This unannounced inspection took place on 1 and 4 September 2017. The service was previously inspected on 9 and 10 June 2015 when the service was rated as ‘Good’ overall. However, we found some minor concerns relating to the administration of medicines. We also carried out a focussed inspection on 24 August 2016 to look at the way people’s care needs were being planned and responded to. We made a recommendation regarding record keeping. At this inspection we found actions had been taken to address the issues we found at the previous inspections and there were no breaches of regulations. People received a good service.

Quay Court Care Centre is a residential care home which provides personal care for a maximum of 38 people. It does not provide nursing care. People who live at the home access healthcare through the local community healthcare services. The home is owned by the Devon Care Group, and is part of a group of eight care homes. At the time of this inspection there were 29 people living there.

There was 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.

People told us they were happy living at Quay Court Care Centre. Comments included, “I think they are absolutely super. They are very attentive,” and “I love it. It is perfectly alright. They feed me. I have a nice room. I have a bath. What more do I want?”

People received a safe service. At the time of this inspection there were sufficient staff to meet people’s needs safely. Call bells were answered promptly and people told us staff responded quickly if they requested assistance. We saw staff sitting and talking to people, and assisting people to move around the home in a relaxed and supportive manner. Routines were carried out in a timely way.

Risks to people’s health and safety had been assessed and measures had been put in place to reduce risks where possible. Risks such as choking, weight loss, dehydration, and pressure sores were assessed and reviewed regularly, and measures put in place to reduce the risks where possible. For example, where people were at risk of falling, the risks had been assessed, medical assessment and treatment sought, and equipment provided if necessary.

Medicines were stored and administered safely by competent and trained staff. Records of medicines received into the home, administered to people, and unwanted medicines returned to the pharmacy were accurate. There were systems in place to audit the records which meant that any errors were picked up and addressed promptly.

Safe recruitment procedures were followed before new staff began working in the service. There had been a low turnover of staff, with many of the staff having worked in the home for a number of years. The registered manager had been recently recruited and had begun to put in place a number of changes and improvements. These included regular supervision sessions for all staff. Staff meetings were held regularly and there were handover sessions at the start of each shift to ensure staff received information on any changes in people’s needs. Staff told us they felt well supported. Staff received training and updates on a range of health and safety topics, and other topics relevant to the needs of the people living there. Comments from staff included “The training here is excellent!”

People lived in home that was well maintained, clean and safe. All areas were bright, modern, attractively decorated and comfortably furnished. There were safe patio areas and gardens where people could sit outside in warmer weather. All equipment was regularly checked and serviced.

People received food and drinks to meet their individual dietary needs. All of the people

Quay Court Care Centre is a residential care home which provides personal care for a maximum of 38 people. It does not provide nursing care. People who live at the home access healthcare through the local community healthcare services. At the time of the inspection there were 34 people living at the service.

The home is owned by the Devon Care Group, and is part of a group of 10 care homes.

We carried out an unannounced comprehensive inspection of this service on 9 and 10 June 2015 when the overall rating was ‘Good’. We received concerns in August 2016 that related to people being made to get up very early in the morning, and staff were working very long hours. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Quay Court Care Centre on our website at www.cqc.org.uk.

A registered manager was employed by 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.

We arrived at the service at 7.20am and there were eight people washed and dressed sitting in either the lounge or the dining room. We spoke with seven people who all told us they were happy to be up and dressed. One person was asleep and we did not wake them.

We spoke with two night staff and they told us about the help people had needed during the night. One person had been brought down into the lounge at about 1am as they had been restless when in their room. We saw this person’s care plan stated they could be anxious and shout out for long periods, and sometimes would only settle when in the communal area. This showed staff were following the information stated in the person’s care plan.

Staff told us people were never made to get up. They said people were able to stay in bed as long as they wished. Staff said if people needed help with personal care in the night they were encouraged to go back to bed after they had received the care they needed. Staff also told us they had never been told they must get a certain number of people up, by a specific time.

We saw no evidence that people were being made or encouraged to get up early. However, when we looked at three people’s care plans we saw their preferences regarding getting up times were not recorded and there was no record of when they usually woke and required assistance. We also saw that the records of people’s care throughout the night did not match with what we were told by staff. It also did not match with what was on the night checklist used to handover information to day staff.

As part of the concerns that we received we were told that staff were working very long shifts with no break in between. Rotas showed that this was not the case. The longest period of time staff worked was 12 hours. Staff we spoke with told us they never worked longer than 12 hours at a time.

We discussed all the concerns with the registered manager. They told us they would ensure people’s preferences about what time they wanted to get up in the mornings were recorded on their care plans. They also said they would ensure staff were reminded of the importance of recording accurate information in people’s records. The registered manager confirmed that staff rotas were planned so that staff worked no longer than 12 hours at a time. They also said staff had a long break in between shifts except very rarely in an emergency.

We have made a recommendation in relation to record keeping.

We undertook this inspection because we had received concerning information from health care professionals. These concerns related to the management of pressure areas and the high levels of care needs of the people who lived at the home not being met appropriately. Concerns had also been raised about poor hygiene practices and that the manager of the home did not address issues when they were raised by healthcare professionals.

We spoke with the manager of the home, two care workers a visiting GP and a health care professional. We also spoke with four people who lived in the home and who concerns had been raised about. We also looked at the care records for five people who lived at the home.

We found that people’s care needs and in particular pressure area care was being addressed appropriately. We found that the manager was dealing with the issue of people’s high levels of care needs by ensuring people were being reviewed by social services.

We found no evidence to support the concerns that were raised.

We spoke with the registered manager, company director and operations manager for the group, two care staff and two senior care staff. We also spoke with and met people who lived within the home and their families.

People we spoke with told us they were very happy with the care they received from the home and they were enjoying their lives. One person told us "You can’t expect full time attendance but they are very good. We get quite a variety of food and plenty of it and the staff are always happy". A family member told us “We looked at several home's before we decided on this one. We chose it due to the manager being so warm and welcoming". We saw that people had specific and individualistic care plans. These had been updated daily in accordance with people's wishes. Support staff worked at a level required by the individual and promotion of independence was evident. Staff had all received a thorough core training programme that included safeguarding and attended regular updates.

There were sufficient staff to meet people's needs and appropriate background checks had been completed on all staff. Audits were in place to continually monitor and assess the quality of care and support provided.

We (the Care Quality Commission) spoke with three people, four staff, two relatives and one visiting healthcare professional. Some people, because of their complex needs, were not able to share their experiences and so we used the principles of the Short Observational Framework for Inspection (SOFI). This was a specific way of observing care to help us understand the experience of people who could not talk with us. We also spent time observing care and lunch time and looked at four care plans.

On the day of our inspection, 04 July 2012, 35 people were living at the home and receiving care from the service. One person was receiving respite care.

One person described their experience of the home as “very, very nice.” One person described the staff as “friendly and helpful” and said “I think highly of the staff.”

One relative told us about the “friendships” their relative had made and how they enjoyed “reading the paper and doing the crossword.” They added that their mother had breakfast in her room which was her preference.

Two relatives talked about the “lovely Jubilee” and described the sensory garden as “really lovely”.

Prior to our inspection we had received information of concern relating to staff numbers. We asked one person if there were enough staff and they said “I think they are working at their limits. It’s not very often they’re short. It’s alright from my point of view.”

We asked a visiting healthcare professional about the quality of care at the home and they described it as “not too bad, quite good.” They added that they “did not have any complaints.” They talked about how they “worked together” with the home regarding the use of pressure relieving equipment.

One care worker described the standard of care as “very good really” but said it was “difficult if staff were off sick or on holiday.” They said the home had been short of staff in the last month and this meant there had not been time for “activities and sitting with people.” The manager said that, following successful recruitment, the home would be fully staffed by the end of August 2012 and that current staff “want more hours”.

Staff were not up to date with supervision, appraisal and training. However a training coordinator had been appointed.

Quay Court Care Centre is a residential care home which provides accommodation and personal care for up to 38 people. It does not provide nursing care. People access healthcare through the local community healthcare services. This unannounced inspection took place on 9 and 10 June 2015 when there were 33 people living there, many of whom were living with dementia.

The service was last inspected on 19 March 2014 when it was compliant with the areas that were inspected.

A registered manager was employed by 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.

Prior to this inspection in June 2015 we received concerns from one person’s representative about the care their relative had received whilst receiving respite care at the service. We discussed the issues with the registered manager who accepted they had not been able to meet the person’s needs. This was because the person’s needs were greater following admission than they had originally been assessed as. Following our inspection the registered provider’s group locality manager has visited the representative to discuss their concerns.

People’s medicines were not always managed safely. Medicine Administration Records (MAR) sheets were not always completed correctly. There were no clear directions for staff on when to administer all medicines prescribed to be taken when required.

People told us they felt safe at the home and with the staff who supported them. One person said “Yes I feel safe” and another said “Definitely” when asked if they felt safe. Risks of abuse to people were minimised because staff had received training in recognising and reporting abuse. People were protected from the risks associated with unsuitable staff because the registered provider had a robust recruitment system in operation. Staff were thoroughly checked to ensure they were suitable to work at the home. People were protected from the risks of financial abuse. Systems were in place to protect people from financial abuse where the service people’s managed.

Care plans contained risks assessments which outlined measures in place to enable people to take part in activities with minimum risk to themselves and others. Moving and transferring and falls risk assessments were in place and were updated when required. Pressure relieving equipment was in place to minimise the risks of people developing pressure sores.

People’s needs were met by sufficient staff in a timely way. On both days of our inspection there were 33 people living at the home. Rotas showed that staffing levels were maintained at nine care staff on duty during the morning. This reduced to seven care staff in the afternoon. Two or three care staff were awake at night according to dependency levels. Supporting staff such as a cook and cleaner were on duty each day and the registered manager was also available throughout the inspection.

People had differing needs and staff had received training to ensure people’s needs were met. There was a comprehensive training plan in place to make sure staff kept up to date with good practice and were able to undertake training appropriate to the needs of people who used the service. For example, staff received training in caring for people living with dementia.

Staff received regular supervision and appraisals. Supervision records showed that future training and development was discussed and planned for. Staff felt well supported by the registered manager.

People told us staff knew how they liked things done. Staff were able to tell us about people’s needs and how each person liked their needs to be met. People were always asked for their consent before staff assisted them with any tasks.

Staff had a clear understanding of the Mental Capacity Act 2005 (the MCA), including the Deprivation of Liberty Safeguards (DoLS) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. For example, staff described how they encouraged one person to eat and drink even though they didn’t like to sit at a table. People were offered plenty of snacks and drinks through the day. People told us the food was “Ok” and “average”, but that they always got a choice. The cook told us that they always cooked enough food for people to have a choice at the table. Special dietary needs were catered for.

People were supported to maintain good health and had access to healthcare services where required. Records showed people had seen a variety of healthcare professionals including GPs, district nurses and speech and language therapists.

People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. People said staff were “Very good”, “Always speak nicely to me” “They are very good and kind” and “Are thoughtful, helpful and considerate”. One person told us they thought the home was “A remarkable place”.

Staff knew people well and were able to tell us how they supported individuals with their needs. Staff were skilled in speaking appropriately with people, including those living with dementia.

Not everyone was able to verbally express their views. Those who could knew about their care plans and said the registered manager discussed it with them. Some care plans contained signatures to show people had been involved in reviewing their care. People’s care needs were clearly defined in their care plans in sufficient detail to allow staff to carry out their role. Care plans were based on people’s assessed needs and reflected their needs and preferences.

People confirmed that staff always asked them what they wanted and how they wanted their needs met. One person told us they were “Very contented here”. Staff responded to changes in people’s needs. One person told us that when they had first been admitted they had been very ill. They told us “They looked after me very well” and that they now often went out into the local town on their own.

People were encouraged to take part in activities, and information was gathered on their pre-existing hobbies and interests. Records were kept that showed how much time people spent engaged in activities and how much time they spent dozing or alone in their room. This enabled staff to identify people who did not participate regularly in activities or spent a lot of time in their room. Staff could then discuss with the person f there was any type of activity they would like. Activities on offer included visiting entertainers, music therapy and exercise sessions.

The registered manager sought people’s feedback and took action to address issues raised. The last meeting for people had been held on 23 April 2015. People had previously said they wanted more outings. The registered manager told people that transport had been found that could take wheelchairs and outings were to be arranged.

People told us they would feel able to raise any concerns they had with the staff or registered manager. The registered manager recorded all complaints. Records relating to these showed they had been responded to in a timely manner, all outcomes had been recorded.

People, staff and visitors felt the service was well led by a manager that was open and approachable. The main office was located in a central position which enabled people to speak with the registered manager at any time. Staff said they felt extremely well supported and were able to make suggestions about the running of the home and the care they provided.

The registered provider carried out an annual survey to gauge the views of people using the service, staff and other interested parties. Results from the last survey showed a high level of satisfaction. One response indicated that more information about activities was needed. The registered manager had arranged for a noticeboard to be put up in the dining room so that information about activities could be easily seen.

Staff were clear about their roles and responsibilities. They told us they would report any concerns they had to a senior worker or the registered manager. Staff were clear about the culture of the home saying that it was to ‘promote independence’ for people living there. People confirmed staff encouraged them to be independent. Staff told us that the feeling within the home was ‘like a family’ with everyone ‘singing from the same hymn sheet’.

There were effective quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care. Where shortfalls in the service had been identified action had been taken to improve practice.