This inspection took place on 13 and 15 March 2018 and was unannounced. At the last inspection in September 2017 we rated the service as inadequate. The service was placed in special measures. At that inspection we found the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of medicines and risk (Regulation 12), person centred care (Regulation 9), dignity and respect (Regulation 10), safeguarding people from abuse (Regulation 13) and lack of effective governance (Regulation 17). The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good.

During this inspection we found some improvements had been made in relation to the safe management of medicines and risk, safeguarding people from abuse and provision of dignified and person centred care. However, further improvements were still required and there continued to be a breach of Regulation 12, Safe care and treatment and Regulation 17, Good governance. We also identified a new breach of regulation in relation to staff training and support; Staffing, Regulation 18. You can see what action we have taken at the back of the full version of the report.

Atkinson Court is a purpose built care home for 75 older people requiring general or specialist dementia nursing care. The home is located in the residential area of Ings Road, Leeds. Atkinson Court provides a modern environment with single en-suite bedrooms arranged over three floors. At the time of our inspection, 49 people were using the service.

Atkinson Court 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.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC); however, they had left the service a few weeks previously. A temporary manager had been appointed by the provider. 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.

Risks to people who used the service were still not fully assessed. Risk management plans in place did not consistently contain the information staff needed to support people safely and manage all risks identified. Environmental risks had not always been assessed and we found areas of the service that should have been kept locked for people’s safety were not. This gave people access to areas with equipment and substances which posed a risk to their health and safety.

We checked the systems for managing medicines at the service and found they now minimised risks and kept people safe. However, some improvements in record-keeping were required. For example, more supporting information was required to protocols for some people’s ‘as and when required’ medicines.

We could not be assured staff had completed the training they needed to effectively carry out their role due to poor record keeping in this area. There were gaps in staff’s knowledge about current good practice in relation to the Mental Capacity Act (MCA) 2005. Records did not indicate specialist training in dementia care had been provided or that all staff had completed an induction. Some staff told us they had experienced difficulties in being able to complete training due to their workload. Mos

The inspection of Atkinson Court Care Home commenced on 6 and 7 September 2017 and was unannounced.

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with the Care Quality Commission (CQC) about the incident indicated potential concerns about the management of risks. This inspection examined those risks.

Atkinson Court Care Home is a purpose built care home for older people requiring general or specialist dementia nursing care. The home is located in a residential area of Leeds and is easily accessible. Atkinson Court Care Home provides a modern environment with 75 single en-suite bedrooms with shower facilities arranged over three floors. The home has 24 ‘intermediate care beds’ for people discharged from hospital who need more support before returning home.

At the time of our inspection, there was a registered manager in post. 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.

Our last inspection of the service took place on 3 and 8 November 2016 when we rated the service 'Requires Improvement'. We found two breaches of the legal requirements in relation to staffing levels and reporting notifiable events. During this inspection we found improvements had been made and the service was now compliant with these regulations.

During this inspection, we found the provider had failed to establish and operate effective governance systems. Audits undertaken in relation to people’s care plans failed to assess the quality of information provided to staff or drive improvements as required. Care plan evaluations were not always completed when required and were not an effective tool to identify shortfalls.

Internal ‘inspections’ carried out by the provider failed to highlight issues identified during our inspection and had not ensured compliance with Regulations 9, 10, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People did not always receive safe care and treatment because known risks were not appropriately mitigated or planned for. Staff did not have access to relevant guidance to ensure care was delivered safely or consistently.

Staff, who had not completed relevant training, used physical interventions to deliver care and support to the people who used the service. The use of physical interventions had not been appropriately planned or reviewed.

People’s care plans did not always reflect their current level of need. We found people’s care plans did not always include relevant information to ensure staff could deliver person-centred care.

We found the principles of the Mental Capacity Act 2005 were followed within the service. However, appropriate records had not been created following best interest meetings which meant it was not always clear care and support was delivered in people’s best interests.

People were not always treated with dignity and respect by staff; we witnessed a member of staff talking to people in an inappropriate and uncaring way.

People were supported by suitable numbers of staff who had been recruited safely. Records showed staff had completed a range of training and received appropriate levels of one to one support as well as annual appraisals.

People received care and treatment from a range of healthcare professionals. People were supported to eat a balanced diet of their choosing. However, we found limited options for people who were vegetarian.

People were supported to make decisions in their daily lives. People we spoke with to

This was an unannounced inspection carried out on 3 & 8 November 2016. Our last inspection took place on 20 January 2016 when we gave an overall rating of the service as ‘Requires Improvement’. We found three breaches of the legal requirements in relation to the safe management of medicines, staffing levels and governance.

Atkinson Court is a purpose built care home for older people requiring general or specialist dementia nursing care. The home is conveniently located in the residential area of Leeds and is easily accessible. Atkinson Court provides a modern environment with 75 single en-suite bedrooms with shower facilities arranged over three floors. The home has 19 intermediate care beds for people discharged from hospital who need more support before returning home.

At the time of our inspection 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.

Staffing levels were not sufficient to meet the needs of people using this service. Rotas showed there were occasions when shifts were not fully staffed. People told us there were delays in staff responding to their needs. We found a high turnover of staff and consistent use of agency staff.

Staff inductions were not always completed within identified timescales and supervisions were not carried out in line with the registered provider’s supervision policy. Staff had received an annual appraisal. Training records showed staff received appropriate training to safely meet people’s needs. Recruitment practices were found to be safe as appropriate checks had been carried out.

Activities were not well documented and clearer information was required to ensure people had the opportunity to become involved. Care plans were sufficiently detailed to enable staff to provide effective care. People were not involved in their monthly reviews, although they participated in their annual review.

People were supported by staff to have access to healthcare professionals when needed. The administration and management of medicines was found to be safe. People had a positive mealtime experience. People felt safe and risks were appropriately managed and reviewed.

Staff received training in the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. People were given choices about the care they received, although formal records of their agreement had not been signed.

People were complimentary about regular staff who provided their care, although they expressed concerns about agency staff who did not know their needs. Privacy and dignity was respected by staff and people confirmed this happened.

Complaints were recorded and responded to appropriately. A programme of audits was in place which was found to be effective. Regular staff and relative meetings took place. People were given an opportunity to feedback about the service through surveys.

Notifications were not submitted to the CQC as required under the terms of the registered provider’s registration. We dealt with this outside the inspection process.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

This was an unannounced inspection carried out on 20 January 2016. Our last inspection took place on 15 October 2014 when we gave an overall rating of the service as ‘Requires Improvement’. We found two breaches of the legal requirements in relation to management of medicines and staffing levels.

On 04 June 2015 we carried out a focused inspection to look at the breaches we found at the inspection in October 2014. We found the provider had followed their action plan and saw medication was administered safely and people were supported by suitably qualified and skilled staff. Recruitment practices were safe. There were sufficient numbers of staff on duty to ensure people’s safety. We rated the service as ‘Requires Improvement’ against ‘safe’ domain.

Atkinson Court is a purpose built care home for older people requiring general or specialist dementia nursing care. The home is conveniently located in the residential area of Leeds and is easily accessible. Atkinson Court provides a modern environment with 75 single en-suite bedrooms with shower facilities arranged over three floors. The home has 19 intermediate care beds for people discharged from hospital who need more support before returning home.

At the time of our inspection the manager was in the process of registering to become registered manager of this service. 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.

Medicines were not always safely managed as there were some gaps in the recording of medicine administration and the supply of a key medicine for one person was allowed to run out.

Staffing levels were not sufficient to meet the needs of the people who lived in the home. Nurse calls bells were continuously ringing and staff switched them off without providing assistance to people as they were busy.

The home was found to be clean and without malodours, although some people expressed concerns about infection control.

People enjoyed the food and drink on offer, although we saw some people had their drinks placed in areas which were out of reach. Some people who needed assistance with eating and drinking did not receive adequate support.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff knew how to identify abuse and where they should report their concerns to. Recruitment procedures used by the provider were found to be safe.

Staff were satisfied with the induction they received and refresher training was provided. Staff received support through the use of supervisions and appraisals. Staff were aware and knew how to respect people’s privacy and dignity. Staff were kind, caring and patient when they were assisting people. Care plans contained sufficient detail which allowed staff to provide person centred care.

The records we looked at showed staff had completed training about the Mental Capacity Act. Care plans reflected the choices people were able to make and we saw evidence of applications for Deprivation of Liberty Safeguards (DoLS) and authorisations in place.

Staff felt appreciated by the home manager who they liked. The home manager was supported through regular visits and audits carried out by the senior management team. Confidentiality was not well managed as sensitive information was left in communal areas by staff which put information security at risk. The unit managers in the home needed more time to be able to manage their staff teams.

We found breaches of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an unannounced comprehensive inspection of this service on the 15 October 2014 at which two breaches of the legal requirements were found. This was in relation to, management of medicines and there were not always sufficient staff to keep people safe.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on the 4 June 2015 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for “Atkinson Court” on our website at www.cqc.org.uk

Atkinson Court Care Home is registered to provide accommodation and nursing care for 75 people who may also have a dementia related condition. Atkinson Court Care Home has 10 Intermediate Care beds which are for people who have been discharged from hospital but who still require support prior to returning home. There were 59 people living at the home at the time of our inspection.

The home had a peripatetic manager who has worked in this role since February 2015. This person is not registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

At our focused inspection on the 4 June 2015, we found the provider had followed their plan which they had told us they would and legal requirements had been met.

People who used the service told us they were happy living at the home and they felt safe. We looked at the arrangements in place for the storage, administration, ordering and disposal of medicines and found these to be safe. Medicines were administered to people by qualified nurses.

We found people were cared for, or supported by suitably qualified, skilled and experienced staff. Recruitment and selection were taking place and appropriate checks had been undertaken before staff began work.

Atkinson Court Care Home is registered to provide accommodation and nursing care for 75 people who may also have a dementia related condition. Atkinson Court Care Home has ten Intermediate Care beds which are for people who have been discharged from hospital but who still require support prior to returning home.

The home is located in the outskirts of Leeds with access to public transport. There are three dining rooms, several lounge areas and a hairdressing salon.

A registered manager was in place. 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.

We looked at the medication records of four people who used the service. We found in some cases the recording was confusing and may have led to errors. We also found peoples eye drops were correctly stored in the fridge; however, they needed to be discarded after 28 days. The date of opening was not recorded we could not therefore be sure people’s eye drops were being administered safely.

Staffing levels were adequate, however, we found on the day of our inspection on one unit instead of two nurses and three members of care staff there was one nurse and four members of staff. This unit heavily relied on nursing staff as some people had just been discharged from hospital and still required a high level of nursing input. We saw this impacted on how care was delivered, for example the nurse was interrupted half way through the medication round to deal with a medical emergency which meant the administration of people’s medication was delayed.

There were occasions throughout the day where call bells were not responded to in a timely manner. We also noted where people were asking for assistance staff did not always notice straight away. We saw this concern was mentioned in the satisfaction survey carried out in November 2013 and we could not see an action plan to resolve this.

Everyone we spoke with said they felt safe living in the home. A relative of a person who used the service told us, “We are confident my mum is safe here, there is a pressure mat so staff know if she moves in her room.”

The registered manager had submitted four applications for Deprivation of Liberty Safeguards; this showed us the manager understood the necessary steps to take when people’s liberty was restricted. Staff had received training in the Mental Capacity Act (2005) and were able to confidently describe how it affected their working day, one member of staff said, “We have to be very clear about people’s capacity to make decisions about how they live their lives.”

During our inspection of Atkinson Court Care home we observed warm and caring interactions between staff and residents. One person we spoke with said, “It’s such a good atmosphere here, people are always laughing.”

We found people’s care plans were person centred and individual to people’s needs. Care plans were regularly reviewed to ensure they were still appropriate and where necessary changes were made and risk assessments were updated.

People we spoke with told us they knew what to do should they need to complain. People that had complained told us their complaints were dealt with appropriately. We saw the complaints policy displayed in the reception area of the home.

There were robust systems in place to monitor the quality of care delivered at Atkinson Court Care Home. We saw evidence of audits of infection control, medication, care plans and the environment. Quality monitoring was carried out by the registered manager and the operations director.

People we spoke with told us the registered manager was ‘very approachable’. Residents, staff and relatives all spoke highly of the management team, which included the registered manager and the unit managers.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with eight people who used the service and six members of staff; we also spoke with two relatives of those who used the service. We reviewed ten care plans. The people we spoke with were happy living at Atkinson Court. We saw evidence that peoples consent was obtained. We saw evidence of consent for the use of photographs in people’s notes. People we spoke with told us, “They always ask first if it’s alright” and “I get the best staff in here, they don’t do anything without my say so.”

People told us they were happy with the care provided. One relative told us, “My Mum is getting well looked after, if she doesn’t eat the meals, they give her different options such as a sandwich, my sister is involved in discussions with staff and she gives consent for my Mums care.” One person said, “I feel valued as a person; staff help me all the time and make me comfortable.”

We saw the communal areas and the bedrooms were clean and free of any malodours. One person who used the service said, "It's always clean, someone is always cleaning my room every day." There were effective systems in place to reduce the risk and spread of infection.

During the visit we observed staff supporting people and saw that staff responded promptly to any requests for assistance. Staff told us the staffing levels were sufficient to meet people's needs.

One member of staff said, "I like working here, it’s a nice home and I get a lot of job satisfaction."

We used a number of different methods to help us understand people’s experiences of living at Atkinson Court. We assess how their needs were being met by the staff and spent time observing the care provided to people during a lunch-time period. We noted that people looked well cared for and were dressed appropriately for their age, culture, gender and the weather conditions.

People we spoke with during the visit to Atkinson Court felt the care and support provided was excellent and responded “it felt like home.” People commented that they felt supported and that staff were approachable. One person who used the service said: “Staff are friendly and I get the care I want” and another person said “I really like living here.”

Some people living at Atkinson Court had a diagnosis of dementia and as such their ability to recall their experiences and express their views was limited. Due to the above some people who live at Atkinson Court were not able to tell us about events and/or incidents which had taken place. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time observing what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they appeared to have had positive experiences.

Relatives we spoke with told us staff were polite and kind and they respect people’s privacy. Relatives advised that they were able to raise concerns with staff and said they felt the home was safe. They said if they were concerned about any aspect of the care they felt able to talk to the staff who were “approachable” and they felt they “could ask questions”.

Relatives told us that the home was ''lovely and there are lots of activities'' and their relative was happy living there. They said that their relatives could choose to do whatever they wanted and they did go to a local community centre for activities. They felt service users were always treated with absolute respect. They told us they were always treated well by staff and “staff work hard and night staff are lovely.”

Relatives told us they appreciated that the home kept them informed about their relatives’ progress and always told them if they were unwell or if any untoward incidents had occurred, for example if their relative had a fall.

During the visit we spoke to three people who live at the home, they told us they are happy living there and said they were looking forward to Christmas.

This review did not include a visit to the home and we have not received any information from people using the service or their representatives. When we visited in December people living in the home told us they were happy there.