This was an unannounced inspection which took place on 22, 23 and 24 November 2016.

We last inspected the service in January 2015 At that inspection we found the service was not meeting all the regulations that we reviewed.

At the last inspection on 5, 6 and 7 January 2015 we rated the service as ‘Requires Improvement’ At that inspection we identified two regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to good governance. This inspection was to check improvements had been made and to review the ratings. We saw evidence to confirm that action required had been taken.

Arbour Court is registered with the Care Quality Commission (CQC) to provide personal and nursing care and accommodation for up to 60 older people living with dementia. The home is owned and managed by Barchester Healthcare Homes Limited. Accommodation is on two floors all bedrooms are single and have en-suite facilities available. Car parking is at the front of the building. At the time of this inspection 58 people were living at the home.

A registered manager was not 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 location has a condition of registration that it must have a registered manager, but it does not have one. However steps were being taken by the provider to recruit one within a reasonable timescale.

Following this inspection the registered provider notified us that a registered manager was in post from 17 January 2017.

People who used the service and their relatives were complimentary and positive about the support provided and attitude of the staff team and management. They told us they were happy with the service provided and overall their needs were being met. They also told us the registered nurses and care staff treated people caringly, sensitively and with respect.

People were supported by sufficient numbers of suitably trained staff. We saw that recruitment procedures helped to make sure staff had the appropriate qualities to protect the safety of people who used the service and we saw they received the training and support required to meet people’s needs.

Care staff and nurses we spoke with told us they had undergone a thorough recruitment process. They told us following their employee induction, training appropriate to the work they carried out was always available to them. This helped to make sure the care provided was safe and responsive to meet peoples identified needs.

Individual staff training records indicated that all care staff had received appropriate training to carry out their roles effectively. Some staff were working towards a nationally recognised qualification in care such as a National Vocational Qualification (NVQ) in health and social care and the Care Certificate. The Care Certificate is a professional qualification which aims to equip health and social care staff with the knowledge and skills they need to provide safe care and support to people using the service. This qualification helped them to carry out their roles effectively. Staff members confirmed they had received safeguarding and whistle blowing training and knew who to report to if they suspected or witnessed abuse or poor practice.

Care records were in place to reflect peoples identified care and support needs. Information about how people wanted to be supported, their likes and dislikes, when support was required and how this was to be delivered was also included in the care records we examined. Information regarding people’s dietary needs was included in their care records and clear guidance for staff members helped make sure these requirements were met.

We saw written evidence that people a

Arbour Court is part of the Barchester Care Group. The home provides accommodation and care for up to 60 people and was fully occupied on the day of our inspection. The home provides nursing care for people with dementia and with mental health needs.

Accommodation is provided on two levels with communal areas, bathrooms, toilets and bedrooms on both floors. A passenger lift provides access to both floors. The home is set in its own grounds with an enclosed courtyard and a roof garden terrace. Car parking is available within the grounds. The home is located in a residential area just outside the rural town of Marple.

The manager had been in post since 2013 and was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We found the care records provided information about the individual care needs of people and directed staff in the safe delivery of people’s care, support and nursing needs. We saw the care plans were safely and securely stored when not in use ensuring confidentiality was maintained.

The service worked closely with other healthcare professionals so people’s current and changing needs could be met.

We found that the service was meeting the requirements of the Mental Capacity Act 2005 in respect of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted.

Routines were relaxed, with people spending time as they chose. People were offered a range of activities both in and away from the home, offering variety to their day.

Robust recruitment policies and procedures were in place to check applicant’s suitability for working at the home.

We were told staffing arrangements were kept under review so sufficient numbers of staff were available to meet the needs of people. Staff told us they felt they were supported and directed by the manager and deputy manager in delivering good care.

Training and development opportunities were provided to staff so they had the knowledge and skills needed to support people.

Arbour Court is part of the Barchester Care Group. The home provides accommodation and care for up to 60 people and was fully occupied on the day of our inspection. The home provides nursing care for people with dementia and with mental health needs.

Accommodation is provided on two levels with communal areas, bathrooms, toilets and bedrooms on both floors.  A passenger lift provides access to both floors. The home is set in its own grounds with an enclosed courtyard and a roof garden terrace. Car parking is available within the grounds. The home is located in a residential area just outside the rural town of Marple.

The manager had been in post since 2013 and was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We found the care records provided information about the individual care needs of people and directed staff in the safe delivery of people’s care, support and nursing needs. We saw the care plans were safely and securely stored when not in use ensuring confidentiality was maintained.

The service worked closely with other healthcare professionals so people’s current and changing needs could be met.

We found that the service was meeting the requirements of the Mental Capacity Act 2005 in respect of the Deprivation of Liberty Safeguards. People’s human rights were therefore properly recognised, respected and promoted.

Routines were relaxed, with people spending time as they chose. People were offered a range of activities both in and away from the home, offering variety to their day.

Robust recruitment policies and procedures were in place to check applicant’s suitability for working at the home.

We were told staffing arrangements were kept under review so sufficient numbers of staff were available to meet the needs of people. Staff told us they felt they were supported and directed by the manager and deputy manager in delivering good care.

Training and development opportunities were provided to staff so they had the knowledge and skills needed to support people.

We carried out this inspection to see what progress the provider had made to improve the standards of care for the people living at the home.

We observed staff carrying out their duties and responsibilities in good humour and in a relaxed and positive manner. We could see that staff enjoyed good relationships with the people who lived at the home and had sufficient time to meet their needs without hurrying.

All the people spoken with during our visit made positive comments about the staff, standard of care and facilities and services provided. One person said “I am happy and well looked after”. Another person said, “I can not say I am happy but I can say that I am well looked after”.

We looked at the care records for four of the people who lived at the home and could see that improvements had been made in the way care plans were being written. Records showed that each person’s health and well being was monitored and where appropriate staff sought medical attention or advice and guidance from the person’s health and social care professionals.

We found that there were areas where improvements were needed. These included care planning and food and fluid balance monitoring records. These issues had been raised following our previous inspection. Although the manager had devised a satisfactory action plan to address them it was clear that more work needed to be done to ensure people were safeguarded from inappropriate or ineffective care.

All the people we spoke with made positive comments about the care provided at the home. One person using the service told us, “The girls are very nice. They always have a chat with me and let me know what is happening.”

People told us that the food was good and they enjoyed the meals provided.

As part of this inspection we sat in on a relatives meeting. During the relatives meeting, relatives said that “the food is very good, good quality and their family members had sufficient quantity”. One relative remarked that the chips when served were sometimes cold. The deputy manager told them this would be looked into and following the meeting fed this back immediately to the chef.

We spoke with three relatives who told us that the staff had asked them about their family member’s choices and meal preferences and that these were taken into account. They raised no concerns with us over the food choices, amount or presentation. All those we met and spoke with told us they assisted their family member with their meals and choices so saw the meal service at least daily and said they would be able to raise any issues on the day with the staff or deputy manager.

People told us that they felt safe and well cared for and made positive comments about the staff. A visiting relative said “the staff are wonderful but there are times when there are not enough of them”. Another visiting relative told us that staffing levels had improved in recent months, and overall there had been significant improvements in the standard of care provided.

Arbour Court provides a service to people with dementia. Consequently, there were few people who could share their views on the quality of the service with us.

Two relatives of people accommodated in the home told us that the service had improved since our last visit on 23 September 2011. Both relatives confirmed that any issues they raised had been dealt with promptly.

We observed the care and support that people received during the breakfast period. It was pleasing to see that staff were developing a person centred approach by recognising and respecting that each person had different needs in the way they should be supported. Staff demonstrated patience in giving people enough time to make decisions on what they would like to eat and drink. We observed that staff initiated meaningful conversations with the people they supported. This approach had improved the wellbeing of the people accommodated during mealtimes.

None of the people we spoke to raised any concerns about the care and support they received and we found people to be contented and relaxed during the time we spent in the home.

Because this home provides a service to people with dementia there were only a few people who were able to share their views with us.

Some people using the service said that staff didn’t speak to them very much and they were not asked their views about what happened in the home. One person told us that staff referred to them as a complainer.

We heard that relatives used to be invited to meetings to discuss the service provided by the home. However, these meetings had stopped some considerable time ago.

One person commented that they had to wait for long periods of time for a member of staff to take them to the toilet, by which time they said it was often too late.

This was an unannounced inspection.

The service does not have a registered manager. However, a new manager was in place and an application to become registered had been submitted to CQC in December 2014. 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 home provides nursing care for up to 60 people. Accommodation is on two floors and comprises of two communal lounge rooms and two separate dining areas. There are enclosed garden areas. All bedrooms are single and have en-suite facilities available. Car parking is available at the front of the building. There were 57 people living at the home at the time of our visit. The home is owned and managed by Barchester Healthcare Homes Limited.

Staff working in the home understood the care needs of the people who lived there and we saw that care was provided with kindness and dignity. The provider had skilled staff employed at the service to make sure the care provided was in line with best practice. A person using the service and a relative told us they were happy with the care being provided and the staff working at the home. Staff were appropriately trained and skilled and provided care in a safe environment.

Training was available to help make sure that the care provided to people was safe and effective to meet their needs. They had all received a thorough induction when they started work at the service and understood their roles and responsibilities, as well as the values and philosophy of the home. Throughout our inspection we saw examples of people and their families being included and consulted in the planning of their care and were treated with dignity, privacy and respect.

The provider consistently assessed and monitored the quality of care using an in house auditing system that was being completed regularly. The regional director told us that the organisation was introducing a dependency indicator care equation (DICE) tool to monitor the workforce numbers. The provider encouraged feedback from people using the service and their families.

Feedback was given in the form of complaints, comments, compliments and an annual service user satisfaction survey. Copies of the complaints procedure were displayed on notice boards around the home and were available for people to read. Feedback received was used to make improvements to the service.

We found a breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.