We inspected this service on 6 and 8 November 2018. The first day of the inspection was unannounced. This meant that the service did not know we were coming. We last inspected the service on 22 and 25 August 2017 where it was rated as requires improvement in safe, effective, caring, responsive and well-led. This meant it was requires improvement overall.

During the last inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regulations 18 staffing, 12 safe care and treatment for medicines management, risks and infection control, 15 premises and equipment, 10 dignity and respect and 17 good governance. We also made recommendations in relation to supervisions and appraisals, activities and recording.

Following our last inspection, we met with senior members of the management team including the nominated individual for the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, caring, responsive and well-led to at least good. During this inspection we found improvements had been made. However further improvements were required in relation to managing medicines and recording of consent in people’s care files. We also made recommendations in relation to individual risks assessments, mental capacity assessments and care planning.

Sherwood Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Sherwood court is registered to provided accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury for up to 68 people in one purpose-built building over two floors. All bedrooms were of single occupancy and bathrooms and toilet facilities were available to people. There were communal lounges and dining facilities on both floors and people had access to outside space. The service was situated in a residential area of Preston close to public transport links and shops. There were 48 people on day one of the inspection and 49 people on day two of our inspection living in the service.

The service had a registered manager in post at the time of our inspection. 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 was run.

We saw evidence that servicing and checks of the environment and equipment were taking place which confirmed the home was safe and monitored. Fire risk assessments were seen along with essential fire checks. Individual risk assessments had been completed however not all care files had been updated to reflect people’s current risks.

Improvements had been noted in relation to the management of medicines however further improvements were still required. People received their medicines safely from staff.

Staff had completed relevant safeguarding training and there were polices and guidance available to guide them about how to deal with any allegations of abuse. Records we looked at included details of completed investigations and the actions taken as a result.

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. Capacity assessments and best interests decisions were recorded in most people’s care files. Where gaps were seen the registered manager gave us assurances that they would update these. Staff were observed asking people’s permission before undertaking any care or activity. However, we saw little evidence of formal

Sherwood Court Care Home is registered to provide nursing and personal care for 68 people, some who are living with dementia. People living at the home have varying needs from specialist support and help with everyday living to those who need a helping hand to retain some independence. People can stay on a permanent basis whilst others stay for short periods of time.

The previous inspection took place on 22 June 2015, during which no breaches to the Regulations were identified, and the service was rated as good. This inspection took place on 22 and 25 August 2017. The first day of the inspection was unannounced. The second day was announced.

There was no 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.

The previous registered manager had left the service in May 2017. Since then, a regional management team had been at the home, and an acting manager had been in position. However, on 18 August this regional management team had been replaced, and a new management team had been appointed to oversee the home. “’

Our observations and discussions found that people using the service did not always have enough staff available or suitably deployed to meet their assessed needs. Staff were found to very busy, and they felt that they could not always offer people the person centred care that they wanted to. Relatives had concerns that the staffing levels or deployment of staff was unsatisfactory. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our observations and discussions found that the measures in place relating to the safe handling of medicines, the prevention of risks and the prevention of the spread of infection and cleanliness within the home were not satisfactory. Some areas of the home was found to be unclean, risks around people's behaviour had not been properly assessed and measures put in place to reduce these risks had not been properly addressed. A registered nurse was seen to make a "minor" mistake whilst administering medicines, and as a result the inspector had to intervene to ensure correct procedures were followed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

One of the units within the home was specifically used as a dementia care unit, and we found that the environment and adaptations were unsatisfactory as they did not met the expectations of the current best practice and guidelines relating to dementia friendly environments. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We noted that on occasions, staff interactions with people living with dementia was minimal, and on one occasion, very undignified. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People using the service must be treated with respect and dignity at all times.

Our evidence gathering and observations found that there had been a lack of management oversight within the home overall in the last six months. This had led to some people being exposed to potentially avoidable risks, and that good governance issues such as effective infection control measures, risk assessment, record keeping, staff deployment and morale, audit and monitoring systems had not been routinely been addressed. As a result, the systems and processes that enabled the service provider identify and assess risks to the health and welfare people who use the service were not satisfactory. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations

This scheduled inspection was planned to follow up areas of non compliance identified from our inspection in July 2013. We looked at outcomes 4, 8, and 21 at this inspection. In July 2013 we identified non compliance with health and welfare, prevention and control of infection and record keeping. At this inspection we saw improvements in these areas.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.

We found family members were happy with the care of their relations

We saw the home was clean and hygienic with no odours. People who used the service and family members commented on the standards of cleanliness. One family member told us, “I was impressed how spotlessly clean it is. The staff are constantly busy cleaning and I was surprised how good it was and there was no smell of urine”.

We brought forward this scheduled inspection as a result of concerns raised and to follow up on areas of non compliance identified during our themed inspection of this service in October 2012. We looked at outcomes 4, 5, 8, 13, 16 and 21at this inspection. In October 2012 we identified non compliance with meeting nutritional needs, staffing and record keeping. At this inspection we saw improvements in meeting nutritional needs and staffing. However we found continued non compliance with record keeping and non compliance with the care and welfare of people that use services.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.

We found family members were happy with the care of their relations

We saw that there were no rules imposed on people.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by two Care Quality Commission (CQC) Inspectors joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

We talked with eight staff and nine people who live at the home as well as family members.

We looked at the care plans for six people who lived at the home to see how their needs should be met.

People living at the home who were able, told us that they were satisfied with the food provided by the home and if they didn't like something they could ask for an alternative and this would be provided.

On the day of our visit we saw that group activities had been arranged and people were encouraged and supported to participate.

People living at the home told us that they felt safe at the home.

This inspection was carried out on 22 June 2015 and was unannounced.

Sherwood Court Care Home is registered to provide nursing and personal care for 68 people, some who are living with dementia. People living at the home have varying needs from specialist support and help with everyday living to those who just need a helping hand to retain some independence. People can stay on a permanent basis whilst others stay for short periods of time.

When we last inspected the service on 11 March 2014 we found them to be meeting the required standards and regulations of the Health and Social Care Act 2008 (Regulated Activities).

There were regular quality assurance checks carried out to assess and improve the quality of the service. Activities in the home required some more consideration and the management team had identified this. They were in the process of starting additional activity coordinators to ensure people could continue with hobbies and interests.

Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put 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 applications had been made to the local authority in relation to people who lived at the service and were pending an outcome. Staff were fully aware of their role in relation to MCA and DoLS and how people were at risk of being deprived of their liberty.

People received their medicines safely and had regular access to health care professionals. There was a good choice of food and drink and people who were at risk of not eating or drinking enough were closely monitored. People received care that met their individually assessed needs and preferences. There was sufficient staff to meet their needs and those staff had received the relevant training for their role. Staff felt supported and the leadership in the home had improved.

People felt safe and staff were knowledgeable about how to protect people from the risk of abuse and other areas where they may have been assessed as being at risk. Falls, accidents and incidents were monitored to ensure the appropriate action had been taken if problems are identified.