This inspection took place on 10 April 2017 and was unannounced. At our last inspection on 17 and 19 May 2017 there were three breaches of the Regulations. These were for Regulation 18, Staffing; Regulation 9, Person-centred care; and Regulation 12, Safe care and treatment. During this visit we found some improvements had taken place, but there were areas which continued to require improvements from out last visit, and other concerns identified.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions to a rating of ‘good’.

Ardenlea Court is a ‘care home’ which provides nursing care. 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 home provided support to people with physical disabilities and people who live with dementia. The ground floor provided permanent residency to eight people, and an Intermediate Care Unit (ICU) comprising of 18 beds. The ICU provided beds contracted by the NHS for people who were ready to leave hospital but required further assessment to determine their longer term needs. These are termed 'discharge to assessment' beds. The first floor provided a maximum of 29 beds for people who lived with dementia. On the day of our visit 51 of the 55 beds were occupied.

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. The registered manager was new in post and had been registered with the CQC in February 2018.

Since our last inspection the management team at the home had changed. The previous registered manager and deputy manager left at the end of 2017, and a number of staff left around the same time. Up until the departure of the previous registered manager and deputy manager, we were informed there had been improvements at the home; but on the departure of key people, the standards of care and treatment had again slipped.

At our last inspection the provider breached Regulation 9 of the Health and Social Care Act, Person Centred Care. This was because people who lived on the first floor dementia unit had little engagement with staff and limited opportunities to be involved in activities that reflected their interests and hobbies. During this visit we found some improvements had been made, but not enough to achieve compliance of this regulation. This was because whilst some people were receiving a responsive service, a number of people with more complex needs on both floors were not receiving the responsive service they needed. Care records often provided just adequate information about people, and some information was difficult to read.

At our last inspection the provider breached Regulation 12 of the Health and Social Care Act; Safe care and treatment. This was because medicines on the Intermediate Care Unit were not always managed safely and risks to people’s health and welfare had not always been appropriately assessed. Prior to our visit we had been informed there were concerns with medicine management on the intermediate care unit. This was particularly around the management of medicines for people newly admitted to the home and nursing staff ensuring that people received the correct medicines when their prescription had changed. At the time of our visit this had started to improve, but there continued to be issues. We found some improvements in the areas of risk management identified at our last inspection, but during this inspection we found that people’s risks had still not always been appropriately ident

This inspection took place on 17 and 19 May 2017. The first day of our visit was unannounced; however we informed the manager we were returning on 19 May 2017.

Ardenlea Court is a nursing home which provides nursing care to people with physical disabilities and people who live with dementia. The ground floor provides a permanent residency to eight people, and an Intermediate Care Unit (ICU) comprising of 18 beds. The ICU provides beds contracted by the NHS for people who are ready to leave hospital but require further assessment to determine their longer term needs. These are termed ‘discharge to assessment’ beds.

The first floor provides a maximum of 29 beds for people who live with dementia. On the day of our visit there were 50 of the 55 beds occupied.

There was 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 our last visit we had rated the home as ‘Good’ overall and ‘requires improvement’ in ‘Responsive’. During this visit we found the quality of the service had slipped and the rating was now ‘Requires Improvement’ overall. We found however, that the organisation was aware of most of the concerns found at this inspection, and had already started to take steps to improve the service.

The registered manager had to take an unexpected leave of absence which lasted a few months. They had recently returned and were being supported by a regional support manager to improve the service after internal management checks found the service was not meeting the organisation’s internal compliance standards.

A combination of staff deployment and/or insufficient staff meant nursing staff on the ground floor were not able to meet people’s needs safely, and staff working in the dementia unit, were not able to support people’s independence, social and emotional needs well.

Prior to our visit, the home’s medicine management had been audited by an external pharmacy technician. They found concerns in the home’s management of medicines. During our visit we found further concerns. Risks related to people’s health and well-being were not always fully or accurately assessed.

As was identified at our previous inspection, people who lived at the home on a permanent basis, continued to not have enough support to take part in individual or group activities, or activities that reflected their needs and wants.

Staff understood the Mental Capacity Act, and Deprivation of Liberty Safeguards (DoLs) had been applied for where people’s liberty was restricted. Most people’s capacity to make decisions had been assessed.

The menu for the home offered people a choice of meal each day. However, care practice meant that people who lived with dementia were not offered a choice in a way they could understand. The home catered for people with specific diets and nutritional needs.

Staff had received sufficient training to support people’s health and safety. Nurses received training to support them in clinical practice and to maintain their nursing registration. Staff did not receive sufficient training to support practice at the home being classed as ‘specialist dementia care’.

Checks were carried out prior to staff working at the home to reduce the risk of employing staff unsuitable to work at Ardenlea Court. Staff understood their roles and responsibilities to keep people safe.

Premises and equipment were safe for people to use. The dementia unit had recently been redecorated and provided a nicer environment for people who lived with dementia.

Most staff were caring and kind and treated people with dignity and respect. Staff felt the registered manager was approachable and open to their suggestions and ideas.

Visitors were welcome at t

We carried out this inspection on 4 March 2015. The inspection was unannounced.

Ardenlea Court is registered for a maximum of 55 people offering accommodation for people who require nursing or personal care. At the time of our inspection there were 52 people living at the home.

The home is purpose built and has two floors. The ground floor accommodates people with nursing needs, some of which are end of life care. It also has 18 intermediate care beds. These beds are used to assist in the prevention of admission to hospital and for rehabilitation after leaving hospital. The first floor accommodates people with a diagnosis of dementia and also people who need support to maintain their mental health

A requirement of the service’s registration is that they have 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 a 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 time of our inspection a registered manager was in post.

At our last inspection in September 2013 the home was found to be compliant in all areas we inspected.

Care provided at Ardenlea Court was effective but we saw it was sometimes less effective on the first floor. Some people on the ground floor were receiving physiotherapy and occupational therapy, and others were people with nursing needs who lived at the home permanently. Staff were able to support them effectively. People on the first floor, some with dementia, had their physical needs met, however staff were not always able to provide care and support that was responsive to their social and emotional needs.

People’s health and social care needs were reviewed regularly with appropriate referrals made to other professionals. Risk assessments were completed and plans minimised any identified risks so care was provided safely.

Checks were carried out prior to staff starting work at the home to ensure their suitability for employment. We saw staff had training to do their jobs effectively and were encouraged to continue to develop their skills in health and social care.

People told us they liked living at the home. We saw there was a variety of food available and snacks and drinks could be accessed when people required them. People with special dietary needs were catered for and relatives could come and enjoy a meal with their family member if they wished to.

Everyone we spoke with was positive about the management and the running of the home. The registered manager knew the staff and people at the home well. We saw good systems were in place to make sure the environment was safe and effective for people that lived there. People knew how to complain if they wished to and complaints were actioned quickly and effectively.

People told us they enjoyed some of the activities at the home and most of these were group activities. However, we saw less activities or social interaction on the second floor where people lived with dementia and although there were enough staff to keep people safe, they did not have time to sit and talk with people.

People told us the staff were very caring. We saw many examples of this and people were treated as individuals with their preferences and choices catered for where possible. Staff showed dignity and respect when providing care and all the people we spoke with were positive about the staff at the service.

Staff knew about safeguarding people and what to do if they suspected abuse. Medicines were stored securely and systems ensured people received their medicine as prescribed.

Staff understood the Mental Capacity Act, and Deprivation of Liberty Safeguards (DoLs) had been applied for where people’s liberty was restricted. We saw that when there were concerns about people’s capacity to make decisions, appropriate assessments had been made.

We visited Ardenlea Court to follow up on concerns we raised about afternoon and early evening staffing levels in the dementia unit. We also followed up on a previous recommendation regarding infection control training for staff.

We saw that the service had carried out the action plan they sent to us which set out how they were going to address the issues identified. This included providing an additional member of staff for the afternoon shift.

We spoke with two staff. They told us that the additional staff support in the afternoon had helped them provide more effective care to people with dementia.

We spoke with three people living with dementia. One person told us the staff were, "very good". Another said, "On the whole (the staffing) is very good". A third person told us, "It's wonderful, we have a wonderful leader capable of answering all my questions".

Since our last visit the home had been refurbished and decorated. We spoke to one relative who told us they were pleased with the changes. The person they visited now had a patio door which could be opened to the garden. We noted attention had been paid in the design to help people with dementia. For example, hand rails and door handles were painted different colours so people could easily see them.

We looked at the cleanliness of the home. We were satisfied there were good systems in place to support the health and hygiene of people living at Ardenlea Court.

We visited Ardenlea Court at 3.30pm on Wednesday 8 May 2013. We stayed until 9.15pm. We spent most of our visit observing life at the service and talking with people who lived and worked at Ardenlea Court.

We spoke at length with seven people receiving care, and three visiting relatives on the first floor dementia unit. We also spoke with eight staff.

We observed a good rapport between staff and people living at Ardenlea Court. Staff were observed to be kind and caring and took their time when delivering care.

We saw work being undertaken to improve the environment. The service had ensured systems were in place to ensure people living and working at Ardenlea Court were safe during this period of disruption.

We looked at care records. We were satisfied they provided staff with sufficient information to support them in their care and nursing roles.

We looked at the food and drinks provided to people. People told us they enjoyed their meals. We saw people received sufficient hot and cold drinks to keep them hydrated.

We looked at the safety and suitability of equipment and were satisfied that equipment used at Ardenlea Court was well maintained and suitable for its purpose.

We looked at staffing levels. We were satisfied there were sufficient staff on duty on the ground floor of Ardenlea Court. We were concerned there were insufficient staff during the afternoon to meet the complex needs of people in the first floor dementia unit.

People told us they understood and agreed to the care and treatment they received. For those who did not have the mental capacity to consent, there were systems in place to make decisions in their best interest.

We saw good care and treatment provided to people living in the home. We were told by people "it's excellent, the staff are really lovely...they've treated me with dignity and respect", "the staff have been lovely, some are extra lovely...they have that ability to perceive what a patient needs without asking", "the one word that keeps coming to me is 'fantastic' I haven't got a complaint what so ever".

We spoke with visiting relatives. One said the care was "brilliant". Another told us "I am very pleased with the care, staff are very kind and the home is nice and clean".

We looked at how the service manages medication. We saw medication locked securely and staff paid attention to security when administering it. The medication adminstration records (MAR) had been completed appropriately and one person told us "medication is prompt, always when it should be". We saw some errors linked with one record but this was dealt with on the day we were there.

We saw good recruitment systems in place to ensure staff are safe to work with people. Staff told us they liked working at Ardenlea Court. One said "I love this place, I feel part of a family".

People told us the manager was approachable and would deal with any concerns or complaints promptly.

People living at the home told us they were very happy there and felt safe. They said that staff cared for them very well and they were content. They also told us the food was very good. They received their medication from staff at the right times. People living at the home benefit from having a staff team who receive ongoing training to develop their skills.