This unannounced inspection took place on 26 October and 02 November 2017. Anson Court is registered to provide accommodation and personal care for up to 33 people, who are mainly older people with Dementia. At the time of our inspection 32 people were using the service. At our last inspection on 26 October 2016 the provider was rated as requires improvement overall because people’s medicines were not always recorded and stored accurately and staff recruitment was not always carried out safely. We found the principles of the Mental Capacity Act (MCA) were not always being followed and the governance system operated by the provider was not always comprehensive and detailed. At this inspection we found recruitment systems had improved and the principles of the MCA were now embedded in practices at Anson Court. However, the recording of and storage of people’s medicines had not improved and the quality assurance system in place had not improved which meant they were not now meeting the requirements of the law.

During this inspection we identified two breaches of the Health and Social Care Act 2008 relating to governance systems and failing to notify us of certain events. You can see what action we told the provider to take at the back of the full version of the report.

At the time of our inspection there was a 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.

People told us they felt safe living at Anson Court. However, we found the system operated by the registered manager did not always demonstrate people got their medicines as prescribed. Risks to people’s health and safety were not always managed in a consistent way. Staff had received training in how to protect people from the risk of harm and knew what to do should they suspect any abuse had taken place. People told us and we saw there were sufficient staff to meet people’s needs.

Staff told us they had received training to help them meet people’s needs. People’s rights were upheld through effective use of the Mental Capacity Act 2008. People told us they enjoyed the food at Anson Court and they received sufficient nutrition to remain healthy. When people’s health needs changed or required reviewing we saw they had access to other healthcare professionals to support them.

People told us and we saw staff treated them with kindness and compassion. We saw people’s privacy and dignity was upheld by staff. Staff understood the need and we saw they promoted people’s independence. We saw people were encouraged to maintain relationships that were important to them.

People and their relatives told us they were happy with the care they received. Staff knew people’s individual needs well and therefore people received care that was responsive to their individual needs. There were activities available should people wish to join in. The provider operated a complaints system which meant people could complain should they wish to.

The provider had failed to notify us when people were being deprived of their liberty in line with their legal duty. The quality assurance system operated by the provider was not effective at identifying the areas our inspection highlighted where improvements were required. People and their relatives told us the home was well led and they were happy living there. Staff told us they were supported by the registered manager and were involved in the running of the home.

Anson Court is registered to provide accommodation and personal care for up to 33 people, who are mainly older people with Dementia. At the time of our inspection 33 people were using the service. Our inspection was unannounced and took place on 26 October 2016. The service was last inspected on the 20 February 2014 where the provider was found to not be meeting two of the regulations associated with the Health and Social Care Act 2008.

At our inspection of 20 February 2014, we found that the provider was not meeting Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 because they were not involving people in decisions and choices about their care. We found that people were woken very early by staff and there was no evidence to state that this was their choice. We asked the provider to send us an action plan of how they were going to meet this regulation which they did. Since our previous inspection the law has changed and the regulation is now Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found on this inspection that the provider was now meeting the requirements of the law.

We also found during our last inspection the provider was not meeting the requirements of Regulation 20 HSCA 2008 (Regulated Activities) Regulations 2010. This was because records did not always reflect people’s choices and preferences. We found on this inspection they had met the requirements of the law. The law which replaces this regulation is now Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

The administration and recording of medicines given to people was not always done safely. Medicines were not always stored at the correct temperature required to keep the medicine at its best. Although criminal records checks were undertaken before staff were able to begin their role, where disclosures had been raised on these checks, risk assessments were not in place to ensure that people were not at risk. A full work history for staff had also not always been obtained. Staff supported people in a way that made them feel safe. Staff understood the procedures they should follow if they witnessed or suspected that a person was being abused or harmed.

Where medicines were given without people’s knowledge, there was no evidence that discussions had been made to reach a best interests decision where people did not have the capacity to make decisions for themselves. Staff had the skills and knowledge required to support people effectively. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going training to assist them in their role. Staff could access supervision and felt able to ask for assistance from the registered manager and senior staff, if they should need it. Staff knew how to support people in line with the Mental Capacity Act and gained their consent before assisting or supporting them. Staff assisted people to access food and drink and encouraged people to eat healthily. Staff supported people’s healthcare needs.

Quality assurance audits were not always comprehensive enough to allow patterns and trends to be observed accurately. People were happy with the service they received and felt the service was led in an appropriate way. Staff were supported in their roles. Staff felt that their views or opinions were listened to.

People were involved in making their own decisions about their care and their own specific needs. People felt listened to, had the informat

This was an unannounced inspection which commenced at 6.30 am to check actions the provider had taken since our previous inspection undertaken on 08 August 2013. The provider or staff did not know we were visiting.

During the inspection we spoke with three people who used the service, three staff, one relative, the provider, the manager from another home and the registered manager who came in whilst on annual leave. We spent time observing the care people received as most people due to their health conditions were unable to speak with us.

One person told us: "The staff are very good". A relative said: "I don't know what I will do without the staff when my mum goes home, everyone has been great".

We found that people who lived in the home or if appropriate their relatives were not fully consulted about their preferences about the care they wanted or needed.

We found that improvement to people's care records was needed, to ensure that people received safe and appropriate care.

The home had appropriate systems in place to enable people to raise concerns. Improvements had been made in the way that complaints were recorded.

This was an unannounced inspection which commenced at 6.15 am following alleged concerns we had received about the service. The home did not know we were visiting. During the inspection we spoke with four people who used the service, six staff, six relatives and the registered manager. We spent time observing the care people received as most people due to their health conditions were unable to speak with us.

All people we spoke with during our inspection told us that they or their relative received good care. One person said: "We are really happy chappies here. They look after me as if I'm their mother. I feel happy and well cared for". Another person said: "The care is wonderful; they look after me very well. We have activities that keep me occupied ". One relative said: "I'm so glad we found this place - it's brilliant. They treat my relative with respect and love, nothing is too much trouble". Two people told us before we visited about their concerns about care provided at Anson Court.

We found that improvement was needed to protect people from the risk of falls and ensure they received safe and appropriate care. Care records were not accurately completed and did not protect people from the risks of inappropriate or unsafe care.

We found that appropriate arrangements were in place to store and manage people's medicines.

The home was a clean and pleasant place for people to live.

People were positive about the staff and told us that staff were caring. Concern had been highlighted about the sufficiency of the staff. We found that there were sufficient staff and arrangements were in place to cover staff absence.

The home had appropriate systems in place to enable people to raise concerns and people said that they were confident that any concerns they had would be addressed. However we were unable to find evidence that concerns were investigated and addressed as no record of complaints made was available.

We carried out this inspection to review improvements made following our previous inspection in January 2012.

The inspection included the observation of care experienced by people living at the home, talking to people who were living in the home, talking with the manager and staff on duty, looking in detail at all aspects of care for three people some of whom had complex needs, viewing people's rooms and discussing their care with staff. This process is known as pathway tracking.

People we spoke with were positive about the service provided. One relative told us, " I am very pleased, she always looks clean and well looked after", another relative said "I have no concerns, she is happy here".

People and their relatives were consulted about the care they needed. People were able to choose how they spent their day and when they got up and go to bed. Friends and relatives were made welcome and were able to visit.

The service had appropriate systems in place to protect people from harm. One relative said, "She is happier here and she is safe".

There were sufficient staff to meet people's needs. We were told that staff were caring. One relative said, "Staff are very helpful, they work really hard". Another relative said, "The staff here are first class".

The service had appropriate systems in place to check that people received safe and appropriate care that meets their needs.

The home provides care and support for older people. Most people living at the home have poor understanding and comprehension due to their dementia. We spent more than two hours during our visit observing the care that people receive and interactions that take place with staff. We also spoke with twelve relatives.

Relatives we spoke to were mostly happy with the care their relative received. We were told, "She has settled in really well here", and "I can't fault the care they give". Relatives also told us that they were told when their relative was unwell. One relative said, "They always get the doctor when she is unwell and they always let me know when the doctor has been".

We found that the main lounge and dining room were crowded and lacked homeliness. Three relatives we spoke to expressed their concern about the lack of homeliness. One relative said "It’s getting very full and its sometimes a struggle to find somewhere to sit with them. Another relative told us, "Staff do their best but the lounge still looks like a waiting room".

Staffing levels are not sufficient to meet people's needs. We saw that staff struggled to provide the care people need with people waiting to receive the care they needed. We saw that that there were insufficient staff to provide valuable social interaction to maintain people's wellbeing. Relatives told us, "Most of the staff are very good but they struggle to cope". We observed that people did not always receive the care they needed in a timely way.