About the service: Lancaster Court provides accommodation, personal care and nursing care for up to 65 people. At this inspection 59 people were living at the service.

People’s experience of using this service:

Everyone we spoke with part of this inspection told us they were happy living in Lancaster Court because staff were kind and all their needs were met.

People`s independence was promoted; they were involved in the home`s day to day life and formed friendships with each other and staff working in the home.

Staff promoted people`s privacy and dignity and their choices were respected. Care and support was delivered in a personalised way by staff who knew people`s likes, dislikes and preferences.

Risks to people`s well-being and health were well managed and regularly reviewed to ensure they were safe and protected from the risk of harm. Staff received training and had their competencies assessed to ensure they were skilled and knowledgeable to meet people`s needs effectively.

The environment was homely, clean and welcoming. Staff used effective infection control measures to protect people from the risk of infections. Appropriate equipment was in place where needed for people to receive support in a safe way.

People had opportunities to take part in organised group activities or pursue their hobbies and interests. Staff had a genuine interest to keep people involved and occupied.

People and relatives told us there were enough staff in the home to meet people`s needs. People felt listened to and they told us they were happy living in Lancaster Court.

Everyone we spoke with, people, relatives and staff praised the registered manager for being approachable, supportive and placing people in the centre of the care and support they delivered.

Complaints and feedback from people and relatives were used in a constructive way and lessons were learned to ensure improvements were made.

The registered manager and the provider used a range of effective audits and governance systems to check the quality and safety of the care people received.

Rating at last inspection: Good (report published 22 June 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection was carried out on 31 May 2016 and was unannounced. At their last inspection on 8 October 2014 they were found not to be meeting all the standards we inspected. This was in relation to staffing, medicines, quality monitoring systems, infection control, promoting dignity, nutrition and the provision of activities. The provider wrote to us to say what they would do to meet legal requirements in relation to Regulations 10, 12, 13, 14, and 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found that they had made the necessary improvements and were meeting the regulations.

Lancaster Court provides accommodation and personal care for up to 65 people. At this inspection 62 people were living at the service.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

People were protected from the risk of abuse and staff knew how to mitigate risks to people. Accidents and incidents were reviewed to help identify trends. Medicines were managed safely. There were sufficient numbers of staff to support people and they were recruited through a robust process.

People were supported by staff who received appropriate training and support. People’s consent was sought and where they were unable to make independent decisions the correct process in relation to MCA and DoLS was followed.

People enjoyed their food and they were supported to maintain a balanced diet. People had access to health and social care professionals when needed.

People were treated with dignity and respect and told us staff were kind. Staff had developed positive relationships with the people they supported. People were involved in the planning of their care and staff were aware of their preferences. Confidentiality was promoted.

People’s care needs were met and care plans included clear information to enable staff to provide safe and appropriate care. There was a range of activities available that people enjoyed. People knew how to make a complaint and express their views and these were responded to appropriately.

People, relatives and staff were positive about the registered manager and how the service was run. There were systems in place to monitor the quality of the service and action plans were developed to address any shortfalls identified.

This inspection took place on 8 October 2014 by three inspectors and was unannounced. The service was found to be meeting the required standards at their last inspection on 8 October 2013.

Lancaster Court is a nursing and residential care home which provides accommodation and personal care for up to 65 older people. The home has three floors with a residential dementia unit on the ground floor and nursing units on the other two floors.

At the time of our inspection 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 and associated Regulations about how the home is run. The home has had the same registered manager since 1 October 2010.

CQC is required to monitor the operation of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had been made to the local authority in relation to some people who lived at Lancaster Court and may be considered to have their freedom restricted. The provider had acted in accordance with the Mental Capacity Act (2005) and DoLS.

There were insufficient numbers of care staff available to meet people’s care needs. We observed that people had lengthy waits for personal care to be provided in circumstances that compromised their dignity. Whilst appropriate arrangements were in place in relation to storage, disposal and recording of medicines, people did not always receive their medicines on time due to a lack of staff.

The home was not meeting the required standards for infection control and people were at risk of acquiring an infection as published guidance was not always being followed.

People were happy with the care they received from staff and we observed positive interactions when staff assisted people with their care needs. People were generally treated in a courteous and respectful manner. However we saw that two people were left in an undignified state as staff did not attend to their care needs in a timely manner. People’s health needs were assessed and regularly reviewed, however we found that their nutritional needs were not always supported.

There was a quality assurance system in place. The manager carried out regular audits and reviewed these with the regional manager. However, there were no action plans in place to address issues of concern, such as staffing. Where concerns had been identified there had not been a timely response to improve the quality of the service for the people that live there.

On the day of inspection there were 62 people in residence at the home. The accommodation was appropriately designed, suitable to meet the needs of the people living there and was clean and well maintained. We spoke with several people who lived and worked at the home. One person described the staff as "lovely".

Two staff members stated that they would have no concerns about their own relatives being cared for at Lancaster Court. One staff member had come into the home on their day off to visit one of the people who was not well.

The was a general atmosphere of calm evident in the home throughout the inspection and this contributed well to staff assisting people with their daily needs in a prompt and efficient manner.

Care plans were informative, up to date and staff were aware of their contents. People's health needs were assessed and met. Systems for receipt, storage, administration, recording and disposal of medicines were safe. Staff recruitment, induction and training systems were robust. This ensured people were well cared for and staff were able to learn and progress with their careers.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an ‘expert by experience’, a person who has experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our inspection visit to Lancaster Court we spoke with 13 people living in the home and four visitors.

People we spoke with felt that their personal care was carried out in a manner that promoted their privacy and dignity. We saw that staff were polite and courteous to people and offered them choices about their day to day routines.

People we spoke with were satisfied with the food provided. One person told us, “I am quite happy, the food is quite good." People told us that alternatives were provided, on request, if they did not like the food that was on offer. One person told us that staff were always willing to cater for individual wishes or tastes and gave us examples of this.

Every person living in the home that we spoke with said they felt safe in Lancaster Court and each assured us that if they had any concerns they could discuss it in confidence with either a member of staff or the management.

People living in the home told us that the staff treated them well and were friendly to them. Visitors to the home told us they were satisfied with the way people were supported. One person told us, “It’s a nice place, nice people, hardworking. They do amazingly well.”

A relative of a person using the service stated that low staffing numbers and a lack of management at the home had had a detrimental effect on the care provided for their relative. They told us that the registered manager had been away from the home for several weeks due to sickness and that additional staff sickness has led to reception duties being covered by the maintenance employee.