This inspection took place on 24 May 2017 and was unannounced. A previous inspection undertaken in February 2016 found three breaches of legal requirements in relation to staffing, good governance and failing to notify the commission of specific incidents. After this comprehensive inspection, the provider wrote to us to say what action they would take to meet legal requirements in relation to the breaches.

Northlea Court Care Home is registered to provide accommodation for up to 50 people. At the time of the inspection there were 47 people using the service, some of whom were living with dementia.

The home had a registered manager who had been registered since May 2013. 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.

Appropriate arrangements were in place to protect people using the service from abuse or any concerns in relation to their safety. Staff had received training in identifying and responding to safeguarding concerns. Risks were assessed and mitigating actions identified to ensure people’s care was delivered as safely as possible. Safe recruitment procedures had been followed.

The breach in relation to staffing had been met. During this inspection we saw the atmosphere in the home was calm and relaxed. People’s requests for assistance were met promptly. Staffing levels were now determined based on people’s needs. Feedback from some people and relatives was that more staff were needed during busier times of the day. We have set a recommendation that the provider considers their feedback and reviews the deployment of staff throughout the day.

Staff received training and support to effectively meet the needs of the people they cared for. We saw training was up to date and well monitored. Staff were supported to further their personal development through regular supervisions and an annual appraisal.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

Care plans were specific, based on assessed needs and regularly reviewed to ensure they remained up to date. We saw evidence that staff had liaised with healthcare professionals an incorporated their advice into records.

People were positive about the food on offer in the home. Where people needed support to eat this was provided in a compassionate way by staff. Kitchen staff were aware of people's dietary needs, and a choice of meals were always available. We saw some food and fluid charts were unavailable to view, we fed this back to the registered manager who told us they would address this.

People we spoke with and their relatives told us they were happy with the care provided. We observed staff were friendly and respectful towards people. Staff knew people and their needs well. A range of activities continued to be offered for people to participate in. People and their relatives were aware of the complaints procedure. We saw complaints had been responded to in line with the provider's policy.

The provider's quality assurance system was in-depth and covered a range of checks and audits to ensure standards at the service were being maintained and improved. Representatives from the provider visited the home regularly to provide feedback on the service and to highlight any areas for improvement. The quality assurance system included monitoring any identified actions for improvement to ensure they were carried out. The registered manager was a visible presence. People, relatives and staff told us the service was well run.

This inspection took place on 16 and 17 February 2016 and was unannounced. A previous inspection undertaken in January 2015 found two breaches of legal requirements in relation to safety and suitability of equipment and safety of premises. After this comprehensive inspection, the provider wrote to us to say what action they would take to meet legal requirements in relation to the breaches and told us they would complete the actions by June 2016.

Northlea Court Care Home is registered to provide accommodation for up to 50 people. At the time of the inspection there were 31 people using the service, some of whom were living with dementia.

The home had a registered manager who had been registered since May 2013. 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.

Staff were aware of the need to safeguard people from abuse and had a good understanding of potential abusive situations. They told us they had received training in relation to this area and were able to describe the action they would take if they had any concerns. Records showed that any safeguarding issues had been dealt with appropriately and relevant authorities notified.

At the previous inspection we found proper fire safety checks had not been undertaken. At this inspection we noted outstanding work from a fire safety audit had been completed and proper fire safety checks were being carried out regularly. Additional checks on risks around the home, such as water temperatures and on lifting equipment were also being carried out. At the previous inspection we had noted emergency call buzzers did not operate between floors, meaning staff could not always be summoned quickly in urgent situations. At this inspection we the saw the system had been revised to ensure any emergency calls were audible throughout the home.

People told us they did not have to wait long for support and help. We noted there were long periods when no staff were visible around the home and lounge areas were not regularly checked to ensure people were safe and well. The regional manager told us staffing had been reduced because of the number of people living at the home. We noted there had been a significant number of unwitnessed falls at the home over the past five months, including five in the lounge areas. Staff told us they felt there were not enough staff on duty at times and this meant people sometimes had to wait for support. Suitable recruitment and vetting procedure were in place.

We found medicines were appropriately managed, administered and stored safely. Audits on the safe administration of medicines were undertaken. We found some issues with regard to topical medicines and records. Topical cream records held in people’s rooms were not always completed and did not reflect the records made by nurses on the main MAR sheets.

Staff told us they had the right skills and experience to look after people. They confirmed they had access to a range of training and updating. Records showed completion of online training was high. Additional training had been undertaken by the provider’s trainers to enhance staff skills. Staff told us, and records confirmed regular supervision and annual appraisals took place.

People told us meals at the home were good and they enjoyed them. Alternatives to the planned menu were available. Staff supported people with their meals appropriately and in a dignified manner. Kitchen staff demonstrated knowledge of people’s individual dietary requirements. Diet preference/ requirement sheets were reviewed and updated regularly. Where people were on food and fluid charts, to help monitor their intake, these were completed well and up to date.

CQC monitors the operation of the De

People we spoke with told us that the food at the home was very good and they enjoyed it. People told us, "The meals are lovely. They don't have to ask me about breakfast they know I like tea and toast, but you get a choice if you want it" and "You always get a choice and there is always something on the menu that you would like." We saw there was a choice of meals on the menu and heard staff asking people what their preference was for that day's meals.

People were protected from unsafe or unsuitable equipment because the provider had in place suitable systems and checks to ensure regular maintenance and upkeep of equipment. We found that baths and showers were fully working and were accessible. One person told us, “You can have a bath or a shower anytime you like. You just have to ask the staff.” Call systems were in operation, so that people could summon help to their rooms. One person told us, "They do come. You don't have to wait too long, maybe a couple of minutes."

Due to the nature of people's illnesses it was not always possible to speak in detail with people who used the service.

The manager told us that since our previous inspection a number of actions had been taken to improve the standard of care. We saw assessments of people's needs had been undertaken and care plans reflected the needs identified. Staff we spoke with told us about the care people received and had good knowledge of their care plans. One person we spoke with told us, "The carers look after me very well."

We looked at the medicine records of people who used the service. We noted all the Medicine Administration Record (MAR) sheets were complete and there were no missing signatures. The provider had established record sheets for the application of topical creams. MAR records contained daily and weekly audit sheets. We concluded medicines were safely administered and appropriate arrangements were in place in relation to the recording of medicines.

We examined the records of five people who used the service. We saw each person had a care plan that had arisen from an assessment of their needs. Care plans were detailed and had been updated. Where people had particular needs, then these were documented. Other care records were up to date and complete, such as; the recording of people’s blood sugar levels, checks on people’s bedrails and the recording of people’s weight. We concluded people’s personal records were accurate and fit for purpose.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of inspection. Their name appears because they were still a Registered Manager on our register at the time.

We included in our inspection a review of care and welfare and medicines management because of information of concern received from other organisations.

During our inspection we looked at four care plans of people who used the service and spoke to three people.

Assessments of people's needs were carried out to highlight areas of care. Risk assessments had been undertaken and updated on a monthly basis. However, we found that referrals on to other services for support and advice had not always been progressed. This meant the person may not get the help needed and staff may not know the best way to support the person.

Overall, we found appropriate arrangements were in place for recording the administration of medicines. However, we saw two people each missed a prescribed medicine for five days because a further supply had not been ordered. In addition, we saw records for the administration of creams and ointments by care workers were poorly maintained.

We found records were not always maintained or updated appropriately. Care plans did not always reflect people's identified risks or changed care needs and that there was no indication one person had been reviewed by wheelchair services.

The home had 39 people accommodated and 11 vacancies.

We spoke with some relatives at the inspection and with one person over the phone. Some of the relatives we spoke with said that they had been unhappy over the past few months about the care. All these people said that their concerns had been raised at the time but several changes of manager had eroded their confidence about the way the home was run. People stressed to us that the staff were kind and approachable. One person said, "The staff have a nice manner with people, management has recently been a difficulty, it has not affected the care but it affects my confidence." Another person said," The matter has been raised and I will be talking to the new manager about it. The staff know what I expect but I feel that if I am not here it may not happen. But the staff are very caring towards Mum." One of the people at the home said,"The staff are lovely lasses, they will do anything for you, the meals are decent and we had a coffee morning this morning."

We saw staff attend to people's needs in private and without undue haste or delay. Call buzzers were answered promptly but staff were kept busy all through the shift.

We saw that mealtimes were relaxed and people were assisted discreetly and with regard to their dignity. People's choices regarding whether they joined the activities were respected. Records contained some unexplained gaps but were securely stored and accessible to staff.

The people we spoke with described the care as "good" "fine", one person said; "I have no problems at all, people are kind."

A visitor said "I look out for ( name of relative) she is looked after here and I would be straight on to the staff if not. The job has to be done properly, that is how I did my job, but I have no complaints and I am here just about every day."

Some of the people who use this service could not tell us directly about their care due to their needs. Where we could we talked to representatives of the people who use the service and the staff.

People told us that the care was very good. One person who was visiting a relative said that the care was 'exceptional' and the staff were caring.

This inspection took place on 20 and 21 January 2015 and was unannounced. We also undertook a period of inspection during a night shift on 27 January 2015. A previous inspection, undertaken in February 2013 found there had been a breach of Regulations 9, 13 and 20 of the Health and Social Care Act 2008. Further inspections carried out in June 2013 and October 2013 found that these issues had been addressed and there were no breaches of legal requirements.

Northlea Court Care Home is registered to provide accommodation for up to 50 people. At the time of the inspection there were 36 people using the service, some of whom were living with dementia.

The home had a registered manager who had been registered since May 2013. 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.

Staff were aware of the need to protect people from abuse. There told us they had received training in relation to safeguarding adults. They told us they would report any concerns to the registered manager, deputy manager or the local authority safeguarding adults team. Staff understood the registered provider’s whistleblowing policy. The registered provider monitored and reviewed accident and incidents and care practice was reviewed and updated in light of any identified issues or trends.

The premises were not always effectively maintained. A recent fire risk assessment carried out at the home had highlighted issues that required addressing, despite the home’s own fire system checks indicating there were no issues of note. The registered manager told us these matters were being addressed and we saw evidence of this. We also noted that emergency call bells in the home did not operate between floors, meaning staff from another floor were not alerted to urgent issues on the alternate unit.

The registered manager showed us the system used to review people’s needs and how this information was used to determine appropriate staffing levels. However, staff told us that they felt additional staff would be helpful on day shifts and we found some care tasks and observations were not undertaken correctly because night staff were busy with care for other people or completing other tasks. The registered manager told us she would look into this. Suitable recruitment procedures and checks were in place to ensure staff had the right skills to support people at the home. We found medicines were appropriately managed, recorded and stored safely.

Staff told us they had the right skills and experience to look after people. They confirmed they had access to a range of training and updating. Records showed there was regular monitoring of staff training to ensure it was up to date. Staff told us, and records confirmed regular supervision took place and that they received annual appraisals.

We found targets for fluid intake identified for three people were not being reached and there was limited evidence the issue was being addressed. Relatives told us they felt the standard and range of food and drink provided at the home was adequate. They said the meals were good and alternatives to the planned menu were available. Kitchen staff demonstrated knowledge of people’s individual dietary requirements and current guidance on nutrition.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff understood the concept of acting in people’s best interests and the need to ensure people made decisions about their care, wherever possible. We saw assessments and best interest meetings had taken place, where appropriate. The registered manager confirmed that applications had been made to the local authority safeguarding adults team to ensure appropriate authorisation and safeguards were in place for those people who met the threshold for DoLS, in line with the MCA.

Relatives told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. Staff were able to explain how they maintained people’s dignity during the provision of personal care.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care. A range of activities were offered for people to participate in. The personal activities leader worker explained how she reassessed the range of activities depending on people’s needs. The manager told us there had only been one recent complaint and people and relatives told us they would speak to the registered manager if they wished to raise a complaint.

The registered manager undertook regular checks on people’s care and the environment of the home. Staff felt well supported and were positive about the registered manager’s impact on care at the home and the running of the service. There were regular meetings with staff and relatives of people who used the service, to allow them to comment on the running of the home.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to the suitability and safety of premises and suitability and safety of equipment. You can see what action we told the provider to take at the back of this report.