The inspection was unannounced and took place on 26 July 2018. We agreed with the registered manager to return on 03 August 2018 to complete the inspection. Prior to the inspection we had received concerns about care at the home and the inspection followed up on these concerns and we also discussed the information with partner agencies.

The home is registered to provide accommodation and personal care, for a maximum of 68 people and there were 68 people living at the home on the days of the inspection.

A registered manager was in place. A 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.

We last inspected Boldmere Court on 16 February 2017, when we rated it as ‘good’ overall, however we rated the key question, ‘Is the service well-led’ as requires improvement because we found we saw that there were systems in place to monitor and improve the service but they did not always identify shortfalls that needed to be addressed. At this inspection we found improvements had been made.

People were cared for by staff who were trained in recognising and understanding how to report potential abuse. Staff knew how to raise any concerns about people’s safety and shared information so that people’s safety needs were met.

People felt safe living at the home. Staff were available to people and demonstrated good knowledge about people living at the home. People were supported by staff to have their medicines and records were maintained of medicines administered.

People and relatives complimented the cleanliness of the home. Staff maintained good hygiene and used protective clothing when appropriate.

Staff told us training helped them meet the specific needs of the people living at the home and they attended regular training to ensure they kept their knowledge updated.

Staff understood the importance of ensuring people agreed to the care and support they provided and when to involve others to help people make important decisions. The registered manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS) and had submitted the appropriate applications where they had assessed that people were potentially receiving care that restricted their liberty.

People enjoyed a choice of meals and were supported to access professional healthcare outside of the home, for example, they had regular visits with their GP and any changes to their care needs were recognised and supported by staff.

People said staff were caring and treated them with respect. We saw people were relaxed around the staff supporting them and saw some positive communication with staff. Staff showed us that they knew the interests, likes and dislikes of people and people were supported to enjoy various activities. We saw that staff ensured that they were respectful of people’s choices and decisions.

People were involved in planning their care. Relatives also said they were involved in reviews of people’s care and said staff listened to them. People and staff told us that the management team were approachable and if they had any concerns they would be listened to.

The management team ensured regular checks were completed to monitor the quality of the care that people received, and action had been taken where areas were identified for improvement.

People, relatives and staff were positive about the overall service. Relatives and staff complimented the improvements made under the new management. Staff felt supported to carry out their roles and responsibilities effectively, so that people received care and support in-line with their needs and wishes.

This inspection took place on 16 and 17 January 2017 and was unannounced on the first day but the registered manager knew we would be returning the second day. At our last inspection of 27 and 28 January 2016 we saw that improvements were needed in some aspects of the service provided although no regulations had been breached. At this inspection we found that further improvements had been made.

Boldmere Court Care Centre provides accommodation and support for up to 68 people with nursing and personal care needs. Some people were living with dementia. There were 65 people living in the home when we inspected.

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.

There were systems in place to monitor and improve the quality of the service, but these had not always been sufficient to ensure that shortfalls in the service had been identified so that they could be addressed in a timely manner.

People and their relatives were happy that their views about the service were listened to and responded to and actions taken where needed to improve the service. People, their relatives and staff were extremely positive about the registered manager and his interactions with them.

People received a safe and effective service because staff received the appropriate training and support to provide safe care. Staff were knowledgeable about people’s needs and people received an individualised service. People received support from staff that were caring and considerate.

People were supported to have their health needs met through support to take their medicines and to attend and receive medical attention when needed.

People were supported to eat and drink food that met their needs and that they enjoyed.

People’s human rights were protected because consent was received from people or their relatives for the care provided. Staff worked according to the principles of the Mental Capacity Act to achieve this. This meant people were given choices and opportunities to be involved in making decisions about the care they received.

This inspection took place on 27 and 28 January 2016 and was unannounced. At our previous inspection of 8, 10 and 11 June 2015 we found that the service was in breach of regulations in respect of keeping people safe, not meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards, not having sufficient staff to meet the needs of people and not having systems in place to ensure good governance. As a result of our inspection we issued warning notices in respect of staffing levels and governance.

At this inspection we found that improvements had been made and the requirements of the warning notices had been met although some aspects of the governance of the service needed further improvements.

Boldmere Court Care Centre provides accommodation and support for up to 68 people with nursing and personal care needs some of whom were living with dementia. There were 67 people living at the home when we inspected.

People were protected from harm because staff understood their responsibility to take action to protect people from the risk of abuse and harm and the provider had systems in place to minimise the risk of abuse.

People were involved in planning their care and management of any risks identified in relation to the care they received. People received care and support from staff that were trained and supported to carry out their roles. The social needs of people living with dementia were not always met in an appropriate way.

There were sufficient staff available to meet people’s needs and recruitment process ensured that suitable staff were employed.

People were supported to receive their medicines as prescribed.

People were supported to make choices about their care and staff worked in line with the Mental Capacity Act and Deprivation of Liberty Safeguards to ensure their human rights were protected.

People enjoyed their meals but actions were not always taken to ensure any weight loss or gain was investigated in a timely manner.

People received support from healthcare needs to monitor their ongoing health conditions and emergency treatment as needed.

People were treated with kindness and care and their privacy and dignity was maintained.

People received responsive care and their views were gathered through surveys, meetings and complaints.

The management and leadership in the home had improved and the morale within the staff group was good and people were happy with the service they received.

Systems were in place to monitor the quality of the service but further improvements were needed.

This inspection took place on 18 November 2014 and was unannounced. At the last inspection carried out on 28 January 2014 we found that the provider was meeting all of the essential standards we inspected.

Boldmere Court provides nursing care for people with life limiting illnesses and dementia. It is a purpose built home designed for up to 68 people and bedrooms are provided on three floors. All bedrooms are for single occupancy and have an en-suite facility. Passenger lifts provided access to all floors. At the time of our inspection there were 67 people living there.

The registered manager had a left a few days prior to our inspection. The provider’s representative told us that an individual had been identified and an application would be submitted to us to become the registered manager 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.

We saw that the systems for monitoring the quality of service provided were not effective in identifying shortfalls so actions could be taken to remedy them.

All staff spoken with understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and we saw that DoLS applications had been made when required so that people’s rights were protected. The provider had not ensured that we were notified of the restrictions in place on people’s liberty as legally required.

This meant that there were breaches in regulations. You can see what action we told the provider to take at the back of the full version of this report.

All the people and relatives we spoke with said that people were safe in the service. We saw that people were protected from harm because procedures were in place that ensured the service was safe and their rights protected. Staff knew how to protect people from abuse and how to escalate any concerns they had.

People told us there were sufficient numbers of staff available to support them people felt safe. Relatives and people that lived there felt that the staff were good and we saw that they had received training that ensured they had the skills and knowledge to care for people.

People were supported to receive their medicines as prescribed.

We saw that people were supported to have choices and received food and drink at regular times throughout the day. . People’s weights were monitored so that any changes in people’s health could be identified.

People received support to access healthcare professionals so that their health was monitored and treatment provided when needed.

Friends and relatives were able to visit people at any time and were enabled to be support them where appropriate. This meant that people were able to maintain relationships important to them.

People’s privacy and dignity was maintained and people were supported to remain independent where possible.

People were able to choose to be involved in planned group activities that they were interested in and there were times when people had individual activities that included chats and having their nails painted. Some people preferred to stay in their bedrooms. This showed that people were enabled to choose be involved in activities if they wanted.

People and their relatives told us that they felt listened to and able to raise any concerns they had. We saw that complaints were addressed promptly.

On the day of our inspection 65 people lived at the home. We spoke with the operations director, the manager, five members of staff, nine people who lived there and, six of their relatives. We also spoke with the activities coordinator.

We saw good interactions between people who lived there and staff. We observed that people were at ease in the company of staff. One person told us, "I'm very pleased with the care and staff."

We found that people were asked to give their consent before support was given. This meant that staff acted in accordance with people's wishes and ensured that people received care and support in the way they liked.

We saw that people's care needs were assessed and identified so that their health and wellbeing was promoted and met. Systems were in place to support staff to provide care and support that met people’s needs and kept them safe. One person said, "Staff look after us very well."

We found that there were enough staff to meet people's needs and ensure their safety.

We found that people were asked for their views about the home and people were listened to. The provider had a robust system in place to ensure the quality of service provision was monitored so that any necessary improvements could be made.

There were 45 people living at the home on the day of our inspection. We spoke with four people living in the home, four relatives, the operations director, the manager, four care staff and a nurse.

During our previous inspection we raised some concerns about the home. We were told by the operations director that there had been changes in management as well as the care staff. One relative we spoke with said, “There has been changes in staff, things have steadily gotten better”.

We saw that people were involved in making choices about what they wanted to do and what they ate and drank.

We found that people's needs were assessed and planned to ensure that the care people received was safe and appropriate. All of the people we spoke with told us they were happy with the care they received. One person told us, "It’s nice here”. A relative we spoke with said, “They are brilliant with my mum, she absolutely adores it here”.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people.

People received their medicines as prescribed by their doctor to ensure their health needs were met.

People’s health and welfare needs were not met by sufficient numbers of staff.

There home was recording accidents and incidents and taking feedback. However, they were not being analysed to implement the learning.

Some people were very positive about their care at Boldmere Court nursing home: “I couldn’t fault it”; “I am very happy here”; " I have no complaints". One person described the nurses and care workers as “brilliant”. Some families were complimentary: “It’s marvellous here"; “we consider ourselves very fortunate to have got a place for him here”.

However, two families had complained about the care. One family had reported that nurses and care workers did not give good care when it was required. Another family had described neglectful care and said that staff were unhelpful.

This inspection was carried out over three days on 8, 10 and 11 June 2015 and was unannounced.

We last inspected Boldmere Court Care Centre on 18 November 2014. At that inspection we found the provider was not meeting regulations because they were not informing us about restrictions that had been agreed to be placed on some people’s liberty and monitoring the quality of the service provided. During this inspection we found that the provider had kept us informed of the restrictions that had been agreed for people where they were needed. Although improvements had been made on how the quality of the service was monitored further improvements were required.

Boldmere Court Care Centre provides accommodation and support for up to 68 people with nursing and personal care needs some of whom were living with dementia. There were 67 people living at the home when we inspected.

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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There were not always enough staff on duty to ensure that people were adequately supervised and so that their needs were met in the way they wanted. This was a breach of regulations.

Staff understood their responsibility to take action to protect people from the risk of abuse and harm because the provider had systems in place to minimise the risk of abuse. However, we saw that staff did not always follow the risk management plans in place to minimise the risks associated with people‘s care and this put people at further risk of injury. This was a breach of regulations.

Staff understood how to get consent from people to the care they received and how to involve people in their care. However, we saw that staff had not always recognised when their practices were putting restrictions on people’s ability to move around freely. This meant that they were not meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards which meant that people’s human rights were not protected. This was a breach of regulations.

People who could tell us told that they felt safe living at the home. Relatives that we spoke with told us that their family member was safe and well cared for at Boldmere Court Care Centre.

People were supported to receive their medicines but medicines were not always available and people did not always receive their medicines as prescribed.

Some staff interaction seen were caring and kind and provided effective, personalised care but was not always based on individual preferences. Staff did not fully understand dementia and the effects that dementia had on people, so staff interactions did not always show compassion and care.

People received food and drink based on their needs and preferences. People were provided with appropriate support to eat their meals when needed. People were not always happy with the standard of the food.

People were supported to receive advice and treatment from a variety of healthcare professionals so that they remained healthy and received treatment if they were unwell.

Staff did not always show care and compassion towards people and were not always responsive to their needs.

Systems were in place to monitor the quality of the service provided but they did not always identify poor practice and ensure the appropriate actions were taken to improve the service.