deprived. Effective systems of referral for people at risk of being deprived of their liberty were in place.

Systems were in place to ensure medications were administered, stored and recorded safety in the home. We observed staff during part of the morning medication round. People told us staff informed them what medication they were taking. Staff told us they would ensure a medication that had not been dated as opened in the fridge was appropriately dated and signed.

Duty rotas which detailed staffing numbers in the home identified consistency, however staff, relatives and people who used the service we spoke with told us there was not enough staff cover in the home. We were told that the staffing numbers were low on the day of our inspection due to sickness however we noted extra staff arrived to cover the shift.

Care files we looked at had evidence of nutritional assessments in them including, fluids charts with targets and evidence of care plans relating to their dietary needs. Prior to our inspection we had been made aware of concerns that related to one person who used the service and observation by staff during their meal times. We looked into this during our inspection and discussed our concerns with the interim manager of the home. They told us an investigation had been commenced and confirmed actions had been taken as a result of the incident. There was evidence of care planning that was person centred and met people’s individual needs.

People we spoke with told us they received good quality care at the home. For example one comment we received was, "The staff are very caring, I get to see the doctor if needs be and I can be alone when I want to." Relatives we spoke with were complimentary about the care their relative received in the home. We observed the care provided to people who used the service in a variety of the public areas of the home. We noted people who used the service were consulted about their care and staff responded in a positive manner to them. However we noted two of the dining areas were left unsupervised at times during meal times. There was evidence of activities taking place on the day of our inspection we saw the children from the local school visited to sing carols.

We looked at the complaints and compliments file that was kept in the home. We saw evidence of positive feedback about the home. There was evidence of the complaints with dates of the complaint and notes relating to investigations that had taken place including actions that had been taken.

We received mixed feedback about the support staff received from the manager in the home. Relatives of people living in the home told us they felt the home was well led.

Systems to ensure people who used the service were safe and monitored were in place. This was because we looked at how the provider monitored and audited the home. We saw the home completed a monthly manager’s audit which had been done recently.

We spoke with several people living in the home and observed medicines being administered. One person told us ‘’Staff are very kind’, they look after me’’. Due to people having varying degrees of dementia we could not obtain their direct views but overall we found medicines were being safely and appropriately managed.

We visited this service because there were some concerns about the way medicines were managed at our last visit in July 2013.

We did not talk to people about their medicines during this visit. We observed how they were given their medication and we spoke to the nurse and carer administering medicines on the day of our visits. We also looked at records about their medication and the medicines in the home for them.

We visited this service because some concerns about the way medicines were managed had identified by the safeguarding team in May 2013.

We did not talk to people about their medicines during this visit. We observed how they were given their medication and we spoke to the nurses administering medicines on the day of our visits. We also looked at records about their medication and the medicines in the home for them.

People using the service told us they were satisfied with the care provided at Addison Court and were encouraged to make choices and be as independent as possible. One person said, “I have never had trouble with the care, they look after me alright”.

We found that suitable arrangements were in place for the safe keeping and handling of medicines.

We saw that members of staff were attentive to people’s needs and responded promptly when people required assistance. One person told us she didn’t have to wait long when she rang the nurse call bell.

We noted that systems were in place to monitor the quality of the service provided. People using the service were involved with making decisions which affected them personally.

We saw that people were treated with respect and their dignity promoted. One person said,” I’m looked after and the staff are lovely.”

We were told that new members of staff were provided with induction training appropriate to their role. This ensures that people are protected from receiving unsafe care.

We found that staffing levels had been increased throughout the home in order to improve the standard of care provided and ensure people’s health and social care needs were met.

People using the service told us they were happy living at Addison Court. One person said, “They look after me well”. However, we saw that people’s right to dignity was not always maintained.

People who were able to express an opinion told us they were satisfied with the care provided at Addison Court. However, we found that care was not always delivered by properly trained care workers on the dementia unit which meant people were at risk of receiving unsafe care.

We saw that suitable arrangements were in place for the safe keeping and handling of medicines.

Although there was enough staff on duty on the residential unit we found that staffing levels on the dementia unit were insufficient to fully meet the care needs of people using the service.

We found that a system was in place for monitoring the quality of the service provided. We saw evidence to demonstrate that people using the service were given the opportunity to express their views about the home.

We carried out an unannounced inspection of Addison Court on 14 and 17 August 2015.

Addison Court is registered to provide accommodation and nursing and personal care for up to 50 people, including a separate unit for 13 people who are living with dementia. At the time of the inspection there were 48 people accommodated in the home. The service is purpose built over three floors and is located close to Accrington town centre.

The registration requirements for the provider state the home should have a registered manager in place. There was no registered manager in post on the day of our inspection as the previous registered manager had left in March 2015. 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.

A new manager had been recruited and had been in post for seven weeks. The manager would be making an application to be registered with CQC.

At the previous inspection on 16 December 2014 we found the service had failed to notify CQC of abuse or allegations of abuse in relation to a service user. The registered provider was asked to take action to make improvements and this action had been completed.

Prior to this inspection visit there had been concerns raised regarding the delivery of people’s care, the numbers of staff, the standard of the environment and the recording of people’s care and support. We brought our planned inspection forward.

During this inspection visit we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to failure to provide sufficient numbers of staff and failure to maintain an accurate record of care and treatment given.

People told us they did not have any concerns about the way they were cared for. They said, “Staff are very good with us; staff are kind” and “I’m happy here; I’m cared for.” Relatives also spoken with expressed satisfaction with the service. They said, “Staff are very kind; I’m thankful for everything they do.” During the inspection we did not observe anything to give us cause for concern about how people were treated.

During our inspection visit we were told the service had been short staffed and that short notice sickness/absenteeism had created additional problems. We found a variance in the number of available staff on a day to day basis and observed that people were left unattended for periods of time. We were told, “Staffing is an issue. Sometimes people don’t turn up.” People’s opinions about staffing levels varied. One person said, “There are enough staff; always someone around.” Visitors said, “There have been staff changes resulting in lack of continuity” and “There are enough staff.” The manager told us she had recently recruited a number of nursing and care staff who were awaiting completion of employment checks. You can see what action we told the provider to take at the back of the full version of the report.

Prior to the inspection we were told there were concerns about the lack of detail in people’s care records. We found the detail in the care plan did not reflect the care and support that was being given, the care people needed or how their care would be delivered by staff. In addition the care plans had not been updated regularly by staff and people had not been involved in the reviews of their care. However people told us they were kept up to date with any changes and decisions about care and support. You can see what action we told the provider to take at the back of the full version of the report.

We looked at the arrangements for keeping the service clean and hygienic. We found the home was clean although there were odours in some areas of the home. We discussed this with the manager who was aware of improvements that needed to be made. We made a recommendation about the need to follow guidance in this area.

We saw there were not always strategies recorded to guide staff with dealing with behaviours that challenged the service. However, staff had received training in this area which would help to keep themselves and others safe. They told us they were able to respond appropriately to behaviours that challenged the service. We made a recommendation about seeking advice with regards to the appropriate recording of strategies to support people with behaviours that challenged the service.

Staff had an understanding of safeguarding vulnerable adults from harm and had received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. We noted appropriate DoLS applications had been made to ensure people were safe and their best interests were considered.

The complaints procedure was displayed and advised people how to make a complaint and how and when they would be responded to. People were encouraged to discuss any concerns during meetings, during day to day discussions with staff and management and also as part of the annual survey. People told us they could raise any concerns with the staff or managers. One person said, “I would certainly speak up if I wasn’t happy with something”. Visitors said, “I have raised concerns but they keep happening due to staff changes” and “There is a new manager and I would speak to her; I’m sure she would get things sorted.”

Employment checks were completed before new staff started work to make sure they were suitable to work in the home. Staff had been provided with induction, training and support to help them look after people properly.

People told us they enjoyed the meals. They told us, “The food is alright; the cook knows what I like”, “The meals are very good and very tasty; there is always a choice”, “I can have a supper; there is always something” and “If I don’t like the meal they will make me something else or even go to the shop for me.” We saw people being sensitively supported and encouraged to eat their meals. The menus and records of meals served indicated people were offered alternatives to the menu.

People were able to participate in a range of suitable activities both inside and outside the home. People living in the home said, “There’s always plenty going on” and “I’m not bored. I have made some new friends to talk to. There is always something to read or do.” A visitor said, “It’s difficult to suit everyone but they try to keep people interested.” Activities provided included games, exercise, shopping, chit chat club, movie afternoons, gardening, church services, hand and nail care, one to one sessions, arts and crafts.

Improvements had been made to the way people’s medicines were managed. There were safe and appropriate processes in place for the ordering, receipt, administration and disposal of medicines.

We looked around the home and found areas were well maintained. People told us they were happy with their bedrooms and some had created a homely environment with personal effects such as furniture, photographs, pictures and ornaments. Appropriate signage was in place throughout the home although the top floor corridors were not very interesting or stimulating for people who were living with dementia. Safe and secure gardens could be accessed from the ground floor. Aids and adaptations had been provided to help maintain people’s safety, independence and comfort. We made a recommendation about the need for a dementia friendly environment.

We found systems were in place to assess and monitor the quality of the service although we found some gaps in the auditing systems. The manager had already identified this shortfall and action had been taken to re introduce the quality monitoring systems.

People’s views and opinions were sought about the running of the home. People had completed a customer satisfaction survey to help monitor their satisfaction and happiness with the service provided. The results had been analysed and displayed on the notice boards and showed 50% of people were overall happy with the service and 80% were overall satisfied with the service. This information was being used to improve the service.