This inspection took place on 6 and 8 March 2018 and was unannounced. Northbourne Court is a purpose built residential care home that provides accommodation for up to 120 older people, some living with dementia. At the time of this inspection 109 people were using the service. 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.

At our last inspection on 12, 13 and 14 January 2016 the service was rated Good overall. We rated the key question ‘Safe’ Requires Improvement because we had concerns about the high level of falls at the home. At this inspection we found the provider had taken action to monitor and manage the risk of falls appropriately at the home.

The home had 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.

All of the staff we spoke with said they enjoyed working at the home. Most said they received good support from the registered manager and unit managers. However some staff felt their contributions were not always recognised or that manager’s had not listened to what they had to say. We have made a recommendation about motivating staff and team building.

People told us they felt safe living at the home. Training records confirmed that staff had received training on safeguarding and there was a whistle-blowing procedure available and staff said they would use it if they needed to. There was a good staff presence at the home and staff were attentive to people’s needs. Action was taken to assess any risks to people and risk assessments and care plans included information for staff about action to be taken to minimise the chance of accidents occurring. Medicines were managed appropriately and people received their medicines as prescribed by health care professionals.

Staff had the knowledge and skills required to meet people’s needs. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Most people told us they enjoyed the meals provided to them and they could choose what they wanted to eat. People were supported to maintain good health and they had access to healthcare professionals when they needed them.

People had been consulted about their care and support needs. These needs were assessed before they moved into the home. Care plans and risk assessments included detailed information and guidance for staff about how people’s needs should be met. People’s privacy and dignity was respected. There were plenty of activities for people to partake in if they wished to do so. The home had a complaints procedure in place and people said they were confident their complaints would be listened to and acted on.

The provider recognised the importance of monitoring the quality of the service. They sought the views of people using the service, their relatives and friends through residents and relatives meetings and satisfaction surveys. The registered manager worked with other care provider’s and professional bodies to make improvements at the home.

We spoke with some people who used the service and some people's relatives about their experiences of the care and support they received. Most people we spoke with were happy living at the service. One person's relative told us "the staff are good, and the care is good". The same relative told us that when they had raised concerns in the past these had been dealt with promptly and appropriately. We found people were supported by staff who were overall compassionate and responsive to people's needs. We formally observed the support people received during one mealtime using our SOFI tool, and found staff interacted and supported people well.

We carried out this inspection to check whether the provider had implemented improvements following our inspection on 12 and 13 June 2013 in relation to care planning, medicines management and quality assurance. At our inspection on 11 March 2014 we found the provider had implemented most of the improvements we required. For example, a new care plan format was in place and people's needs were assessed and care was appropriately planned and delivered. Some improvements had been made to medicines management such as more robust auditing and staff training. Quality assurance processes ensured that where actions were identified, relevant improvements were implemented.

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 "practising professional"; people who have experience of delivering 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.

We spoke to some people who used the service and also some relatives of people. People told us their privacy and dignity was respected and that staff were polite towards them. One relative told us they were involved in their family members’ six monthly reviews but they did not know about the care plan.

A relative told us that they had concerns about the level of stimulation people received throughout the day and that staff did not have time to interact with people other than when performing tasks. Another relative told us there was lots going on during the day and people who used the service were stimulated.

People who used the service told us they enjoyed the food. One person said they rated the food “eight out of ten”. Another person said their lunchtime meal was “lovely.”

People told us they knew how to complain if they had any concerns. People who had complained or told us their complaints were listened to.

People who live at the home told us that they were happy there. They said that they were well cared for and that the staff were friendly and supportive. One person said, ‘this home is perfect’. Another person told us, ‘the staff are the best and everyone is kind and caring’.

People told us that the home was well maintained and that they were able to do the things they wanted. They told us that they had their needs met and that they were able to make choices about their lives.

At our inspection on 8 April 2015 we found several breaches of legal requirements. The systems for the management of medicines were not safe and did not protect people using the service. People were not supported by a sufficient number of staff to ensure that their needs were met. In addition people’s capacity to give consent had not been assessed in line with the Mental Capacity Act 2005 (MCA). We asked the provider to make improvements in these areas. We also recommended that specialist advice was obtained to deal with fluctuation of water temperatures and potential issues associated with water born infections. Following that inspection the provider sent us an action plan telling us of how and when they were going to make these improvements. They kept CQC informed of the changes that had been made.

At this inspection we found that significant improvements had been amde in all of these areas. We found that systems for the management of medicines were safe, the provider was acting in accordance with the MCA and action had been taken to support people with sufficient numbers of staff. However, we had concerns about the high level of falls at the home and have made some recommendations within the report about this issue.

Northbourne Court is a large care home located in the London Borough of Bexley. The home is registered to provide accommodation and support for up to 120 people and specialises in caring for people living with dementia. At the time of our inspection 112 people were using the service.

There was a manager in place who was in the process of applying for registration. 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 using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider took into account the views of people using the service and their relatives and staff through surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the manager. The manager and other managerial staff at the home conducted regular checks to make sure people where receiving appropriate care and support.