We carried out an unannounced inspection of The Court Retirement Residence on 6 and 7 September 2018. The Court Retirement Residence is a ‘care home’ without nursing. Nursing care, if needed, is provided by the community healthcare team. The Court Retirement Residence also offers temporary respite stays and one person was staying as respite during this inspection with a view to permanent support. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The Court Retirement Residence accommodates up to 21 people in one adapted building but the service rarely goes above 16 as they use double rooms as singles. At the time of our inspection there were 13 people living at The Court Retirement Residence.

There was a registered manager at the service. A registered manager is a person who has registered with the 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. They had worked at the home for many years and were planning to retire in early 2019.

The last comprehensive inspection was in September 2016; at that inspection the overall rating for the service was good and we found that people were safe. At this inspection in September 2018, people were not always enabled to take part in meaningful activities on a regular basis that reflected their needs, preferences and interests. There were no audits about how people were spending their day. Activities offered by staff and external entertainers, did not ensure each person had their social and leisure needs met.

Some checks and audits were carried out but these had not always identified issues that were found during the inspection. Audits were not completed around maintenance and room checks, care plan reviews or falls. At the last inspection in September 2016, we noted there were some elements of good quality monitoring systems but these were not fully evidenced and the provider was making improvements to ensure systems were effective. This was not shown at this inspection in September 2018. Care records did not always fully reflect people's risks and needs when changes occurred and staff relied on verbal communication and recording in the daily notes. When incidents had happened, plans did not always record how staff were to reduce the risks of reoccurrence, although they knew this information verbally. Although records were not always up to date staff were very knowledgeable about people’s needs through verbal communication and a small, stable staff team.

There was no system such as a dependency tool to enable the provider to know what level of staffing was required to meet people’s needs. Staff felt there was not enough staff and people told us they sometimes had to wait for support. In addition, staff did not have time to spend quality time with people and offer regular meaningful activities. We recommended that the provider use robust systems to ensure there were enough staff at all times.

This inspection was brought forward because of safeguarding concerns. Prior to our inspection, the service became part of an individual safeguarding relating to pressure area care. This meant the local authority safeguarding team had informed us of their concerns. We found this was substantiated and pressure area care management was not robust to ensure people were safe.

On the day of the inspection there was a calm and relaxed atmosphere in the home, with music playing in the entrance hall. Staff interacted with people in a friendly and respectful way and were keen to deliver good support, for example ensuring people received full personal care at their own pace. People were able to choose where they

The inspection took place on 8 September 2016 and unannounced. The service was last inspected on 23 September 2014 when we found a breach in regulation 21: Records. At this inspection we found the provider had taken actions to address the breach and the service was fully compliant.

The Court Retirement Residence is registered to provide accommodation for 21 people who require personal care. The service does not provide nursing care. At the time of this inspection there were nine people living there, including one person who was in hospital.

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 there and felt safe. Comments included, “The home runs smoothly. Everything has to be done at the right time and the right day.”

People were protected from abuse or harm by safe recruitment procedures. Staff had received training on safeguarding adults and were confident they knew how to recognise and report on any suspicions of abuse. People were supported by staff who had received a range of training that provided them with the knowledge and skills to meet each person’s health and personal care needs effectively. Staff received regular supervision and support. They were positive and enthusiastic and told us they enjoyed their jobs.

People told us there were sufficient staff to meet their needs. One person told us “I am amazed how many there are.” Two people told us they occasionally had to wait for assistance when they pressed their call bell, but said they understood there were times when staff were assisting other people and could not come immediately. All of the staff we spoke with said there felt the staffing levels were good. Comments included “Yes, there definitely is (enough staff)”.

A new computerised care planning package had recently been purchased. Before new people moved into the home their needs were assessed and the staff consulted with the person to draw up and agree a plan of their care needs. The care plans were easy to use and covered all areas of each person’s health and personal care needs. All anticipated risks were explained and regularly reviewed. Staff were given information on the actions necessary to minimise the risks. The home worked closely with local health professionals to ensure people received the correct care and treatment. Equipment was in place to enable people to move safely and prevent further risk of harm.

Medicines were stored and administered safely. Records of medicines administered showed people had received their medicines at the correct times. Staff followed safe procedures when ordering stocks, receiving stocks in to the home, and ensuring unwanted medicines are disposed safely.

People told us they were happy with the care they received. One person said “I have found it very pleasant. The girls are very caring.” A relative told us “These girls ‘go the extra mile’. They are fantastic. We can’t thank them enough. They do a great job. They are brilliant. From the guy who does the cleaning to the care staff they are all wonderful. Nothing is too much trouble.”

The service was well-led. People told us the service ran smoothly. The provider was in the process of updating and improving many areas of the decoration, furnishings and equipment. There were some elements of a good quality monitoring and improvement system in place but these were not fully evidenced. The provider told us about improvements they were about to make to ensure their monitoring systems are effective.

We carried out this inspection in response to concerns received about the general care of people living at The Court Retirement Residence. We found that the general care of people using the service promoted their health and well-being but there was the potential for risk that was not being adequately managed.

On the day of our visit we were told there were 13 people living at The Court Retirement Residence. We spoke with four people living at the home, one relative, four members of staff, which included the registered manager and the provider. We also spoke with a visiting healthcare professional. We spent time observing how people's care and welfare needs were met and looked at four people's care files in detail.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People's individual risks were identified and the relevant risk assessments were conducted. This meant that when staff were accessing information about a person's needs through their risk assessments, they would be able to determine how best to support them in a safe way. Where risk had been identified the home had taken steps to minimise that risk, for example changing the layout of a room. However, there were not adequate risk assessments of the shared home environment, such as stairs, used by some people. This had the potential to increase risks to people.

Health care professionals said, through feedback surveys to the home and when speaking with us, that they did not have concerns about the care people received. One had written in September 2014 “All recommendations of care are acted upon in a timely manner”.

The provider had not notified the Care Quality Commission at the first opportunity of three accidents at the home. This meant we were unaware of some potential risks at the home. The notifying of incidents had been improved by the time of our inspection visit and will be monitored by CQC.

There was increased risk to people using the service because some records were not fit for purpose. For example, information crossed out without explanation of why or by whom, very minimal pre admission assessment and many records undated or unsigned. However, other records, such as medicine administration records, were detailed and clear. There were also detailed records of steps taken by the home in response to health care professional advice.

Is the service effective?

The service was effective because people were spending their time in the way they chose. We spoke with four people about the home. They told us they were satisfied with the care with comments including "I am quite satisfied"; "I think it's lovely. Everybody's so friendly" and "They (the staff) are friendly and kind". One confirmed they had been visited before admission by a staff member to establish what care they needed. A health care professional had written “I found the home to be calm and the residents were happy.”

Care plans were up-to-date and in general contained clear instructions. They were broken down into separate sections, making it easier to find relevant information, for example, risk from falling. We saw evidence of health and social care professional visits and appointments, for example GP, district nurse and speech and language therapist. These records demonstrated how other health and social care professionals had been involved in people's care to encourage health promotion and ensure the timely follow up of care and treatment needs.

Is the service caring?

The service was caring because staff were attentive to people’s needs and offered them choices and opportunities. For example, some people went out for the morning. Another person enjoyed a sherry before lunch.

We saw the relationships between staff and people in the home were positive. Throughout our visit we saw people were appropriately dressed and cared for to promote their dignity. For example, attention had been given to the use of jewellery and hair care. Staff offered care which was both kind and compassionate in order for people to experience a general sense of wellbeing.

Is the service responsive?

Care files gave information about people's health and social care needs. However, they lacked enough detail, which would be particularly important should a person be unable to state what care they needed and wanted. Care plans included personal information and identified the relevant people involved in people’s care. The care files had been regularly reviewed although in one case the plan had not been reviewed following an incident. This might have led to less responsive care following a change in the person’s needs.

The Court Retirement Residence provides care and support for older people. We talked with seven people who lived at the home, eight staff including the manager and two relatives. We looked at the care records of five people living in the home including records relating to their community nursing support. There were 17 people living in the home at the time of our inspection.

The people we spoke with were complimentary about the home and told us they were well looked after. One person told us, “We’re very well looked after here, the staff are so kind”. We saw how people’s care and welfare was provided with dignity and respect in line with their care needs.

People’s nutritional needs were met through a balanced and nutritious diet with choices available at each meal time.

The home was clean and tidy and we saw how the manager and provider had improved the environment and cleanliness and hygiene practices since our last inspection in November 2012.

We found there were sufficient staff to support people’s needs; the staff we spoke with told us how they met people’s care and social and emotional needs through effective care plans.

We saw improvements in the way quality assurance checks were made for the service and improvements had been made to areas identified in our previous inspection.

Records were accessible and care plans reflected the current needs of people living in the home; staff demonstrated a good knowledge of people’s needs and how to meet them.

The Court Retirement Residence provides care and support for frail older people, some people living in the home had a diagnosis of dementia. We talked with six people who lived at the home, six staff and three people visiting the home. We looked at the care records of five people.

There were 17 people living in the home at the time of our inspection. The people living in the home told us they liked the home and were happy with the care being provided by the staff. One person who lived in the home said “it’s lovely living here” and “we’re looked after ever so well”. One visitor told us that staff were “kind and caring here”.

People appeared comfortable and we saw that staff had good knowledge of the needs of people in the home. Staff were observed being patient and kind towards people when they assisted them. We saw that staff offered people choices in accordance with their assessed needs and preferences.

People we spoke with said they generally found the home clean and tidy however we found some aspects of cleanliness and hygiene were not always appropriate. For example we found some rooms had broken tiles or peeling wallpaper. Personal protective equipment wasn’t stored appropriately.

We saw that people were safe in the home however the provider didn’t always have quality assurance processes in place to monitor the quality of their service; for example safe storage of equipment and routinely maintaining documents relating to people and the running of the home.