Premier Court Residential and Nursing Home provides accommodation for up to 59 older people who require nursing care. At the time of our inspection 45 people lived at the home.

At the last inspection in November 2015 the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe living in the home. Risks to people’s health and wellbeing were appropriately planned for and managed. Robust recruitment processes were followed. People told us there were enough competent staff to provide them with support when they needed it.

Staff had received appropriate training, support and development to carry out their role effectively.

People received appropriate support to maintain healthy nutrition and hydration. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were supported to make choices to have maximum control of their lives and staff supported them in the least restrictive way possible.

People and their relatives told us and our observations confirmed that people were treated with warmth and kindness by staff who respected their privacy and upheld their dignity.

People were given the opportunity to feedback on the service and their views were acted on. People received personalised care that met their individual needs and were given appropriate support and encouragement to access meaningful activities. People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

The management team worked hard to create an open, transparent and inclusive ethos within the service. People, staff and external health professionals were invited to take part in discussions around shaping the future of the service. There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

The inspection took place on 30 November 2015 and was unannounced.

Premier Court Residential and Nursing Home provides accommodation for up to 59 older people who require nursing care and may also live with dementia. At the time of our inspection 45 people lived at the home.

The home had a registered manager. 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.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. Some people who used the service were able to make their own decisions and those who were unable to do so had their capacity assessed. DoLS applications for people who required bed rails to reduce the risk of them falling from bed were pending an outcome. Staff members were not all clear of their role in relation to MCA and DoLS and the registered manager had arranged for further training to improve their understanding.

When we last inspected Premier Court Residential and Nursing Home in June 2015 we found that the manager had addressed shortfalls with medicines and care planning that we had identified in January 2015. The service was meeting the required standards at that time.

People and their relatives told us that they felt people were safe living at Premier Court Nursing and Residential Home. The manager and staff team demonstrated a clear knowledge of safeguarding matters. Risks to people`s health and well-being were identified and plans developed to mitigate the level of risk. The registered manager operated safe recruitment practices and records showed that the necessary checks had been undertaken before staff began to work at the home. There were suitable arrangements for the safe storage, management and disposal of people’s medicines.

People received their care from a staff team who felt supported by the management team. The staff had the basic core skills and knowledge necessary to provide people with safe and effective care and support. People enjoyed the food provided and received support to eat and drink sufficient quantities. People’s health needs were well catered for because appropriate referrals were made to health professionals when needed.

Staff were calm and gentle in their approach towards people and were knowledgeable about individual’s needs and preferences. Relatives and friends of people who used the service were encouraged to visit at any time and people’s privacy was promoted.

People’s care plans were sufficiently detailed to be able to guide staff to provide their basic care needs. People had opportunities for activity and stimulation in the home. Relatives and people who used the service told us that they would be confident to raise any concerns with the management team. The provider had made arrangements to facilitate feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided.

There was an open culture in

We carried out an unannounced comprehensive inspection of Premier Court Nursing Home on 20 January 2015 at which breaches of regulations 9 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 were found, which correspond to regulations 9 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was because people’s care plans did not always accurately reflect their needs and risk assessments were not always in place. Medicines were not always managed safely for people and records had not been completed correctly.

Following the comprehensive inspection, the provider wrote to us on 17 April 2015 to tell us how they would meet the legal requirements. We undertook a focused inspection on the 08 June 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Premier Court Nursing Home on our website at www.cqc.org.uk

Premier Court Residential and Nursing Home provides accommodation for up to 59 older people who require nursing care and may also live with dementia. At the time of our inspection 37 people lived at the home.

The home’s registered manager had been in post at Premier Court Nursing Home since October 2014. 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 and associated Regulations about how the service is run.

At our focused inspection on 08 June 2015, we found that the provider had followed their plan which they had told us would be completed by 31 May 2015 and legal requirements had been met.

There were suitable arrangements for the safe storage, management and disposal of people’s medicines, including controlled drugs.

People’s individual care and support needs had been assessed and documented. There was clear instruction for staff to follow to manage any risks to people’s health, safety and wellbeing.

This inspection was undertaken on 20 January 2015 and was unannounced. Our previous inspection was undertaken on 14 June 2013 where we found that all of the regulations were met.

Premier Court Residential and Nursing Home provides accommodation for up to 59 older people who require nursing care and may also live with dementia. At the time of our inspection 52 people lived at the home.

The service has experienced a period of instability in the local and regional management team which has had a negative impact on the quality of the service provided. There is a new manager in post who has submitted an application for registration at the time of this inspection. 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.

CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection no applications had been made to the local authority in relation to people who lived at Premier Court Residential and Nursing Home.

The administration of medicines did not always promote the safety and well-being of people who used the service. Staff contacted healthcare professionals if they needed additional support. However, people’s care plans did not always reflect their needs and risk assessments were not always in place.

Staff recruitment processes were safe and there were enough staff employed to meet the needs of people in the home. A range of training was provided to staff to give them the skills and knowledge required to undertake their roles. People told us that the staff were kind and caring. Care and support was delivered in a way that protected people’s privacy, promoted their dignity and respected their wishes.

Although people’s nutritional needs were met however, some people told us that they experienced varied mealtime experiences. People who chose to eat their meals in the communal dining room received appropriate support. However, people who chose to eat in their rooms said that food was frequently cold when it was delivered to them.

Personal care and support was delivered in a way that protected people’s privacy, promoted their dignity and respected their wishes. However, the arrangements in place to store people’s confidential information and medical histories were not effective.

The provision of activity and stimulation was appreciated by those people who were able to take part. However, activities had not been tailored to meet people’s specific interests. The provider had arrangements in place to support people and their relatives to raise complaints or issues of concern and provide feedback about their experiences but these were not always effective.

Effective systems were not in place to assess, monitor and manage risks to people’s health, safety and welfare. For example, the lack of effective medication audits resulted in potentially unsafe PRN practice and lack of effective care planning audits resulted in people being at potential risks of choking or developing pressure ulcers.

At this inspection we found the service to be in breach of Regulations 9 and 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These correspond to regulations 9 and 12 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.

Some of the people who used this service had difficulty understanding and responding to verbal communication. During our visit we were able to hold a conversation with five people. A few others were able to make comments about specific issues however; most of the information about people's experiences of Premier Court was gathered through our observations.

People’s care records were not always dated, signed or stored securely.

We observed that staff showed respect to people using the service. One person with whom we spoke said, "Staff are respectful and speak nicely to people, there is no animosity."

People using the service said they liked the food. One person told us, "There is a good variety, enough of it and it is well cooked." We saw that people were given the right amount of help to eat their meals.

The environment was tired and in need of refurbishment. Work had started to improve the environment however there were no risk assessments undertaken to ensure the safety of the people living in the home whilst the refurbishment work was undertaken.

When we visited Premier Court Residential and Nursing Home, on 13 October 2011, people using the service told us that they were happy with the care they were receiving. One person said, ‘I am very well cared for’.

People told us that they had good relationships with the staff and management team who support them and said they were ‘pleasant’ and ‘helpful’.

People said that they were kept informed and staff listened to them. They confirmed they are able to make decisions about their individual daily routines. For example the time they like to go to bed or having meals in their own room rather than the dining room.

People confirmed that they felt safe, received their personal mail and could deposit money for their own personal use.

People told us that staff responded within a reasonable time when they use their call bell, during the day or at night, and were available when they needed them.

People told us that they enjoyed their meals and if they did not want the choice of options available on a particular day something else would be made for them. One person told us ‘there is always something to look forward to’.

People told us about the entertainment and social activities they could take part in if they wished. One person particularly liked listening to the choir that visit regularly. Another person told us they enjoyed visits from a local ballet group and speaking to volunteers who visit.

During our inspection on 10 June 2013 people told us they were always asked if they agreed to their care and treatment. We also found that staff had received training in respect of the Mental Capacity Act 2005. We also saw that where necessary people's families had their views sought in relation to a person's support needs.

We saw that care plans had been regularly reviewed and updated where necessary. However we also found that there were a number of instances where people had been kept waiting in excess of 10 minutes when seeking assistance from staff.

At our previous visit to the service in October 2012 we found that the dining room was in need of refurbishment. At this visit we found the facility to be bright, fresh and a pleasant place to dine. We also observed that people who needed assistance to eat were supported in a sensitive manner and visitors were encouraged to offer people support.

During our visit in June 2013 we saw that a programme of refurbishment had taken place creating a clean, fresh and comfortable place for people to live in. We also noted that the provider had taken action to reduce the risk of legionella.

We found that people's records were stored securely and confidentially.