Halcyon Court Care Home 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 (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Halcyon Court Care Home provides accommodation for up to 52 people. People are accommodated with residential care over five floors in single rooms. On the day of inspection there were 43 people who used the service.

At our last inspection in December 2015 we rated the service as ‘Good’. At this inspection the service remained ‘Good’. As the rating of the service has not changed, we have written a shorter version of the report.

This inspection took place on 13 August 2018 and was unannounced. We returned on 14 August 2018 announced to complete the inspection.

The service had a registered manager. 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.

Staff promoted and respected people’s cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Care records could capture more information. We made a recommendation about gaining more information about people. Information was made available in accessible formats to help people understand the care and support agreed.

Systems and processes were in place to safeguard people from abuse; these covered staff recruitment practices and staff training and knowledge on safeguarding procedures. Staff were recruited safely and there were mostly sufficient numbers of staff available to support people. We made a recommendation around staffing levels on a night time in case of emergency.

The registered manager understood their legal responsibilities. They provided good leadership and supported staff and people who used the service. The area manager and the staff team were committed to providing quality care and welcomed feedback and suggestions to enhance people’s quality of life.

People were supported to stay safe. Risks associated with people’s needs had been assessed; safety measures were put in place and they were monitored and reviewed regularly. Staff were provided with clear guidance and information to follow to meet people’s needs.

People received their medicines as prescribed. Medicines were stored and managed safely. People’s nutritional and cultural dietary needs were met and they had access to a range of specialist health care support which ensured their ongoing health needs were met.

People were involved in decisions made about all aspects of their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People had developed positive trusting relationships with the staff team. Staff respected people’s privacy and dignity and independence was promoted. The homely environment ensured people’s safety and privacy. People continued to receive good care and support that was responsive to their individual needs.

People took part in a range of social activities and events and were supported to say what they would like to do. This type of engagement had enhanced people’s physical and mental wellbeing, and their sense of belonging.

People and their relatives and friends all spoke positively about the staff team, management and the quality of care. People had a range of methods to express their views about the service. The manager used feedback and complaints to bring about changes to the service.

People knew how to make a complaint and were confident action would be taken. There w

This inspection took place on 14 December 2015 and was unannounced.

Our last inspection took place on 25 April 2014 and, at that time; we found the service was not meeting the regulations relating to care and welfare of people who used the service, training and staffing. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we found improvements had been made in all of the required areas.

Halcyon Court is a care home registered to provide personal care and accommodation for up to 52 older people. At the time of inspection 30 people were living there. The service 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.

At this inspection we found people were happy with the care they received. People felt staff were caring. We saw people received good support during the inspection and enjoyed the company of staff.

People told us they felt safe and didn’t have any concerns about the care they received.

We found the provider was meeting the legal requirements relating to Deprivation of Liberty Safeguards (DoLS).

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA). Staff understood how to help people make day-to-day decisions and were aware of their responsibilities under the MCA and Deprivation of Liberty Safeguards (DoLS).

We found that staff had training throughout their induction and also received refresher training in areas such as dementia care, MCA, DoLS, safeguarding, health and safety, fire safety, first aid and infection control. This meant people living at the home could be assured that staff caring for them had up to date skills they required for their role.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. Appropriate arrangements were in place for the ordering, storage and disposal of medicines.

People enjoyed a range of social activities and had good experiences at mealtimes. People’s health needs were met.

People told us the food at the home was good and that they had enough to eat and drink. We observed lunch being served to people and saw that people were given sufficient amounts of food to meet their nutritional needs.

The care manager and registered manager had reviewed staffing numbers to help ensure there were enough staff to keep people safe. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff felt supported and had regular supervisions and appraisals in place within the home.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service. This showed through audits that this was an effective system.

People told us they would feel comfortable raising concerns or complaints. People provided positive feedback about the registered manager.

This inspection visit was conducted by an inspection team consisting of an inspector, pharmacy inspector, and a specialist professional advisor. This inspection considered our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We found that the service was safe because people were protected against the risks associated with the use and management of medicines. People received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely.

The provider monitored the environment and had action plans in place to address areas for improvement.

Staff employed to work at the home were suitable and had the necessary skills and experience. Although people who used the service and staff members told us there were enough staff on duty to ensure people’s safety there were not always sufficient staff to meet people’s needs in a timely way.

Although nobody living at the service required a Deprivation of Liberty Safeguards (DoLS) authorisation staff were aware of DoLS. The manager told us of a situation where the need for a DoLS authorisation renewal had been considered and ruled out.

Is the service effective?

We found care plans for managing medicines were detailed and gave clear guidance to care workers about how to administer and handle medicines appropriately.

People told us they were generally happy with the care they received and their needs had been met. However some people told us they sometimes had to wait too long to be supported to access the toilet. One person told us “I wait and wait.The facility’s terrible. You can wait an hour.” Another person said, “They’re busy.They’re there to help you but they don’t always come when you want to go to the toilet.”

From speaking with staff it was evident they had a good knowledge of the people they supported.

Is the service caring?

People were supported by kind and attentive staff who knew them well and spoke positively about people as individuals. Care records showed people were cared for using person centred approaches.

Staff were very knowledgeable about people’s needs. One person who used the service told us, “Staff are smashing. All of them.”

Is the service responsive?

People’s needs were assessed before they were provided with support by the service. People’s needs were regularly reviewed and their health monitored. Where necessary referrals were made to other health professionals.

Relatives of people who used the service told us they felt their suggestions were considered when making improvements to the service.

Is the service well-led?

We saw a system for quality assurance and monitoring of medicines management was in place. Action had been taken promptly by managers when any discrepancies, or failure to follow procedures, had been identified.

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People told us they felt involved in the running of the service and felt their opinions mattered. Staff were clear about their roles and responsibilities.

Records showed the management team worked with all staff and people who used the service to maintain standards and secure improvement.

We found medicines were not always kept safely, Medication was not always stored at the correct temperature. Not all medicines were administered safely.

We saw that people living in the home were prescribed medicines which needed to be taken before food. We found that these medicines were not given properly.

Records were made when doses of medication were changed. However the records showed that new doses were not given properly.

Many people in the home were prescribed medicines to be taken “when required”. We found that there was no information recorded about how to give medicines prescribed in this way.

We saw that the stock of medicines for each person were not always accurate because staff failed to always carry forward any stock left over from the previous month.

We found that the standard of cleaning at the home had improved since our last visit in October 2012. Cleaning schedules and procedures were in place. The effectiveness of cleaning arrangements were regularly reviewed. Staff were aware of their responsibilities and the importance of reducing the risk of infection of people who used the service.

We spoke with three people who used the service. They said they were happy with the care they received. People were complimentary about the staff. They said that staff were courteous and respected their dignity and privacy. One person said that “Although the staff can be very busy they listen to me and talk to me." Another said that they could “Choose when to get up and have breakfast. The food is good and I have a choice of what I want."

We spoke with five members of staff. They expressed genuine concern for the care and welfare of people at the home. However, some members of staff said that at times they could be very busy and felt that they did not have enough time to sit and talk to people. Staff had access to training and support through regular supervision, however we noted that training in infection control and care planning was overdue for some staff.

People told us they felt safe. The staff we spoke with were able to explain what to look for and what they would do to safeguard a vulnerable adult. The care provider had systems in place to identify and review the quality of the service, identify risks and areas for improvement. There was evidence that learning from incidents took place and appropriate changes were implemented.

We also looked at cleanliness and arrangements to prevent and control infections. We found infection control procedures were inadequate and have issued compliance actions.

People who use the service told us they could make decisions about what they did. Several people said they chose what time they wanted to go to bed and what time they wanted to get up on a morning. One person said, “If you want to go to bed, you go to bed, if you want to get up, you get up.”

People who use the service told us they were well looked after and felt safe. One person said, “I’ve always felt comfortable.”

People who use the service were complimentary about the staff. One person said, “From the bottom to the top, from the cleaners to the managers, they are spot on.”

A visitor said people were well cared for. They said staff contacted them when it was appropriate and they felt they could approach staff and management when they wanted to discuss anything.

Staff told us people received good care. One member of staff said, “The level of care is brilliant, staff are good to work with and know residents needs”. Another member of staff said, “People’s needs are well met. They get extremely good care and people are happy”.

Staff we spoke to said they had received training to help them recognise good care practices and maintain the privacy and dignity of people using a service. One member of staff told us about a ‘dignity champion’ course which helps promote good care principles throughout the service.

We spoke to staff who confirmed the service had enough staff to meet people’s needs, although some staff thought they were sometimes too busy to spend quality time with people. The registered manager said staffing levels were increasing as the number of people who use the service were increasing.

In September 2011, the manager’s application to register with CQC was approved. Staff said the manager was a good leader and the service had improved since she started working at the home. One member of staff said, “We’re well supported, the management team are very supportive.”

Halcyon Court Nursing Home cares for people with a range of complex needs. We used a number of methods to help us understand the experiences of people who used the service. We observed how cared was provided, we talked to staff, relatives and visitors.

We saw people were appropriately dressed, well presented and looked well cared for. Staff engaged warmly with people. Visitors to the home told us the staff were very friendly and caring. They said people were treated with respect. One said the home had a, “Nice atmosphere” and the staff, “Were friendly and helpful."

The provider had procedures to record people’s consent to share personal details but consent to care and support was not always recorded. Care plans indicated whether or not people had mental capacity to make decision for themselves. However, the care plans did not make it clear whether this was all decisions or only some decisions.

People’s needs were assessed and their individual needs identified. Care plans were person centred and included details of the support they required. Risk assessments had been completed and guidance was available for staff on how to support people.

The provider had procedures to obtain and store medicines. The manufacture’s storage instructions were not always followed and some people were not given their medication appropriately. Records about the administration of medicines were not always accurate.

During our visit we saw that people’s needs were met and calls for assistance were responded to promptly. People visiting the home told us there were always enough staff on duty and they were always helpful. The staff we spoke with did not have any concerns about staffing levels.

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted upon.