About the service: Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of our inspection there were 68 people using the service.

People’s experience of using this service: Improvements had been made to the service following our last inspection in July 2018. The provider and acting manager had improved the way the risks of falls were managed, the maintenance of falls sensor equipment, the maintenance of the wheelchairs and the effectiveness of the audits.

The registered manager had left and a new manager had come into post the day before we inspected. In the four months the deputy manager was overseeing the service they had driven improvement and made positive changes. Systems for overseeing the service were far more effective. The changes had enabled staff to address issues noted at previous inspections. However, the changes made were not fully embedded and further time was required for the provider and manager to be assured that these were effective.

Staffing levels now met people's needs but the provider’s dependency tool did not assist staff to complete an accurate assessment of needs.

Staff stated they felt confident and able to raise safeguarding concerns. People discussed past concerns and at previous inspections we noted that concerns were not always sent to safeguarding teams. The new manager said they would check that concerns had been raised and where appropriate referrals had been sent.

Building works were being completed to improve the medication rooms and plans were in place to upgrade the kitchen. Medicine management was generally effective.

People and relatives in general felt the service had improved and was meeting their needs. Staff said they felt positive about how the service was being operated now and that staff morale had improved. They now felt able to contribute to the operation of the service.

Rating at last inspection: Requires Improvement (report published 13 September 2018).

Why we inspected: Philips Court has been rated as requires improvement since September 2017 and during this period we have inspected on three other occasions. We completed this focused inspection to review the service’s progress and see if they met the regulations. The service had improved in one of the two key questions that we reviewed.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

We conducted the inspection from 10 July 2018 to 23 July 2018. It was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

In September 2017, the local authority commissioners raised concerns around the operation of the service. The provider agreed to not accept new placements and this was regularly reviewed by the local authority and on 12 July 2018 this ended.

We completed a comprehensive inspection on 14 September 2017 and found the provider was meeting the fundamental standards of relevant regulations. We rated Philip’s Court as ‘Requires improvement’ overall and in all five domains. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, maintaining people’s privacy and dignity, providing personalised care and having good governance systems in place.

Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve.

On 30 January 2018 we completed a focused inspection to check that improvements were being made. We found that although some improvements had been made and they were now compliant with the regulation related to maintaining people’s privacy and dignity. The provider however, continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action plan they had previously sent stated they expected to be compliant with the regulations by the end of June 2018.

Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of our inspection there were 63 people using the service.

The service had a registered manager 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 this inspection we found that action had been taken to resolve the issues found at the last inspection.

We found practices had improved but the staffing levels on the downstairs nursing unit often prevent these from being fully implemented.

On the downstairs nursing unit staff were expected to complete 15-minute observation for six people on this unit, as they were prone to falling. We observed practices on the unit and found for long periods of time staff were not visible. The 15-minute checks were not completed but the records were retrospectively filled in to suggest this had happened.

We found there were insufficient staff to ensure effective observations were completed and the quality assurance processes had not identified this issue.

Four door sensors were in place across the service. We found only one was working and this had a warning light on suggesting the battery was running out. Staff believed all were working and were unable to tell us who was responsible for fitting sensors or how these were checked.

We found that staff were being supported to complete training but the provider needed to ensure there were sufficient qualified first aiders to cover 24 hours every day. Staff had not completed falls prevention training or being taught how to use bed, floor and door sensors.

During our visits we found that the temperatures in the service exceeded 25°c. The registered manager informed us that the provider had authorised them to have air conditioning units fitted.

We observed the meal time experience and found on the first day that the meal-time was chaotic and it took two hours for everyone to have a meal. Also, staff adopted poor practices when handling food such as leaving food with people who needed support for over 20 minutes then putting it back in the fo

This focused inspection of Philip’s Court took place on 30 January 2018. It was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

We last inspected the service on 14 September 2017 and found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Philip’s Court as ‘Requires improvement’ overall and in all five domains. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, maintaining people’s privacy and dignity, providing personalised care and having good governance systems in place.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? and Is the service well led? to at least good.

In September 2017, the local authority commissioners raised a number of concerns around the operation of the service and the registered manager’s practices and since then the provider has had a range of regional staff working at the service. The provider agreed to a voluntary embargo on accepting new placements at the service whilst action was taken to improve the operation of the service.

This focused inspection was done in part to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 14 September 2017 had been made. We were also aware that local commissioners and healthcare professionals had raised further concerns following their recent visits.

We inspected the service against two of the five questions we ask about services: is the service well led, and is the service safe? This is because the service was not meeting some legal requirements in these areas.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. There were 62 people using the service when we visited.

The home has not had a registered manager since 28 June 2017. 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. The provider had recruited a person to be the registered manager who started working at the service at the end of August 2017. They have submitted an application with CQC to become the registered manager.

Staff knew the people they were supporting but the care records still did not reflect this knowledge. Also the records did not provide evidence that could be used to demonstrate to external parties why some people needed one-to-one support. The diaries that had been introduced for this purpose showed people were settled and did not record instances when people had been distressed. The care record documentation also did not provide evidence to demonstrate what people’s needs were, how staff needed to work with individuals and why they were using the service.

We noted that the home was changing from Well-pad back to Boots medication systems in the next few months. However, we found there were multiple issues with medication administration, including failures to ensure appropriate rotation of patches, difficulties with stock balances, failings to adhere to guidelines in relation to

This comprehensive inspection of Philip’s Court took place on 14 September 2017. It was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

We last inspected the service on 2 February 2017 and found the provider was meeting the fundamental standards of relevant regulations. At that time we rated Philip’s Court as ‘Good’ overall and good in all five domains. We carried out this inspection in response to concerns that local commissioners and healthcare professionals had raised following their visits. During our inspection on 14 September we identified shortfalls throughout the service and breaches of regulations.

Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. There were 70 people using the service when we visited.

The home has not had a registered manager since 28 June 2017. 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. The provider had recruited a person to be the registered manager who had started working at the service at the end of August 2017.

We identified a number of health and safety risks such as a fire exit being blocked with mattresses and a fire exit route leading towards an un-railed path that was adjacent to a steep slope. The new manager immediately ensured the fire exits and courtyard were cleared of hazards before we left. The provider took action to ensure the fire exit route had appropriate railings in place.

Although the domestic staff tried their best to keep the service clean there were insufficient staff to do the day-to day work. We also saw that the laundry staff needed more support or better cleaning products. The new manager immediately organised for the service to be deep cleaned and the provider ensured cleaning products were effective and additional domestic staff were employed.

We found staff were not always aware of who needed their food and fluid intake monitoring. Additionally staff needed to improve the accuracy of their recording when monitoring peoples' fluid intake. The manager had identified this gap in practice and was in the process of ensuring staff monitored people and supported them to receive adequate food and fluid.

We found from the review of records that some people displayed behaviours that challenge but staff had not received training to deal with their behaviours safely and the actions they needed to take were not detailed in the care records. During the inspection the manager contacted the provider’s training department and organised for staff to immediately receive ‘safe holding’ training.

Safeguarding and whistleblowing procedures were in place. We found that previously concerns and complaints had not always been dealt with in a meaningful manner and no process had been put in place to ensure the issues were not repeated. Staff had not always ensured concerns were reported to the manager as they only recorded the issues in the particular person’s daily records. The new manager had started to address this matter.

People’s care records were cumbersome and we found it difficult to get a sense of a person’s needs. The lack of a detailed written assessment had contributed to the difficulties around developing the care records as an effective working tool.

Accidents and incidents were monitored, but we found improvements were needed around how the information was analysed and used. We also found that medicines were not always administered safely. The new manager took immediate action to address these matters.

The environment on the upstairs nursing unit was not user friendly and this w

This unannounced inspection took place on 3 February 2017. We last carried out a comprehensive inspection in November 2015 at that time we found the service required improvement.

Philips Court is a 75 bedded care home that provides personal and nursing care to older people including people who live with dementia. At the time of our inspection there were 73 people 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service managed medicines appropriately. They were correctly stored, monitored and administered in accordance with the prescription. People were supported to maintain their health and to access health services if needed. People who required support with eating and drinking received it and had their nutrition and hydration support needs regularly assessed.

Staff were trained to an appropriate standard and received regular supervision and appraisal. As part of their recruitment process the service carried out background checks on new staff.

Where people were not able to make important decisions about their lives the principles of the Mental Capacity Act 2005 were followed to protect their rights. Staff were aware of how to identify and report abuse. There were also policies in place that outlined what to do if staff had concerns about the practice of a colleague.

Care plans were subject to regular review to ensure they met people’s changing needs. They were easy to read and based on assessment and reflected the needs of people. Risk assessments were carried out and plans were put in place to reduce risks to people’ safety and welfare.

Staff had developed good relationships with people and communicated in a kind and friendly manner. They were aware of how to treat people with dignity and respect. Policies were in place that outlined acceptable standards in this area.

There was a complaints procedure in place that outlined how to make a complaint and how long it would take to deal with. People were aware of how to raise a complaint and who to speak to about any concerns they had. There were no outstanding complaints in the service.

The service had a dementia friendly environment that was innovative and creative. The registered manager and her team ensured that people had a structured meaningful day and provided a variety of activities.

Philips Court was well-led by a registered manager and her team who had high expectations around standards of care at the service. A quality assurance system was in place that was utilised to improve the service.

This was an unannounced inspection carried out on 27 November 2015.

We last inspected Philips Court in July 2014. At that inspection we found the service was meeting all the legal requirements in force at the time.

Philips Court is a 75 bed care home that provides personal and nursing care to older people, including people who live with dementia or a dementia related condition. At the time of inspection there were 74 people living there.

A registered manager was 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.

The environment was well designed to help people who lived with dementia to be aware of their surroundings and to remain involved. However, there was not a good standard of hygiene and areas of the premises were showing signs of wear and tear.

People’s care records did not accurately reflect the care and support provided by staff. Staff knew the people they were supporting well. Care was provided with kindness and people’s privacy and dignity were respected. There were activities and entertainment available for people

People said they were safe and staff were kind and approachable. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Systems were in place for people to receive their medicines in a safe way. People had access to health care professionals to make sure they received appropriate care and treatment. Appropriate training was provided and staff were supervised and supported

Philips Court was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Best interest decisions were made appropriately on behalf of people, when they were unable to give consent to their care and treatment.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to.

People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. The home had a quality assurance programme to check the quality of care provided. However, the systems used to assess the quality of the service had not identified the issues that we found during the inspection with regard to record keeping.

Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

You can see what action we told the provider to take at the back of the full version of the report.

Some people who used the service had complex needs which meant they could not share their experiences. We used a number of methods to help us understand their experiences, including carrying out an observation, speaking with people who could share their experiences and speaking with visiting relatives.

During our observation we saw people were treated with consideration and respect. People and their relatives told us they were happy with the care which was provided. One person said, “It's a lovely care home. The service is excellent. Staff are always checking we are ok, during the day and they check in on us during the night too. I feel well cared for."

We reviewed six care records and saw that people's preferences and care needs had been well documented. We spoke with four members of staff. Staff were knowledgeable about the people's care needs and what they should do to support them.

However we saw that care was provided in an environment that was not suitably designed and adequately maintained.

Staff received appropriate professional development and there was an effective system in place to make sure staff training was up to date so that staff could care for people safely and to an appropriate standard.

We found that the provider had made suitable arrangements to protect vulnerable people from the risk of abuse and that there was an effective system in place to monitor and assess the quality of the service.

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

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found-

Is the service safe?

Risk assessments were in place. All risks to people living in the home, their relatives and staff were regularly assessed and appropriate steps taken to minimise such risks. People were supported and encouraged to maintain their independence and this was balanced with the risk to the person. Systems were in place for checking safety equipment and systems such as fire alarms, lifts and hot water temperatures.

Audits were carried out to look at accidents and incidents and the necessary action was taken to keep people safe. Information was available to show that the service worked with other agencies to help ensure people's health needs were met and to prevent admissions to hospital wherever possible.

Staffing levels were in place to ensure all the needs of the people who lived at the service were met in a timely way and to ensure their safety. A member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We were told the necessary applications had been submitted and three people were subject to Deprivation of Liberty orders. We saw proper policies and procedures were in place.

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people’s care and support needs and that they knew them well as individuals. Relatives we spoke with told us that the service kept them up to date with what was happening with their relative's care and they felt able to ask any questions. One relative commented; "Yes I am aware and the plan is regularly reviewed and I sign it." Another person said; "Yes they (the staff) have discussed the care plans and I understand what is included." And; "We have had an initial meeting in the first four-six weeks. We have discussed things specific to Dad."

Staff had received regular training to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff, who showed patience and gave encouragement when supporting people. People commented how helpful and friendly staff were. Several people we spoke with commented how pleased they were with the care provided by staff at the home. We observed staff were patient and supportive as they worked with people. One person said; "I like it here, I’m not saying I like it every day but 99% of the time I do." And a relative commented; "It’s a lovely home and you are made to feel very welcome and I know he is getting well looked after – I am pleased. Another person commented; "Yes they (staff) are very kind – they know everyone, there is not a great turnover of staff, they know how to talk to everyone." Another person commented; "There are different personalities, some we feel more confident with – some you warm towards, they (staff) are all very friendly and welcoming. Other comments included; "There are some lovely girls in here." And; "The staff are lovely; they are very nice people- it’s nice that they are just not there for Dad, they are there for us."

Is the service responsive?

People’s needs had been carefully assessed before they moved into the home. People told us they had been asked for their views and these had been recorded. Records confirmed people’s preferences, interests and needs had been recorded and care and support had been provided in accordance with people’s wishes. People had access to activities that were important to them and had been supported to maintain personal relationships with their friends and relatives. We saw a large day room had been created on the ground floor for the use of people during the day. The activities person used the room for running activities sessions which were attended by many people throughout the service. Activities included: arts and crafts, pet therapy, knitting club, quizzes, exercise, music, reminiscence, movie afternoons, religious services, pamper sessions and hairdressing. We spoke with some people who used the service who were also involved in gardening. We saw some animals such as guinea pigs, hens and rabbits were kept for the enjoyment of people who used the service. Staff we spoke with were very enthusiastic and the manager had a wealth of ideas to ensure activities were appropriate to help people with dementia remain engaged and stimulated. People were positive about the service and activities. One person commented; "There have been students in and they have made tactile mats. My mother does go down if there are any entertainers on, there are really good activities for people." Another said; "There is all sorts of things to do, we sing and dance and look at the papers. It’s a very, very happy place as far as I am concerned." And; "There are lots of things in here, my father likes the animals outside, the staff try and get him engaged. They take him out he has been to the museum and the thrift shop. Another person said; "I get involved in the meetings about the hens. The hen power meetings."

Is the service well-led?

The home had a registered manager in post. She was aware of dementia research and guidance available from Salford, Bradford and Stirling University. There was an ethos of involvement and it was apparent the manager was passionate about keeping people with dementia involved and engaged in daily living for as long as possible, to improve their experiences. Staff we spoke with were enthusiastic about their role working with people and they were knowledgeable about the support needs of people. Staff told us they were clear about their roles and responsibilities. They said they felt supported by the manager and advice and support was available from the management team. Staff had a good understanding of the ethos of the home and a range of effective quality assurance processes were in place. People who used the service were asked for their views about their care and treatment in regular meetings and their views were acted upon. People spoke highly of the manager. Comments from relatives included; "I feel that the manager has the resident’s best interests at heart and is doing all sorts." And; "To be honest since the manager took over it’s like a different world."