This unannounced inspection took place on 27June 2017.

We had found two breaches of the regulations at our previous inspection in September 2016. At this inspection we looked to see what measures had been taken to ensure the quality of the service, and to see if these measures had been effective and improvements had been achieved. The provider told us that all the actions required to meet the regulations had been completed by the end of November 2016 as scheduled in the actions plans. During our inspection on 27 June 2017 we found that all of the recommended actions had been completed.

Ferendune Court is registered to provide accommodation for up to 48 older people who require nursing and personal care. The home is situated in Faringdon, Oxfordshire. At the time of our inspection there were 46 people living at Ferendune Court.

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.

People told us they felt safe and staff were aware of their responsibility to keep people safe. Risks to people's safety were appropriately assessed and managed. The service promoted positive risk taking resulting in people gaining a huge confidence boost.

Staff displayed a thorough knowledge of how to identify any safeguarding concerns and knew the process of reporting such concerns. Medicines were administered, recorded and stored in line with current guidelines.

Staff had been recruited safely to ensure they were suitable to work with vulnerable people. There were sufficient numbers of suitable staff to keep people safe.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The registered manager and staff understood their responsibility to ensure people's rights were protected.

Records showed that staff received the training they needed to keep people safe. The manager had taken action to ensure that training was kept up-to-date and future training was planned.

Staff told us they felt supported by the management and received supervision and appraisals, which helped to identify their training and development needs.

People had regular access to healthcare professionals. A wide choice of food and drinks was available to people and suited their nutritional needs. People’s individual preferences regarding food were always taken into account.

People had positive relationships with staff and were treated in a caring and respectful manner. Staff delivered their support in a calm, relaxed and considerate manner. People and their relatives were actively encouraged to participate in the planning of people’s care. Staff were empathic when dealing with people's privacy and dignity.

Care plans were person-centred and ensured the care and support suited people’s needs and expectations. People’s own preferences were reflected in the support they received.

The management appreciated and acted on people's and relatives’ opinions on the service, including complaints. Such information was used to implement changes and enhance the functioning of the service. People and staff had confidence in the manager as their leader and were complimentary about the positive culture within the service. There were systems and processes in place to help monitor the quality of the care people received.

This unannounced inspection took place on 2 September 2016. It was a full comprehensive inspection which was also carried out as a follow-up to our previous visit in February 2015. We had found one breach of the regulations at our previous inspection in February 2015. Action had not always been taken by care staff to report their concerns of abuse. At this inspection we aimed to see what measures had been taken to ensure the quality of the service had improved and check if these measures had been effective. The provider had told us that all the corrective actions specified in their action plans would have been implemented by the end of July 2015. During our inspection on 2 September 2016 we found that all the recommended actions had been completed.

Ferendune Court is registered to provide accommodation for up to 48 older people who require nursing and personal care. The home is situated in Faringdon, Oxfordshire. At the time of our inspection there were 41 people living at Ferendune Court.

The service had 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.

People, their relatives and staff raised concerns about staffing levels. We saw people did not always receive support on time and had to wait for staff to be available to provide support.

Staff supervision was not consistent and one- to-one meetings were not carried out regularly. We have made a recommendation about staff supervision.

A quality assurance system was in place but it was not always effective as it had failed to highlight the issues identified at our inspection.

Records kept by the service were not always available, accurate or complete.

Staff and resident meetings were held regularly, however, some staff members told us they had ceased attending the meetings as they had not felt listened to and empowered to contribute to the meetings.

People were supported by staff who knew how to keep them safe. When people had risks to their health and safety identified, staff knew how to support them appropriately. Risk assessments were in place for staff to follow.

There was a robust recruitment procedure in place to ensure prospective staff members had the skills, qualifications and background needed to support people.

Medicines were managed safely. The provider had arrangements in place for proper and safe management of medicines.

The registered manager was knowledgeable about The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The Metal Capacity Act Code of Practice was followed when people were not able to make important decisions themselves. The registered manager and staff understood their responsibility to ensure people's rights were protected.

People received the support they required to meet their nutritional needs. Staff showed an excellent knowledge of the specialist diets people required and gave appropriate support to people who needed assistance with meals. Staff made referrals to and sought support from a range of health care professionals in a timely way.

Staff were kind and caring. They treated people with respect, maintained and promoted people’s dignity.

Staff had built positive and strong relationships with people and their relatives, earning their trust. Staff were aware of people's communication needs and we observed staff engaging people in conversations. A varied activities programme was available that was tailored to people's interests and hobbies.

People and their relatives told us they were comfortable raising complaints. We saw a system was in place which showed that when people complained, they were listened to.

We found two breaches of regulations 17 and 18 of the Health and Social Care Act 2008 (Re

On the day of our visit 41 people were using the service. They were supported by eight care workers. We spoke with eight people who used the service. We also spoke with four care workers, the deputy manager, an interim manager and two regional support staff. One inspector carried out this inspection.

We conducted this inspection because we identified concerns around people’s care and welfare and nutritional needs in January 2014. We found that while the provider had taken appropriate action with regards to people’s nutritional needs, there was still need for improvement to meet expected practices regarding people’s care needs and records.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service effective?

The service was not always effective because people’s needs were not always being met. Care workers did not always follow people's care plans, which put people at risk of inappropriate care or treatment.

People’s care plans did not always contain current guidance for care workers to meet people’s needs. This meant that people could be at risk of inappropriate care or treatment as an accurate record of their care needs had not been maintained.

People were protected from the risks associated with malnutrition, falls and moving and handling. Care workers demonstrated a good knowledge of people’s care needs.

Is the service caring?

The service was caring. We found that people benefitted from kind and caring care workers. We conducted short observational framework for inspection (SOFI) observations throughout our visit. We observed that people were treated with respect.

People spoke positively about the home and the support they received from care workers. People told us and we observed, they had choice around food and drink which they enjoyed.

During our inspection we spoke with seventeen people who used the service, four visiting relatives and three visiting health care professionals. Most people we spoke with told us that generally they were satisfied with the care and treatment they received. Whilst people we spoke with praised the staff and the care they gave they told us that they felt staff were always rushing. One person we spoke with told us “the staff are all very nice and helpful but they never have anytime to chat”.

The inspection was carried out during a time of impending change to the service. The nursing service will cease and residential care only will be provided later this year. It appears that this has caused anxiety for both residents and visitors. One visitor we spoke with told us “I am very worried about the future”.

We observed staff treating people with dignity and respect. Staff called people by their preferred name and always knocked before entering a person’s room. We found that there were some shortfalls in the recording of the assessing and planning of care. We found that there were some inconsistencies between assessments and guidance for staff and have required that improvements are made.

People were not always supported to be able to eat and drink sufficient amounts to meet their needs. Staff did not always have the time needed to ensure that people received the correct support and interaction. We have required that improvements are made.

We found that the provider had policies in place relating to the obtaining, storing, administering and disposal of medicines. Staff had received training before undertaking responsibility for administering medication.

Appropriate recruitment checks were carried out and recorded. New members of staff completed an induction and attended core skills training. Staff we spoke with told us they received training to support them to carry out their role correctly.

The provider had systems in place to monitor and evaluate the quality of services provided.

We spoke with five people who lived in the home and three relatives. They told us that they were involved in the planning of their care and were able to raise any concerns or issues with staff. People told us that they were able to express their views and influence decisions relating to their care.

We observed staff treating people with dignity and respect. Staff would always knock before entering a person’s room and there was a system in place to alert staff and visitors when individuals were receiving personal care.

Staff told us that they followed care plans which they felt contained adequate information.

The provider and staff were aware of their responsibilities regarding protecting people from abuse and the people we spoke with said that they felt happy and safe. Staff felt supported and the provider had processes in place to ensure that people were assisted and cared for by trained and experienced staff.

The provider had effective systems in place for monitoring the quality of service provision . People using the service had recently been asked for their feedback. People knew how to make a complaint and we saw that complaints that had been made were recorded and dealt with in a timely manner.

People told us they enjoyed living at the home. They said the home offered them "good quality" care in "comfortable, homely" surroundings.

We visited Ferendune Court on 24 and 25 February 2015. Ferendune Court provides residential care for people over the age of 65. Some people at the home were living with dementia. The home offers a service for up to 47 people. At the time of our visit 38 people were using the service. This was an unannounced inspection.

We last inspected in September 2014 when we followed up on actions we had asked the provider to take in relation to care and welfare and nutritional needs. At this inspection we found people’s care and welfare needs were not always being met. We also found people’s records were not always current and did not protect them from inappropriate care and treatment. At our inspection in February 2015, we found the provider had taken action to address these concerns.

In February 2015, there wasn’t a registered manager in post at the service. The provider had an interim manager was in post at Ferendune Court to ensure the service was managed effectively. 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 did not always report incidents where people may be at risk of harm to the manager. This meant people may be at continued risk because incidents may not be investigated and action take to prevent them happening in the future. Staff had all received safeguarding training, and the staff we spoke with knew the importance of reporting concerns to the manager and provider.

People were treated with dignity and respect. Care staff knew the people they cared for, what was important to them and how to promote their independence. Care staff took time to talk to people and make them feel valued.

People were supported to take risks with support and guidance from care staff. People were assisted with all aspects of their care by patient and compassionate care staff.

People had access to a variety of activities and events. People enjoyed these activities. People spoke positively about the food they received. Where people had specific dietary needs, or were at risk of malnutrition action was taken to meet their needs.

Peoples’ care plans provided clear details for staff to follow. Senior care staff and the home’s activity co-ordinator had ensured people’s preferences and life histories were recorded. Staff used this information to build positive relationships with people.

There were enough staff to meet the needs of people living at Ferendune Court. People, visitors and staff spoke positively about the relationships they had. Staff had the training they needed to support people, and had access to professional development and qualifications based in care.

The manager and regional support staff from the provider had implemented effective systems to monitor the quality of the service they provided. Information from audits and people's feedback was used to ensure improvements were made to the service

Staff had access to training they needed to meet people's needs. The manager had made applications where people were being deprived of their liberty, these had been completed in accordance with the Deprivation of liberty safeguards. Deprivation of liberty safeguards is where a person can be deprived of their liberty where it is deemed to be in their best interests or for their own safety.

We found one breach 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.