This inspection took place on the 19 and 24 July 2018 and was unannounced.

Havering Court Care Home is a ‘care home’ that provides nursing and personal care. 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. The provider was registered to provide a service to both older and younger people who had a physical disability.

Havering Court Care Home accommodates up to fifty-two people in a purpose built, two floor building. Each floor has separate adapted facilities. There are dining and common areas on each floor and adapted bathrooms. Other facilities included a cinema room and a therapy room with physiotherapist facilities and a large garden. At the time of our inspection forty-six people were living in the home.

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 the last inspection of the service in March 2015 the service was rated good overall but was rated requires improvement in the key question 'is the service safe?' This was because we identified shortfalls in the administration of medicines that could put people at risk of not receiving their medicines in a safe manner.

At this inspection we found that the previous concerns had not been addressed as we found medicines were not being managed in a safe way. Shortfalls identified included, people’s medicines not tallying with the recorded amounts and some prescribed ointments were being administered not always as prescribed. On occasion, some morning medicines rounds were not completed until lunch time and there was a risk medicines doses were being administered too close together. We saw the storage of some medicines was not appropriate and equipment associated with medicines administration not being cleaned.

Some people and relatives felt that quality of care at the service was not as good as previously. They told us there were not enough nurses and care staff and that they sometimes had to wait to have their personal care provided. We found that the registered manager had not been assessing staffing levels on an ongoing basis and in response to changing circumstances. Therefore, they could not be assured that there was sufficient staffing to meet people’s support needs.

Some people felt safe in the home but others did not. They told us that they thought that staffing levels were not high enough, that their possessions were not always safe, that external fire doors were sometimes left open during the day and they were worried intruders might come into the home and garden. They told us that the registered manager listened to their concerns and complaints but they did feel that their concerns and complaints were appropriately addressed and resolved. We have made a recommendation to the provider about this.

People’s records were not kept accurately and in a contemporaneous manner and gaps in recordings were identified.

The management team undertook audits and checks to monitor and help improve the quality of the service provided. However, these had not been effective in identifying all the concerns we found in this inspection. Where the management team were aware of concerns such as the staffing levels they had not put in place timely measures to address these concerns.

People told us they had enough food to eat. Some people felt the food served was very good and some people thought it could be better at times. Many people at the home required staff support to eat and drink. Nurses and some staff were trained to support some people who had medical procedures to supp

People’s views and experiences were taken into account in the way the service was provided in relation to their care. Relatives had been involved in developing care plans for people. One member of staff told us “its about the relatives as well, we work with them and also support them if they need it”. For example, we found that a menu had been changed after a relative had told the chef what sort of food a person liked.

People we spoke with told us they were very happy with their care. One person said, "there is nothing wrong with this place at all". A relative told us,” the care is brilliant, I have a laugh with all the carers”. Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. People told us they were happy with their rooms. One person said, "I like this place it is clean and bright". We found that all the bedrooms and communal areas were well maintained and clean.

Appropriate checks were undertaken before staff began work.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.

People we spoke with told us they were happy at Havering Court and felt it provided good care. “Its clean and people attend to my needs. I press the buzzer and people come.” “It’s really nice. People are nice; they’re alright!“ were typical of the comments we received.

We carried out an inspection of Havering Court Nursing Home on 4 and 5 March 2015 and the inspection was unannounced.

The last inspection took place on 2 May 2013 and found that Havering Court Nursing Home was meeting the regulations in relation to outcomes we inspected.

Havering Court Nursing Home provides accommodation for up to 52 older people who have nursing and dementia care needs. There were 48 people living at the home when we visited. The service has two floors which both have a kitchen, main lounge, games area and a quiet area. There is also a cinema room, smoking room, physiotherapy room and main kitchen.

A registered manager was 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.

Medicines records were not always completed fully and accurately and we were not assured that appropriate arrangements were in place for the recording, using and safe administration of some medicines.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

Staff received regular training to ensure they had the skills to meet people's needs. Staff had regular supervision meetings in which their development needs were reviewed.

We reviewed paperwork that evidenced where possible people were involved in the planning of the care they received and were actively encouraged to do so. People told us that they felt cared for and respected by staff supporting them.

People told us that they felt safe living at Havering Court and that they were happy there. We observed staff being respectful, compassionate and inclusive when interacting with individuals and were able to meet people’s needs.

The service had a warm, welcoming and inclusive atmosphere whereby there was an open and transparent culture which was regularly audited by the manager to ensure that the service provision was of a high quality.