The inspection took place on 5 December 2017 and was unannounced. Deepdene Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Deepdene Court is registered to provide care and accommodation for up to 36 people who have a range of mental illnesses, including people who have complex and enduring needs as well as substance misuse needs. The home is divided into two buildings, St Catherine's and Fieldings. St Catherine's accommodates people who also require nursing care. On the day of the inspection there were 27 people living at the home.

The home had a registered manager who was present throughout the inspection. 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 the previous inspection on 21 and 23 June 2016, the overall rating for the service was Requires Improvement. We found a number of areas of practice that needed to improve and one breach of regulations. This was because the provider had not ensured risks to people were fully assessed and action taken to mitigate those risks. The provider sent us an action plan explaining how they would meet the requirements of the regulations by 30 November 2016. At this inspection we found that they had taken actions to address the breach of regulations and the quality of the service had improved.

People told us they felt safe living at Deepdene Court. One person said, “It is safe here, they look out for us.” Another person told us they felt “protected,” by the staff. Risks to people were assessed and managed to support them to stay safe. Staff demonstrated a firm understanding of their responsibilities with regard to safeguarding people. One staff member said, “Anything at all that was worrying I would report to the nurse on duty or to the manager.” People’s medicines were managed safely and people were protected from risks of infections. There were enough staff on duty to care for people safely and there was a calm atmosphere in the home. The provider had robust systems for recruitment and staff had a thorough induction before starting to work with people. Incidents were recorded, monitored and analysed to support development of the service.

Staff received the support they needed and training was relevant to the needs of the people they were caring for. There were effective systems in place to support communication between staff and with other professionals involved in the care of people at the home. Feedback from professionals described positive partnership working with staff at the home. People were supported to access health care services when they needed to.

People’s needs and choices had been assessed in a holistic way to include consideration of all aspects of their life. Risk assessments and care plans reflected people’s diverse needs including their cultural needs and religious beliefs. People spoke highly of the food provided at the home and we observed that the lunch time meal was a positive social experience for people. Staff supported people and offered choices including about when and where they wanted to eat. Specific dietary needs or preferences were accommodated.

Staff demonstrated a firm understanding of their responsibilities with regard to the Mental Capacity Act 2005. Consent was sought before providing care and where people lacked capacity to make specific decisions mental capacity assessments and best interest decisions had been recorded in line with the legislation and guidance.

People spoke highly of the staff at the home their comments i

The inspection took place on 21 and 23 June 2016 and was unannounced.

Deepdene Court is registered to provide care and accommodation for up to 40 people who have a range of mental illnesses, including people who have complex and enduring needs as well as substance misuse needs. The premises were divided into two buildings: St Catherine’s and Fieldings. We identified the service’s registration details did not match the facilities as set out in the service’s Statement of Purpose which said the service could accommodate up to 36 people. This was also different from what the registered manager said, that St Catherine’s accommodates up to 18 people who may require nursing care and Fieldings up to 17 people. We discussed this with the provider who agreed that they needed to amend their registration details with the Commission to ensure it reflected the correct number of people they could accommodate. At the time of the inspection there were eight people living in St Catherine’s and 14 in Fieldings.

Each of the two properties had communal lounges and dining areas as well as gardens which people used. All bedrooms were single and all bedrooms in St Catherine’s had an en-suite bathroom and four had this facility in Fieldings. The home had a staff team of 20 care staff and eight registered nurses plus additional staff for cleaning, maintenance and cooking.

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 previous inspection report for an inspection on 2 and 4 February 2015 made two requirements where we found breaches of the regulations:

• Measures to fully protect and safeguard people were not always in place

• The premises were not adequately maintained in Fieldings

The provider did not submit an action plan to say how and when these requirements would be met. An action plan was submitted after two further requests by the Commission, and more than nine months from the initial request. The shortfalls we found regarding measures to protect people have been addressed but we found risk assessments and care plans to protect people were often incomplete, unclear or absent.

At this inspection we found many improvements had been made to the environment and there were further plans to repair and refurbish bedrooms and communal areas.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). There were policies and procedures regarding the assessment of people who may not have capacity to consent to their care. However, we found where people lacked capacity to consent to their care and treatment this was not fully assessed. An application had not been made to the local authority for a DoLS where someone was not free to leave the premises, did not have mental capacity and expressed a wish to leave . This was addressed immediately by the registered manager; by the second day of the inspection mental capacity assessments had been completed where people did not have capacity and DoLs applications made to the local authority where needed.

People told us they felt safe at the service and health and social care professionals reported that staff took action to report any concerns to them including those subject to supervision under the Mental Health Act 1983 and other statutory orders. Staff were aware of safeguarding adults procedures and their responsibilities to report any concerns they had.

Sufficient numbers of staff were provided to meet people‘s needs. Pre-employment checks were made on newly appointed staff so that on

Our inspection concentrated on the regulated activities provided at Fieldings.

We spoke with two people who were accommodated there. They told us they were very satisfied with the care and support provided. They also told us the care staff were able to provide the support they needed. One person said, “I can do what I like. I can have my friends and family to dinner. I can go out when I choose. I am quite happy, thank you!”

People we spoke with informed us they were satisfied with the standard of cleanliness of the premises. One person said, “It’s a very clean home.” Another person observed, “Its alright, the cleaning is done regularly.”

We also spoke with three members of staff who were on duty. They demonstrated they were knowledgeable with regard to the needs of identified people and the levels of support each person required to meet them. They also confirmed they had been required to undergo an interview and that appropriate checks had been made about them before they were appointed.

The atmosphere throughout the visit was good. It was calm, friendly and homely. Care staff were observed to have a good relationship with the people living there. When talking to people, they were friendly and professional.

We also noted care staff on duty provided support skilfully, sensitively and competently.

The registered manager had resigned since our last visit. The new manager had yet to submit an application to register with the Commission.

We were unable to have meaningful discussions when we spoke to people. However we observed interactions between people and staff who were on duty. We noted that it was the practice for staff to discuss with people what needed to be done and to ask for their agreement or consent before providing support. For example, several people who wished to go out needed to be accompanied by a member of staff for their own safety and wellbeing. We observed staff and people planning together when each person could go out to ensure everyone’s needs had been met.

People we spoke with confirmed they have been satisfied with the care provided. One person told us, “This place is better than the last home I was at. The staff give me the support and assistance I need."

People we spoke with confirmed that they believed care staff were competent and skilled when delivering the care and support people they needed. One person told us, "The staff are okay. They are not too bad. They help me when I am feeling anxious." From observation we noted provided staff support skilfully, sensitively and competently.

The people we spoke with who live in Deepdene Court told us that they were very happy living in the home. We spoke with people both individually and in groups and they told us the staff were “better than kind” and were really supportive of their needs.

The inspection took place on 2 and 4 February 2015 and was unannounced.

The home provides care and accommodation for up to 40 people who have a range of mental illnesses, including people who have complex and enduring needs as well as substance misuse needs. The service was provided in two adjoining properties: St. Catherine’s and Fieldings. St Catherine’s accommodates up to 18 people who may require nursing care and at the time of the inspection housed 13 people. Fieldings accommodates up to 22 people who require care and support and at the time of the inspection also housed 13 people. Each of the two properties had communal lounges and dining areas as well as gardens which people used. All bedrooms were single and all bedrooms in St Catherine’s had an en-suite bathroom and four had this facility in Fieldings. The home had a staff team of 20 care staff and nine registered nurses plus additional staff for cleaning, maintenance and cooking.

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.

Staff were aware of safeguarding adults procedures and their responsibilities to report any concerns they had, but mental health professionals said there were occasions when there was a delay in being notified of incidents and concerns. Details about which professionals to contact where people were subject to legal supervision were not clear for one person. The staff had not followed the admission for one person which had the potential to place people at risk. People gave us mixed views about feeling safe in the home. One relative and one person we spoke to referred to incidents of violence in the home. We also found there was a lack of clarity regarding the liaison and reporting of events and incidents to those professional who had responsibility for the formal legal supervision of people.

Care records included assessments of any risks to people and corresponding action staff should take to reduce these risks. These included details about people’s behaviour which presented a risk and for supporting people who were at risk when going out in the community.

Sufficient numbers of staff were provided to meet people‘s needs. Pre-employment checks were made on newly appointed staff so that only people who were suitable to provide care were employed.

People’s medicines were safely managed and guidelines were recorded when staff needed to support people with medicines they needed on ‘as required’ basis. However, not all nursing staff had attended recent medicines training.

People told us they were supported by staff who were well trained and competent. Staff had access to a range of relevant training courses and said they were supported in their work.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were aware of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). There were policies and procedures regarding the assessment of people who may not have capacity to consent to their care and the registered manager knew when these procedures needed to be used. The registered manager and staff were also aware of when to refer someone for assessment for assessment or treatment under the Mental Health Act 1984.

People were supported to eat and drink and to have a balanced diet. There was a choice of food and people said they liked the food. Special dietary needs were catered for and nutritional assessments carried out when this was needed so people received an adequate diet.

People’s health care needs were assessed and recorded. Care records showed people’s physical health care needs were monitored and that people had regular health care checks. Community health and social care professionals said the staff made appropriate referrals when people needed an assessment of their mental health.

Whilst ongoing refurbishment of Fieldings was noted during our visit there were a number of areas where the design and decoration needed to be improved. This included poor quality flooring which posed a tripping hazard, damaged furniture, decorative defects in bathrooms and bedrooms, and, a communal sitting area which was not warm.

Staff treated people with kindness and had positive working relationships with people. People were consulted about their care and said they were listened to. Staff acknowledged people’s right to privacy and people were supported to develop independent living skills.

Care needs were reassessed and updated on a regular basis. Care plans were completed for each person and reflected how people liked to receive care. There was an activities coordinator who engaged people in activities such as going out in the community. A relative and a social worker felt the provision of activities could be further developed.

The complaints procedure was available in the home. A record was made of any complaints along with details of how the issue was looked into and resolved.

Staff were committed to a set of values which included compassion and promoting equality and respect for people. The registered manager and staff encouraged people to communicate with them regarding the running of the service, although we noted surveys were not used to obtain the views of people or relatives.

A number of audit tools were used to check on the effectiveness of care plans, medicines procedures, and, the environment. These had identified issues with the maintenance of the premises but were not effective in addressing them. The registered manager had a thorough knowledge of community and hospital mental health care and the challenges and risks this entailed.

We found a number of breaches 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 this report.