About the service: Russell Churcher Court is a residential care home that was providing personal care to 43 people aged 65 and over at the time of the inspection. The majority of people living at the home were living with dementia.

People’s experience of using this service:

• Everyone told us they enjoyed living at Russell Churcher Court. They said they felt safe and cared for by kind and compassionate staff.

• Although we found some improvements since the last inspection in October 2017 we found some areas of practice had not improved and had the potential to place people at risk.

• Risks associated with people’s needs were not always effectively assessed and appropriate plans were not consistently implemented to reduce those risks. Where incidents had occurred, there was not always effective and timely action taken to reduce the risk of reoccurrence and it was not clear how lessons were learned from these. Staff recruitment records lacked the required information to demonstrate that staff had been safely recruited. Governance systems used to assess the quality and safety of the service did not always identify concerns and drive improvement; Feedback from people and others was sought but we have recommended the provider seek advice from a reputable source about using this feedback to develop timely actions plans to drive improvement.

• People were supported by skilled staff who were supported to understand their responsibility in relation to safeguarding people and to recognise people’s rights to make their own decisions.

• People received their medicines safely and as prescribed, while being looked after in a clean and well-maintained environment aimed to promote independence and meet people’s needs.

• People received compassionate support which met their needs from kind and caring staff. People had developed meaningful relationships with the staff. Staff knew what was important to people and ensured people had support that met their needs and choices. However, care records to guide staff about peoples individualised needs required work to ensure they were person centred, up to date and accurate. People’s dignity and privacy were respected and their independence was promoted.

• More information is in the detailed findings below

Rating at last inspection: Requires Improvement (report published January 2018)

Why we inspected: This was a planned inspection based on our last rating. At the previous inspection in October 2017, we found three breaches of regulations. These were breaches of Regulation 12, Safe care and treatment, Regulation 17, Good governance and Regulation 18, Staffing. The provider informed us what they would do to meet the regulations. This inspection was planned to follow up on these areas.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We found two repeated breaches of regulations and one new breach of regulation. The service also remained rated as requires improvement, we will request an action plan from the registered provider about how they plan to improve the rating to good and meet the requirements of the regulations. In addition, we will plan to meet with the provider to discuss their plans to make improvements. We will also continue to monitor all information received about the service to monitor any risks that may arise and to ensure the next planned inspection is scheduled accordingly.

This inspection took place on the 9 and 10 October 2017 and was unannounced.

Russell Churcher Court provides residential care and support for up to 44 older people some of who are living with dementia. People were accommodated in individual rooms with a toilet and shower and small kitchenette. Communal facilities include a lounge, dining room and conservatory and secure outside spaces. At the time of our inspection, 44 were living at the home.

A registered manager was not in post and the previous registered manager left on 30 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 manager and they were currently applying for registration.

People told us they were safely cared for at Russell Churcher. However, we found people were not always protected from risks associated with their care and support. We found people’s needs were not always reviewed when they experienced a fall to ensure detailed plans were in place to minimise the risk of a reoccurrence.

Records showed information to enable staff to effectively monitor, evaluate and mitigate the risks to people from dehydration and malnutrition was not consistently recorded. Topical creams prescribed to protect people from the risks associated with pressure sores were not always recorded as applied as prescribed. Information was not always readily available to staff about where to apply the creams. From the examples seen we could not be assured people were always receiving sufficient fluids, food and skin care to prevent the risk of deterioration in their health.

Risk assessments and continuity plans were in place to guide staff on how to support people in an emergency situation such as a fire or flood. People were supported safely and appropriately with their moving and handling needs.

Robust procedures were not in place to ensure medicines were always managed safely. We identified medicines were not always stored and disposed of safely. Cream and liquid medicines were not dated when opened to ensure they remained effective. Staff administering people’s medicines had not been routinely assessed as competent to do so line with the provider’s policy and current guidance.

The provider had recently increased care staff hours during the day. We received mixed feedback about the staffing levels in the home from people and staff. The provider planned to carry out a more detailed analysis of people’s dependency needs to ensure sufficient numbers of staff were deployed to meet people’s needs.

Staff had the knowledge to identify safeguarding concerns and acted on these to keep people safe. Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role.

Staff did not receive regular supervision sessions. Supervision helps to ensure people are cared for by staff who are appropriately supported in their role.

Staff completed an induction and on-going training to develop the knowledge and skills required to meet people’s needs.

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 support this practice.

People spoke positively about the food available in the home. Some people may have benefited from more attention during meal times to encourage eating.

People received support with their healthcare needs from the relevant health care professionals. Care plans did not always contain detailed information about how their healthcare needs were being met. The manager took action to ensure people’s records were updated as required follow