We carried out an unannounced comprehensive inspection of this service on 28 March 2017. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation the breach. We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Loose Court on our website at www.cqc.org.uk.

Loose Court is a residential home providing accommodation and support for up to 42 people who require personal care. The home is located outside the town centre of Maidstone. At the time of inspection 36 people were living at the service.

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 our previous inspection on 28 March 2017, the service was in breach of regulation 12 (Regulated Activities) Regulations 2014. This breach was in relation to medicine management. We found that medicine trolleys were being stored incorrectly, gaps in the recording of storage temperatures for medicines, inaccurate amounts of medicine in stock, no protocols in place for medicines prescribed as when required (PRN) and staff not following prescribed guidance for pain relief patches. At this inspection improvements had been made and the service was no longer in breach of the regulation.

People’s medicines were being administered by competently trained staff. Medicines were being stored safely and there were PRN protocols in place. However, we found two gaps in people’s medicine records that had not been accounted for. We have made a recommendation about this in our report.

People were protected from abuse by trained staff who could identify different forms of abuse and who they could report to. The provider had effective safeguarding systems in place.

The provider had ensured that there were appropriate systems in place to identify and minimise risk for people living at the service. Risks to people's safety had been assessed and actions taken to protect people from the risk of harm.

There were sufficient staff to provide care to people. Staff had safety checks to ensure they were safe to work with adults.

This inspection was carried out on 28 March 2017. The inspection was unannounced.

Loose Court is registered to provide accommodation and personal care for up to 42 older people. Some people were living with dementia, some had mobility difficulties, and sensory impairments. Accommodation is provided on two floors with a lift between floors for easy access. The home has a garden area which provides a safe outdoor space. The premises are situated on the outskirts of Maidstone. At the time of our inspection there were 38 people living at the service.

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 our previous inspection on 26 April 2016, we found breaches of Regulation 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people had not received their medicines as required or as prescribed. The provider had failed to operate an effective quality assurance system and failed to maintain accurate records. Steps taken in the home did not follow the principles of the Mental Capacity Act (MCA) 2005. Staff had not received appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. We asked the provider to take action to meet the regulations.

We received an action plan on 27 June 2016 which stated that the provider would be meeting the regulations by mid July 2016.

People and their relatives told us that they received safe, effective, caring and responsive care and the service was well led.

Medicines were not well managed. Medicines had not been stored appropriately. Medicines records did not always detail why people had ‘as and when required’ (PRN) medicines.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.

The provider followed safe recruitment practice. Essential documentation was in place for all staff employed. Gaps in employment history had been explored to check staff suitability for their role. There were suitable numbers of staff deployed on shift to meet people’s assessed needs.

The premises were well maintained, clean and tidy. The home smelled fresh.

Staff had undertaken training relevant to their roles. Staff were supported to gain qualifications and were supported in their roles. They had received regular supervision meetings and those that had worked longer than one year had received an appraisal to discuss their performance, training and support.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

Staff had a good understanding of the Mental Capacity Act 2005 and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the registered manager.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. Feedback from healthcare professionals was positive.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect.

People’s care was person centred. Care plans detai

This inspection took place on 26 April 2016 and was unannounced.

Loose Court is registered to provide accommodation and personal care for up to 42 older people with dementia. Accommodation is provided on two floors with a lift between floors for easy access. The home has a garden area which provides a safe outdoor space. The premises are situated on the outskirts of Maidstone. People had a variety of complex needs including onset of dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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.

Medicine was being administered crushed to one person, which is called covert medicine administration. The correct process for covert administration of medicine had not been followed.

One to one staff supervision had not been consistent. There were gaps in supervisions which showed that staff had not sometimes had supervision for six months or more.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although the registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements. However, the process had not been fully adhered to regarding medicines and restrictions in the home.

Effective systems were in place to enable the registered manager to assess, monitor and improve the quality and safety of the service. However, shortfalls had not been identified by the registered manager and actions had not been taken in a timely manner to improve the quality of the service.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the home.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe recruitment procedures.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The chef prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and during visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and

The inspection was carried out by two Inspectors over five hours. We found that the home had a friendly atmosphere, and people seemed relaxed and comfortable. There were currently 27 people living in the home, and two people in hospital.

During the day we talked with eight people living in the home, and met most of the others. We also talked with nine staff (as well as the manager) and four relatives. All of the relatives spoke highly of the home and the staff. Comments included: “We are very happy with everything here. Mum likes it here, and it is very homely"; and "The home has a very friendly atmosphere."

We found that care planning reflected people’s individual needs, and was appropriately discussed and agreed with people’s next of kin or representatives.

We inspected food and nutritional processes, and found that people were provided with a good range of suitably nutritious foods.

The staff were aware of the importance of safeguarding vulnerable people from different kinds of abuse and were trained in carrying this out.

The home had reliable medication procedures in place, and we found that these were followed accurately.

We found that there were ongoing systems for staff training which ensured that all staff kept up to date with mandatory training.

The home had a complaints procedure which was easily available, and was clearly written. People told us that any concerns were quickly dealt with and addressed appropriately.