We undertook an unannounced inspection of Life Care Corporation in September 2016. After that inspection we received concerns in relation to moving and handling and the management of people who may present challenging behaviour. As a result we undertook a focused inspection on 7 June 2018 to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Life Care Corporation on our website at www.cqc.org.uk.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Life Care Corporation is a ‘care home’. 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 home accommodates up to 41 people. One the day of our inspection 33 were living at the home.

The home is divided into two wings. Most people in the home were living with dementia.

People were safe living in the home. There were sufficient staff to meet people's needs and staff had time to spend with people. Risks were managed. Risk assessments were carried out and included risks associated with moving and handling and challenging behaviour. People received their medicines safely.

The service followed safe recruitment procedures ensuring staff were suitable to safely work with vulnerable people. Staff were aware of their responsibilities to report any concerns relating to abuse. The home was clean and free from malodours. Staff worked in line with the services policy on infection control to reduce the risks associated with cross infection.

There was not 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 2008 and associated Regulations about how the service is run.

The service was led by the interim manager. A new manager had been recruited who was registering with the CQC.

The interim manager monitored the quality of the service and looked for continuous improvement. Staff told us they felt supported by the interim manager and believed the service was well run. The service worked in partnership with local authorities, healthcare professionals, GPs and social services.

This was an unannounced inspection which took place on 8 September 2016. Life Care Corporation Limited is a care home without nursing for older people and is registered to provide care for up to 41 older people. The service was last inspected on 23 June 2015 and required some improvements in the safe, responsive and well led domain questions. These improvements related to inconsistencies and accessibility of peoples care records and insufficient documentation to demonstrate appropriate responses to concerns and complaints. In addition we noted that the time taken to respond to requests for assistance from people needed to improve and there needed to be more effective delegation of tasks from management. As a result of this inspection we saw improvements in all areas.

The service is provided in a large detached building which is located near to public transport. The home provides a range of services for older people, some of whom may be living with dementia. The home is divided into two units each arranged over two floors.

The home is managed by 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. Relatives and staff felt the service was well managed. The registered manager was felt to be accessible and listened to the views of others and acted on them.

People were kept safe because health and safety issues were effectively monitored, servicing and safety checks were carried out regularly and prompt action was taken to address issues. Staff understood their role in keeping people safe from harm and knew how to recognise and report any concerns about abuse. They were confident management would respond appropriately and act on anything they reported. Staff were trained in and understood how to protect people in their care from harm or abuse. People and their relatives told us they felt safe and could talk to staff and the manager about any concerns they had.

Individual and general risks to people were identified and were managed appropriately. Care records had been updated to a new format and relevant and up to date information was readily accessible. People’s medicines were administered safely. Staff were appropriately trained and their competence was assessed. People’s health needs were effectively monitored and supported.

The staff recruitment process was robust and appropriate checks took place. Recruitment files contained the required evidence of the process. Staff received a thorough induction based on the national Care Certificate competencies. They received on-going training through the provider’s rolling programme. Staff were well supported through supervision, team meetings and annual appraisals. The service had a core of stable staff who communicated well with each other and had built good relationships with the people living in the home. There were sufficient staff on duty throughout the day and night to support people appropriately.

The service understood the relevance of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). Appropriate actions were taken in relation to people’s capacity to consent to a range of decisions relevant to the particular individual. Staff had received MCA training. The MCA legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. Deprivation of Liberty Safeguards (DoLs) provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm.

The house was well kept and repairs were dealt with promptly. Cleanliness was of a generally good standard and infection control procedures were adhered to and appropri

This was an unannounced inspection which took place on 23 June 2015. Life Care Corporation Limited is a care home for older people and is registered to provide care for up to 41 older people.

The service is provided in a large detached building which is located near to public transport. The home provides a range of services for older people, some of whom may be living with dementia. The home is divided into two units arranged over two floors.

The home is managed by 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 home had a range of methods to ensure that people were kept as safe as possible. Care workers were trained in and understood how to protect people in their care from harm or abuse. People told us they felt safe and could talk to staff and the manager about any concerns they had.

Individual and general risks to people were identified and were generally managed appropriately. However, risk assessment records were not easily accessible and were not always updated when changes occurred. Care records were in various stages of transition to a new format. There were inconsistencies in the recording of people’s care needs. Regular members of the staff team had knowledge of the people and their needs. However, people could be put at risk of being provided with inappropriate care because staff may not be sure of what was required.

People’s medicines were administered safely. Staff were appropriately trained and their competence was assessed. Medicines prescribed to be taken as and when necessary (PRN) for the management of behaviour Was not always supported by clear guidelines to ensure that they were given appropriately.

The home had a robust recruitment process to ensure that the staff they employed were suitable and safe to work there. The service had a core of stable staff who communicated well with each other and had built strong relationships with the people living in the home. Staff were praised by people and their relatives for being “kind and thoughtful”, “marvellous” and one person said the “staff here are brilliant”. There were sufficient staff on duty to support people appropriately. However, staff were not always well organised or deployed in the most efficient ways.

The service understood the relevance of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). Appropriate actions were taken in relation to people’s capacity to consent to a range of decisions relevant to the particular individual. Staff had received MCA training. People’s capacity to make decisions for themselves and providing people with as much choice as possible were subjects that were discussed in team meetings. The MCA legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. Deprivation of Liberty Safeguards (DoLs) provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. The registered manager, senior staff and care staff demonstrated their understanding of consent, mental capacity and DoLS.

People were given the opportunity to participate in activities and this was a developing area now that a full time activities organiser had been appointed. People were treated with dignity and respect at all times. They and their relatives were invited to be involved in many aspects of the running the home.

The house was well kept and repairs were dealt with promptly. Cleanliness was of a good standard and infection control procedures were adhered to. It was noted that some cupboards that should be locked had been left open. This could present a risk to people living in the home.

People and staff told us the registered manager was very approachable and could be relied upon to respond appropriately to requests or concerns. It was clear that she was highly regarded by the provider, staff, people and their relatives. People, their relatives and staff told that there had been considerable improvements made in the home over the previous seven months.

The inspection team who carried out this inspection consisted of two adult social care inspectors and an expert by experience. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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.

As part of this inspection we spoke in private with six people who use the service and ten people during lunchtime in the dining rooms and lounges. We spoke with three visiting relatives, the registered manager, the acting manager, seven care staff and a visiting health professional. We looked around all areas of the home and grounds and observed the lunchtime meal on both wings. We reviewed records of people who use the service which included four care plans, community nurse recording, daily records and risk assessments. We also reviewed records relating to the management of the home which included eight staff recruitment files, a sample of organisational policies and a sample of audit documents.

Is the service safe?

People were protected from unsafe or unsuitable equipment but systems were not in place to ensure pressure relieving mattresses and bedrails were used correctly.

Effective recruitment and selection processes were not in place. Appropriate checks had not always been carried out before staff began work.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager was aware of a recent Supreme Court judgement changing the way a deprivation of liberty is determined. The acting manager planned to review all people at the home that the ruling may apply to and was aware of the process to follow should an application be required under DoLS.

Is the service effective?

CQC monitors the operation of the Mental Capacity Act 2005 which applies to all services providing care and support for people. We found that before people received any care they were asked for their consent and the staff acted in accordance with their wishes. However, arrangements were not in place for ensuring only those lawfully able to give consent were asked to do so where the person receiving the care lacked capacity to consent.

Equipment used to support people was clean and in working order but there was a lack of equipment that could support people with dementia in their day to day living and promote their independence.

Is the service caring?

All interactions observed between staff and the people living at the home were caring and professional. We saw staff showed skill when working with people with dementia and were calm and reassuring when helping people who were showing signs of agitation and anxiety. People living at the home told us they felt staff were usually available when they needed them and had the skills they needed when providing their care and treatment. One person told us: "The staff are very good, they come quickly if I ring."

Is the service responsive?

We observed call bells were answered promptly and staff we spoke with felt there were usually enough staff on duty to be able to provide the personal care people needed.

A visiting health professional told us they found the home worked closely with them and always followed any instructions or guidance given.

Is the service well-led?

Since our last inspection the provider had taken action and made improvements to ensure people were protected from the risk of infection because appropriate guidance had been followed.

The provider had also taken action and made improvements to ensure people were protected from the risks of inadequate nutrition and dehydration. People we spoke with said they liked the meals at the home and those that needed help with eating confirmed staff were available when required. One person told us the meals were: "Not bad." Another said the meals were: "Very good."

On the day of the inspection we were joined by an Expert by Experience. We spoke with 14 people and two relatives of people who live at the home. Some people were unable to talk about their experiences in a meaningful way. However, most people we spoke with told us they felt cared for by staff. We observed people treated with respect and they appeared relaxed and comfortable.

Care plans reflected people’s individual needs and associated risks. We found people were provided with appropriate care to meet their needs. Care plans included appropriate plans to ensure people’s nutritional needs were met. However, people told us on the day of the inspection that food was cold and we saw no evidence of alternative choices being offered to people. We saw there were no memory aids for people with dementia for menu choices.

We toured the building and found the standard of cleanliness within communal areas and bedrooms was good. Staff had completed infection control training and regular audits were undertaken. However, we noted that cleanliness and infection control was not adequate in some of the communal bathrooms and toilets.

Staff were supported by receiving regular supervision and annual appraisals. Staff received appropriate training and professional development to enable them to deliver care and support to people safely and to an appropriate standard.

A range of systems were in place for auditing and making sure that the service met people's needs.

During this visit we followed up on the area of non-compliance. We reviewed evidence that demonstrated the provider had taken appropriate action following our last inspection in January 2013.

We spoke with the manager who told us recruitment files for all members of staff had been reviewed and any gaps investigated. We reviewed ten of the 25 recruitment files.

Some people at the home had complex needs and so not everyone was able to tell us their experiences. The two people we spoke with were very positive about the service.

We observed people being spoken to with respect and some positive interactions between staff and people who use the service. One person we spoke with said, “the staff are lovely”

Care plans contained individualised information on people's needs, their personal preferences about how they liked their care to be delivered, and risk assessments.

We looked at two recruitment files. They contained some but not all the information required related to the recruitment of workers.

There were systems in place to ensure people were protected from abuse. Staff had safeguarding training. .

This was an unannounced inspection which took place on 24th & 25th November 2014. Life Care Corporation Limited is a care home for older people and is registered to provide care for up to 41 older people.

The service is provided in a large detached building which is located near to public transport. The home provides a range of services for older people, some of whom may be living with dementia. The home is divided into two units arranged over two floors.

The home is managed by 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 the time of the inspection the manager had been working in the home for two weeks following her return from extended leave.

The home had a range of methods to ensure that people were kept as safe as possible. Care workers were trained in and understood how to protect people in their care from harm or abuse. People told us they felt safe and could talk to staff and the manager about any concerns they had.

At the last inspection of 9 June 2014, we asked the provider to make improvements to ensure that people were safeguarded against the risk of incorrect use of pressure relieving mattresses and bed rails. This action had been partially completed.

Individual and general risks to people were identified and were generally managed appropriately. However, risk assessment records were not always updated when changes occurred. All of the established staff team members had knowledge of the people and their needs. However, records relating to the support of people did not always reflect the care provided as they were not always accurate or up to date.

At the last inspection of 9 June 2014, we asked the provider to make improvements to ensure that all staff had undergone appropriate checks before they started work. This action had been completed.

The home had a robust recruitment process to ensure that the staff they employed were suitable and safe to work there. The service had a core of stable staff who communicated well with each other and had built strong relationships with the people living in the home. However, there had been a high turnover in staff numbers over the previous six months which meant that not all staff had an in-depth knowledge of people’s needs.

At the last inspection of 9 June 2014, we asked the provider to make improvements to ensure where the person receiving care lacked capacity to consent only those lawfully able to give consent on their behalf were involved. This action was ongoing.

The service understood the relevance of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Appropriate actions were taken in relation to people’s capacity to consent to a range of decisions relevant to the particular individual. Staff had received generalised Mental Capacity Act 2005 training. This training was an e-learning package completed online. The Mental Capacity Act 2005 legislation provides a legal framework that sets out how to act to support people who do not have capacity to make a specific decision. Deprivation of Liberty Safeguards DoLS provide a lawful way to deprive someone of their liberty, provided it is in their own best interests or is necessary to keep them from harm. The registered manager, senior staff and some care staff demonstrated their understanding of consent, mental capacity and DoLS. However, although most staff could describe the principles of consent and mental capacity one staff member did not know what MCA was.

The service had involved families and requested best interest meetings where appropriate. For example, an application for urgent authorisation for one person had been made. This concerned divided professional opinion about their capacity to make a decision to leave the home which required a meeting to establish what was in the best interests of the person. The use of bed rails had resulted in DoLS applications being made and these were all recorded in the care plans.

Care plans gave some information on how people gave consent and how staff should support them to make decisions. For example, there were signatures for consent for photographs to be taken. We saw staff giving people choices and encouraging them to make decisions for themselves. All staff told us that they always seek peoples consent with everyday decisions such as what to wear, when to go to bed and what to do with their time. However, no records of these decisions were found in the care plans seen.

People were not given the opportunity to participate in many activities. Generally people were treated with dignity and respect. They were involved in all aspects of daily life and assisted to meet any spiritual, behavioural or emotional needs.

The house was well kept but repairs were not dealt with promptly. Cleanliness was an issue in communal areas and some bedrooms.

People and staff told us the registered manager was very approachable and could be relied upon to respond appropriately to requests or concerns. However, there had been a general deterioration in all aspects of the home during the registered manager’s absence.