This inspection took place on 9 and 10 October 2018 and was unannounced. At the last inspection completed on 4 May 2017 we rated the service Requires Improvement.

At this inspection we found improvements had been made, but more were needed and the service remains rated as Requires Improvement.

Marquis Court (Windsor House) is a Residential 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.

Marquis Court (Windsor House) accommodates up to 52 people in one adapted building. At the time of the inspection there were 44 people using the service.

There was a manager in post at the time of our inspection, they had recently been appointed and had not yet completed their registration application, but plans were in place to do this. 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.

Staff were not always available to support people when they needed help. This meant people did not always receive support which was caring. Governance systems were not always effective in identifying concerns and driving improvements whilst some improvements had been made following our last inspection, more were needed.

Peoples medicines were administered as prescribed. Risks to people were assessed and planned for to keep people safe. Staff were safely recruited. People were protected from the risk of cross infection and safeguarded from abuse. The provider learned when things went wrong.

Staff were supported in their role and had access to an induction and training. People were supported to live in an environment which was suitable to meet their needs. People could choose their meals and were supported to eat and drink. People were supported to maintain their health and well-being.

People had choice and control of their lives and staff were aware of how to support them in the least restrictive way possible; the policies and systems in the service were supportive of this practice.

People had their privacy and dignity protected. People were supported to make choices and staff promoted people’s independence. Peoples communication needs were assessed and planned for.

Peoples preferences were understood by staff. People had access to a range of activities. People were clear about how to make a complaint and these were responded to. There was nobody receiving end of life care at the service so this was not considered during the inspection.

Notifications were submitted as required and the manager understood their responsibilities. People and their relatives were engaged in the service and felt able to approach the manager.

The location has previously been rated as Requires Improvement. At this inspection the provider had made improvements to those areas, but other areas were found to require improvement. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

This inspection took place on 4 May 2017 and was unannounced.

At our last inspection on 22 November 2016, we rated the home as requires improvement overall and asked the provider to make improvements to ensure people were consistently protected from the risk of avoidable harm and to have the opportunity to take part in activities to promote their wellbeing and reduce social isolation. At this inspection, we found some improvements had been made but further action was still needed.

Marquis Court (Windsor House) is registered to provide nursing and personal care for up to 52 people. The accommodation is arranged in three units, Tivoli, Chase and Heath. At the time of our inspection, 34 people were living at the home, some of whom were living with dementia.

There was a registered manager at the service. 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.

People received their medicines as needed but improvements were still needed to ensure that medicines were consistently managed in a safe way and that effective checks and audits were in place to continually monitor this.

Risks to people’s health and wellbeing were assessed and managed and staff understood the actions they should take to minimise any identified risks. There were sufficient, suitably recruited staff to keep people safe and promote their wellbeing and staffing levels were kept under review to ensure they continued to meet people’s changing needs.

The registered manager and staff understood their responsibilities to support people to make their own decisions as much as possible. Where people lacked the capacity to make decisions for themselves, decisions were made in people’s best interests which followed legal guidance. Where people were being restricted of their liberty in their best interests, the registered manager had applied for the required legal approval.

People felt safe living at the home and staff understood their responsibilities to protect people from the risk of abuse. Staff received training so they had the skills and knowledge to provide the care people needed. People were encouraged to eat and drink enough to maintain a healthy diet and were able to access the support of other health professionals to maintain their day to day health needs. People were encouraged to keep in contact with family and friends and visitors were able to visit without restriction. Relatives felt involved in people’s care and were kept informed of any changes.

Staff had caring relationships with people and respected their privacy and dignity. Staff knew people well and people received personalised care. People’s care was regularly reviewed to ensure it continued to meet their needs. Improvements had been made and people were offered opportunities to take part in social activities that met their individual needs.

The provider and registered manager carried out checks to monitor and improve the quality of the service people received. People and their relatives were asked for their views on the service and were positive about the improvements being made by the provider. People felt able to raise concerns and complaints and were confident they would be responded to. Staff felt valued and supported by the provider and registered manager.

This inspection took place on 22 November 2016 and was unannounced.

At our last inspection in September 2015, we rated the home as Requires Improvement overall and asked the provider to make improvements to ensure people received their care as planned. We received an action plan from the provider which said the improvements would be made by the end of December 2016. At this inspection, we found some improvements had been made but further action was still needed. We also found improvements were needed in the management and safe storage of people’s medicines and the checks carried out to monitor the quality and safety of the service.

Marquis Court (Windsor House) is registered to provide nursing and personal care for up to 52 people, some of whom were living with dementia. The accommodation is arranged in three units, Tivoli, Chase and Heath. On Heath unit, a number of people were living with advanced dementia. At the time of our inspection, 43 people were living at the home.

There was no registered manager at the service. 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. There was an acting manager who had started working at the service on 26 September 2016, who was in the process of registering with us.

At the last inspection, staff did not always follow risk management plans to ensure people received their care as planned. At this inspection we found action was still needed to ensure risk management plans consistently detailed the actions staff should take to minimise any identified risks associated with people’s care. We had recommended the provider reviewed the way staff were deployed to ensure people received timely support. At this inspection, we found there were sufficient, suitably recruited staff to meet people’s needs at all times.

Whilst we saw people received their medicines when needed, improvements were needed to ensure people’s medicines were accurately recorded and stored safely. The provider had systems in place to monitor the quality and safety of the service. The acting manager had identified the improvements needed but had not been able to implement these during the short time they had been working at the service.

Staff were trained to meet people’s needs but improvements were needed to ensure they were consistently supported in their role. People’s nutritional needs and preferences were met but the recording of people’s weights needed to improve to ensure prompt action could be taken when their needs changed. Improvements were still needed to ensure everyone living at the home had the opportunity to take part in activities and social events that met their individual needs and promoted their wellbeing.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns or complaints, they felt able to raise them with the staff and management team. Staff understood their responsibilities to protect people from the risk of abuse. Staff had caring relationships with people and promoted people’s privacy and dignity and encouraged them to maintain their independence. People’s care was reviewed and their relatives were kept informed of any changes and were encouraged to visit the home whenever they wished. People told us they accessed the support of other health professionals when needed.

Staff gained people’s consent before providing care and support and understood their responsibilities to support people to make their own decisions. Where people were restricted of their liberty in their best interests, for example to keep them safe, this was authorised in accordance with the legal requirements.

The acting manager had started to develop an open and

This was an unannounced inspection. As part of this inspection we looked at the progress the home had made in meeting the concerns we had raised at our previous inspections. During the inspection we spoke with relatives of people that lived at the home, care and nursing staff, the registered manager and the regional manager. We spent time observing people's care as people that lived at the home were not able to tell us of their experiences.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

Systems were in place to make sure that the premises were safe and secure. The required health and safety checks and servicing were completed.

The home had proper procedures in place in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. Staff were aware of their responsibilities to respect people's rights and to keep people safe.

The home had a risk management system in place and acted upon any incidents or accidents. It worked closely with other agencies to promote people's safety. We had concerns about the diversity of people's needs on one of the units and how the risks to people were managed. We have asked the provider to take action to address this.

Is the service effective?

People's health and care needs were assessed. People’s nutritional, personal care and mobility needs were identified in their plans of care. Monthly reviews of care were completed to make sure that care remained appropriate. Some people needed additional support to manage their behaviour. These plans would benefit from being more comprehensive and including the specific actions staff should take to respond to any incidents.

People that needed specialised diets were provided with them. People were supported to eat and drink. Gaps in some food and fluid charts meant that the amount of food and drink people consumed was not always accurately monitored.

Some signage was in place to help people to know their way around the home. The provider told us that other changes were planned to make the accommodation better for the people that lived there.

Is the service caring?

People were supported by staff that showed them respect and promoted their dignity. Most relatives were pleased with the care provided. One relative said: “I have peace of mind when I leave that they will be well looked after”.

Plans of care included some information about people’s previous lifestyle and individual needs.

Relatives involved with the service had the opportunity to complete an annual satisfaction survey. The home had relatives meetings and the manager took action to address any concerns.

Is the service responsive?

The service gave people the opportunity to take part in a number of activities. There continues to be scope for these to be further developed as we saw periods when people were sitting with little stimulation.

The service had a complaints procedure. This was made available to people. Few complaints had been received but we saw that when they were raised they were acted upon.

The service worked closely with health and social care staff to support people to manage their behaviour.

Is the service well led?

The service had a quality assurance system. A range of audits and checks were completed covering such areas as care planning and medication. Records we saw showed when shortfalls were identified they were acted upon. The service had a remedial action plan in place to improve the service to people.

We completed this inspection to check that the provider had made improvements to the care provided to people. When we visited in July 2013 the provider was not meeting a number of regulations. During the inspection we spent time talking with care staff, people that lived at the service and with relatives. Since we visited last time a new manager was in post. They were not yet registered with us.

People and relatives told us they were satisfied with their care. Some of our previous concerns had been addressed but improvements were still needed to make sure people received safe and appropriate care.

Staff had received training in identifying incidents of potential abuse and knew the actions to take if they had any concerns that abuse had occurred. The manager knew how to refer potential incidents for investigation.

The provider had improved the way that staff were recruited. All the required checks were completed.

We saw that care staff received the training and support to provide care to an acceptable standard. Over 90% of staff had completed training and all the care and nursing staff had met the manager to discuss their work.

Effective systems were in place to monitor and check the quality of care provided to people. Action plans were in place to address the shortfalls these checks identified.

Improvements had been made in the record keeping but further improvements were needed to make sure that the records provided up to date and accurate information.

This was an unannounced scheduled inspection. The home did not know we were visiting. During the inspection we spoke with one person, staff, relatives, the recently appointed peripatetic manager and a regional manager. We spent time observing the care people received as most people were unable to speak with us.

Relatives we spoke with said they felt that the care had improved and they were happy with the care their relative received.

People's needs were assessed and plans of care were in place. People were supported to have their personal care needs met and access health care support. Records of care were not always properly completed to show that people received the care they needed.

People did not receive sufficient stimulation to promote their wellbeing. There were some activities available but some people sat for periods with nothing to do.

Care staff were not well supervised and trained. The home provided a range of training but a lot of staff were not up to date with their training. Supervision of care staff had recently been introduced.

The home sought the views of people and relatives that used the service. The home had a system in place to monitor and review the quality but this had not been consistently completed.

This inspection was undertaken to review actions taken since our previous inspection and assess the service's compliance with the regulations.

We spoke to three people who lived at the home and eight staff members. People we spoke with told us, "They are very good here you know", and "I do love the girls they are so good".

We saw that people were treated with respect and had their dignity promoted. People were given choices about their life in the home and their choices were respected.

We found that the home had made improvements which demonstrated that it was compliant with the regulation we assessed.

We carried out this inspection as part of our planned programme of inspections. The visit was unannounced and neither the staff nor the provider knew that we would be visiting.

The inspection included the observation of care experienced by people living at the

home, talking to people who were living in the home, talking with the manager and staff on duty, looking in detail at all aspects of care for six people with complex needs, viewing people's rooms and discussing their care with staff. This process is known as pathway tracking.

Marquis Court (Windsor House) shares the site with its sister home Marquis Court (Tudor House) which is managed separately.

The home provided care and support for people who had dementia. We found that the home was arranged to accommodate people with mild dementia on the lower ground floor, people with moderate dementia on the middle floor and advanced dementia and behavioural difficulties on the top floor. The lower ground floor was in the process of being refurbishment to provide facilities for a re-enablement unit and will have its own kitchenette to enable people to make their own drinks and snacks and undertake some of their own laundry. It is anticipated that changes to this unit will be completed by the end of August 2012.

We met with the manager, area manager, six staff, four visitors to the service and six people who live at the home. People we spoke with were all positive about the care and support that they or their relative received. One person told us; "It’s a good place to live", another said "Yes it's very nice here". One person living on the top floor told us, "Yes it's ok but it can be noisy". Two visitors told us that the care at Marquis Court (Windsor house) was much better than the home their relative had previously lived at. We were told, "They (the staff) seem to understand dementia and xx seems much happier here".

We found that people's bedrooms were spacious and had the specialist equipment that people needed to keep them safe and comfortable. People, frequently with the support of their families, had personalised their bedrooms as they chose to reflect their taste and interest.

We saw how people spent their day. People were generally given a choice of where they spent their time however there was not much for them to do. One person said, "I just watch television either in here or in my room". People who were able told us that they got up and went to bed when they wanted and that there was always a choice of what to eat and drink. There was a need for more things for people to do and especially activities that promoted people's memory. The appointment of a new activity coordinator and initiatives such as "The resident experience day", would develop positive dementia care for people living at Marquis Court (Windsor House).

We observed staff to be caring and patient despite outbursts of verbal aggression directed at them. We saw that generally staff provided people with the assistance they needed. Increased staffing levels and improved staff training for the management of dementia and challenging behaviour would assist this further.

We found that the service had responded positively to any concerns and had appropriate systems in place to protect people from harm.

The appointment of an experienced mental health nurse as a manager for Windsor House has had a positive impact on the support and management of staff and the care people receive.

We inspected this service on 9 and 10 September 2015. This was an unannounced inspection. At the last inspection on 20 and 23 October 2014, we recommended the provider made improvements to ensure people’s emotional wellbeing was well promoted. We found some improvements had been made but further action was required to ensure people were consistently engaged and stimulated to promote their wellbeing.

The service was registered to provide accommodation and personal care for up to 52 people, most of whom were living with dementia. It provides nursing and personal care to people who live in three units, Tivoli, Chase and Heath. A number of people living on Chase and Heath units were living with advanced dementia and needed one to one support. At the time of our inspection, 49 people were living at the home.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise these identified risks. However, staff were not always following these to ensure people’s safety was maintained.

The provider had a recruitment process that ensured people were supported by staff whose suitability had been checked. Staff were supported and trained to meet people’s individual needs.  We have made a recommendation about how staff are allocated across the service.

People were supported to take part in activities but these were group based and did not always meet their individual preferences. Staff did not always engage with people living with dementia to ensure they received the stimulation they needed to promote their wellbeing.

Staff were kind and caring and people’s relatives told us they felt their relations were safe. Staff understood their responsibilities and the actions they should take to keep people safe from abuse.

People received their medicines in a safe way but improvements were needed to ensure an accurate record of the medicines held in stock at the home was maintained.

People were supported to maintain good health and accessed the services of other health professionals when they needed specialist support. People’s care plans were updated when their needs changed.

Staff acted in accordance with the requirements of the Mental Capacity Act 2005. Where people did not have capacity to make decisions themselves, we saw that mental capacity assessments were in place and records showed that decisions had been made in their best interest. At the time of our inspection, 27 people were subject to a Deprivation of Liberty Safeguard.

People’s relatives knew the registered manager and felt able to raise concerns and complaints. The registered manager sought their opinions on the service and acted on feedback received. There were systems in place to assess, monitor and improve the quality and safety of care people received.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.