The inspection took place on 20 November 2018 and was unannounced. At the last inspection of the service in June 2016, the provider was rated as Good in all five key questions. At this inspection, we found that the rating was now Requires Improvement overall with a breach of regulations within the Well Led domain in relation to Good Governance.

Quality assurance audits were carried out, but these did not identify concerns in all areas.

Administration, recording and storing of medicines given was not always done safely. Medicines were not always given as required and we saw medicine used past its use by date which could impact upon a person’s health and wellbeing. Staff did not always receive the training that they required to support people effectively. These issues were not identified within audits.

Staff were not always available to people and we saw long periods of time where people were left unattended. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed and risk assessments were in place. Staff were recruited safely. Accidents and incidents were responded to appropriately. The environment was hygienic and tidy.

Some staff members did not have a clear understanding of the Mental Capacity Act and how best to support people in line with its principals. We had not been notified where there had been an approval to deprive a person’s liberty. People liked the food provided and staff were supportive when people required assistance to eat. Staff gained people’s consent before assisting or supporting them. Staff received an induction prior to them working for the service and felt prepared prior to carrying out their role. Staff could access supervision and felt able to ask for assistance from management should they need it. Staff supported people’s healthcare needs.

Staff were caring in their interactions with people, but did not always give people their time. People’s privacy and dignity was maintained. People were encouraged to retain an appropriate level of independence and choices were given to people if they were able to make them. Family and friends were welcomed.

People were not consistently offered a stimulating environment. People knew how to raise complaints, but the recording of outcomes was not always in place. Care plans were in place and people’s preferences for how they wished to receive support were known and considered by the care staff. End of life plans were in place.

People and staff spoke positively about the registered manager. Meetings were held were people could voice their opinions. Feedback on the service was taken from people.

There was a registered manager in post and they were present during the 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 is run.

You can see what actions we told the provider to take at the back of the full version of the report.

Allerton Court is registered to provide accommodation and personal care for up to 48 older people. At the time of our inspection 36 people were using the residential service, with 7 people staying on the enhanced assessment unit, in the short term until a longer term plan of action for their care was arranged.

Our inspection was unannounced and took place on 02 June 2016. The service was last inspected on 03 March 2014 where it was found to be compliant.

The manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Medicines were given appropriately and the recording of their distribution was clear and concise; they were kept and disposed of as they should be. People’s long term health needs were addressed and people saw medical professionals when they needed to. People received adequate food and drink.

There were a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs. People told us that they were kept safe. People were able to raise any concerns they had and felt confident they would be acted upon.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. Staff interacted with people in a positive manner and their consent was sought before any care was carried out. Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place. Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective. Quality assurance audits were undertaken regularly and the provider gave the registered manager support.

Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

During our inspection we spoke with seven people who lived there. All of the people we spoke with were complimentary about their experiences of living at the home. One person said, “I am very happy here. I have got a nice big bedroom”. Another person told us, “I do really like it here. I am happy with everything”.

During our inspection of this home on 28 October 2013 we found non-compliance with some aspects of the safety of the premises. We identified that action was needed to prevent burns from hot pipe work, flooring trip hazards and ensure that the premises were adequately decorated. We carried out this inspection to find out if improvements had been made and found that the overall high risks to people had been managed.

No one knew we would be visiting that day as our inspection was unannounced.

At the time of our inspection 45 people lived at Allerton Court. During our inspection we spoke with eleven people who lived there, three relatives/ visitors, six staff and a visiting health care professional.

Everyone we spoke with were complimentary about the overall service provided, their care, and the staff. One person who lived there told us, “I have lived here for a long time. I am happy and I like it here.” Another person said, “I am looked after well and the staff are really nice. One relative told us, “I have not got any concerns”. Another relative said, “They are well looked after”.

We saw that people's needs had been assessed by a range of health care professionals including specialist doctors and district nurses. This meant that people had their health care needs monitored and met.

We found that steps had been taken to prevent abuse and that staff knew what they should do if they had any concerns.

We determined that action was needed to prevent burns from hot pipe work, to prevent flooring trip hazards, and ensure that the premises were adequately decorated.

We found that staffing levels were adequate to ensure that people’s needs were met and that they were safe.

We found that some systems had been used to monitor how the service had been run and people had been encouraged to give their views about the service provided.

During our inspection of this home in November 2012 we found non-compliance with medication management. We identified that some improvement was needed concerning medication storage, recording and temperature control. We carried out this inspection to find out if improvements had been made and found that overall they had.

We spoke with one person living at the home about their medication. They told us, “The staff look after my tablets as I do not want that responsibility. They always give me my tablets at the time I should have them”.

There were 48 people living at the home on the day of our inspection. We spent time with those people to find out about the service provided.

We spoke with eight people, nine staff, three visitors and three health care professionals. People told us positive things about the home. One person said "I am happy and settled here". Another person said "The staff are very kind”.

We saw that staff treated people with dignity and respect. People's needs had been assessed by a range of health professionals including doctors, the community matron and the optician. This meant that people's health care needs had been monitored and met.

We saw that people had been given their medication as it had been prescribed by their doctor and that records of medication administration were maintained. However, we identified that some improvement was needed concerning medication storage, recording and temperature control.

Recruitment processes ensured that staff employed were suitable to work with the people living at the home which protected them from harm.

Records and staff both confirmed that systems had been used to monitor how the home had been run as it was supposed to be.

We spoke with nine people who told us they were very satisfied with the quality of care provided at Allerton Court. Comments included: “I consider this to be my home, staff are so kind and helpful, and nothing is too much trouble”. “The staff are excellent, always helpful”. “You won’t find better staff anywhere, staff are truly wonderful”. “A lovely home, I am so lucky”. “The food is great, and I enjoy the trips out, we went to Twycross Zoo, and I’ve been out for lunch”.” There is always something to do if you fancy joining in, sometimes I do, sometimes I just enjoy being up here (on the unit), and spending time with my friends, and that includes the staff, wonderful they are.”