The inspection took place on 24 September 2018 and was unannounced. This meant the provider was not aware that we would be visiting the service. The service was last inspected in October 2016 and was rated overall requires improvement with breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to staffing, safe care and treatment, and good governance.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Lisburne Court’ on our website at www.cqc.org.uk’

Lisburne Court 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. Lisburne Court is registered with the Care Quality Commission (CQC) to provide care and accommodation for up to 48 older people living with dementia. It is one of 11 residential care homes operated by Borough Care Limited which is a not for profit company providing residential accommodation. The home is located in Offerton Stockport and is situated on a bus route into Stockport town centre.

Borough Care Limited specialise in dementia care. The company's head office is located at Heaton Lane, Stockport, Greater Manchester.

The service has 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 and associated Regulations about how the service is run.

Medications procedures were in place including protocols for the use of ‘as and when required’ (PRN) medications. Staff had received training in medication management and medication was audited in line with the provider’s procedures. There was good guidance for staff regarding how people expressed pain or discomfort, so they could respond appropriately and seek input from health care professionals, if necessary. People had access to a good range of health care services and staff would closely with district nursing services and GP’s.

Staff were aware of the Mental Capacity Act [MCA] and the Deprivation of Liberty Safeguards [DoLS]. At the time of this inspection the registered manager told us some people who used the service had an authorised DoLS in place and others were awaiting authorisation. This legislation was used to protect people who might not be able to make informed decisions on their own.

Staff we spoke with had a clear understanding of safeguarding people and they were confident their managers and the rest of their team would act appropriately to safeguard people from abuse.

The care plans we looked at included risk assessments, which identified any risks, associated with people’s care and had been devised to help minimise and monitor the risks without placing undue restrictions on people. We found that peoples’ needs were thoroughly assessed prior to them staying at the service.

Staff were recruited using robust procedures which ensured only suitable staff were employed to work in the service. There were enough staff to keep people safe and to meet people’s individual needs, and the staff told us they received good training and support. Staff knew people well and had built good relationships. There was also a good mix of staff. However some agency staff continues to be used. We were told this was mostly on nights.

People were encouraged to make choices about their meals, and were supported by staff if they needed any assistance with eating and drinking. We saw people were involved and consulted about all aspects of their care and support.

Staff spoke to people in a caring and positive way, treated people with respect and were mindful of their rights and dignity. There was a nice, relaxed atmosphere a

This was an unannounced inspection which took place on 12,14,18 and 19 October 2016.

We last inspected the service in October 2013. At that inspection we found the service was meeting all the regulations that we reviewed.

Lisburne Court is registered with the Care Quality Commission (CQC) to provide care and accommodation for up to 42 older people living with dementia. It is one of 11 residential care homes operated by Borough Care Limited which is a not for profit company providing residential accommodation. The home is located in Offerton Stockport and is situated on a bus route into Stockport town centre. Accommodation was provided over two floors which could be accessed via a passenger lift. All bedrooms were single without en-suite facilities. At the time of this inspection 42 people were living at the home. Day care was provided for up to four people each day.

Borough Care Limited specialise in dementia care. The company's head office is located at Heaton Lane, Stockport, Greater Manchester.

During the inspection we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations. You can see what action we asked the provider to take at the back of this report.

A registered manager was not in place. 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 an interim manager was in place. This manager was also the registered manager at another Borough Care Ltd location but was not the registered to manager Lisburne Court. The interim manager was assisted in managing the home by a deputy manager.

Written information for a person identified as being at medium risk of weight loss, had not been transferred to their risk management plan and was not shared in a timely way with the management team. Whilst the person had not come to any harm it was apparent their identified risks were not continually monitored to prevent the risk from increasing.

A care record we looked at lacked robust information to enable staff to continually identify and assess some of the risks to their health, safety and welfare. For example, although the district nurse was managing the person’s skin integrity their care record did not contain enough information about the wound treatment or care to be provided by staff members.

Another person’s daily record sheet was not detailed enough to demonstrate their care had been delivered in a person centred way. We also saw a care plan did not clearly instruct staff how to support a person with mental health needs should they display paranoid behaviour. This meant these people were at risk of receiving unsafe and inappropriate care.

Daily record sheets relating to the care and treatment of people who used the service, such as changes to care plans following medical advice, had been archived prematurely. This meant information about decisions taken was not immediately accessible for staff to help them deliver people’s care and treatment in a way that met their needs and kept them safe.

A medicine’s emergency policy aims and guidance, and a policy to support service users consent to examination of treatment, both referred to obsolete care standards and regulations. Both policies had not been updated or reviewed since May 2014 which meant they were not managed in line with current legislation and guidance.

Records showed staff received infrequent supervision and they also told us they had not received an annual appraisal during 2016. The interim manager confirmed there have been no staff appraisals since April 2016. This meant the provider could not show that staff were supported in their role to make sure their competence was maintained and risks to people’s

During our visit to Lisburne Court we spoke with seven people who used the service, three visitors, and six members of staff two of which were from the organisations own bank staff. All the people who used the service had dementia care needs in varying degrees. We also spoke with the Manager and Deputy Manager.

We were told by the people who used the service; “I didn’t choose to come here, but I accepted my nephew’s choice. It is really good and the staff are extremely helpful”; “My relative is smiling, and I haven’t seen them look so happy, even though I think they don’t know us sometimes”. “We think this place is absolutely fabulous”.

We looked at a selection of care records. These contained information regarding the needs and wishes of individuals and the care that they had agreed with the service.

We found that systems were in place to monitor the quality of the service provided.

The members of staff we spoke with said that they had received training and that training was on-going.

We found no evidence to suggest that there were insufficient staff on duty to meet the health care needs of the people who use the service.

We visited Lisburne Court on the 11 October 2012. During our visit we looked at the care files of two people who lived at the home. We also looked at the personnel file of the most recent member of staff to be employed at the home.

We spoke with the manager, two members of staff, a family member and two of the people who lived at the home. We also spoke with a GP who was visiting one of his patients. We also contacted four other family members and a member of staff by telephone.

The family members we spoke with said; “I am happy with the care”; “I am kept informed and I am involved in the annual review of care”; “The girls (care workers) are lovely”; “The bedroom is spotlessly clean”; “There are regular entertainers and there is always something going on”. We were also told by all the family members we spoke with that people’s privacy and dignity was respected.

There had been two safeguarding investigations. One of the investigations resulted in recommendations being made for improvements to record keeping. The second investigation recorded an outcome of unsubstantiated.

After our visit we were informed of a new safeguarding referral which had been made to Stockport Social Services Adult Safeguarding team due to a complaint. This referral was still under investigation at the time of writing this report.