This was an unannounced comprehensive inspection that took place on 19 December 2016. At the last inspection completed on 21 & 22 September 2015,; we found the provider had not met the regulations for ensuring that staffing levels were sufficient to meet people's needs in a timely manner and having systems in place to assess, monitor and improve the quality and safety of the service and to monitor and assess risks. These matters were a breach of Regulation 18 and 17 of the Health & Social Care Act 2008 Regulated Activities Regulations 2014. At this inspection we found the provider had made the required improvements and the regulations were being met.

The service provided residential and nursing care for up to 42 adults most of who were aged 65 years and over. At the time of our inspection there were 37 people using the service 27 of whom required nursing care.

There were enough staff on duty to meet people’s needs. Staff met people’s needs in a timely manner. The manager used agency staff to cover periods of staff absence to ensure that enough staff were deployed to meet people’s needs. We found that the provider has safe recruitment practices which assured them that staff were safe to support people before they commenced their employment with the service.

The service had a manager who had applied to the Care Quality Commission 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.

The service had a culture that strove for continuous improvement. We saw that the manager had made changes to address the issues we identified at their previous inspection. The provider had systems in place to monitor the quality of care that people received. They also worked with other stakeholders to improve the service.

The manager had made changes to the storage arrangements to ensure that people’s records were stored securely and only authorised people had access to people’s personal information. People’s care plans were comprehensive. They reflected their current needs and preferences and guided staff to support people as they chose.

People who used the service, their relatives and staff felt that the home was well-managed. They told us that the manager was approachable and supported them when they required it. Other professionals involved with the services reported a continuous improvement in the service.

People felt safe at Bosworth Care Home. They were supported by staff who knew their responsibilities to keep people safe from avoidable harm and abuse. Staff assessed risks associated with the provision of people’s care and support and provided any required support in a safe and non-restrictive manner.

People were supported to have their medicines. Medicines were only administered by staff who were suitably trained and assessed to complete this task. The provider had plans in place to improve their arrangement for the storage of people’s medicines.

Staff had the skills and experience to support people effectively. Nurses were supported to remain competent and maintain their qualifications. Staff we spoke with had the skills to communicate and support people whose behaviour may challenge others.

People were supported in accordance with Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). They were supported to make their own decision where possible. People’s liberty was not deprived unlawfully. This was because the provider had made applications to the local authority for DoLS authorisation for people that required this.

People received the support that they required to meet their nutritional needs. Staff worked with other professionals to meet the needs of people who were at increase

At our inspection we gathered evidence that helped answer our five questions.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with three people who used the using the service, a relative of one of those people and relatives of two other people. We spoke with four staff including the registered manager. We looked at four people's care records and staff records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service were safe from avoidable harm and abuse because the provider had effective safeguarding procedures. Staff had received training about safeguarding of vulnerable people and knew how to recognise and report signs of abuse.

Senior staff had a good understanding and other staff an awareness of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that protects vulnerable people who are or may become deprived of their liberty through the use of restraint, restriction of movement and control. This showed that staff understood how people's safety was respected and their best interests taken into account. The legislation had been correctly applied at the home for a small number of people who used the service.

People and relatives we spoke with told us the service was safe. They told us they were confident they could raise any concerns if a situation arose where they felt they needed to.

People's care plans included risk assessments associated with people's care and support. This meant that the provider had plans in place to protect people from injury when they received care and support.

The provider had effective recruitment procedures that ensured, as far as possible, that only people who were suited to work with vulnerable people worked at Bosworth Court.

Is the service effective?

People's health and care needs were assessed with them or their relatives. Care plans included details of people's needs and information about how people were supported with their needs. Care plans and records we looked at that showed that people had received the support they required.

Relatives were able to visit the home at times they wanted.

People were supported to maintain good health. Staff had been alert to changes in people's health and had accessed relevant health services when people needed them. The provider had arranged for a GP to visit the home every Monday to attend to people's health needs.

Is the service caring?

People told us they were well looked after. They told us staff were kind and caring. Our observations of how staff cared for and supported people confirmed what people had told us. Staff referred to people by their preferred name when they spoke with

them. We saw that staff engaged with people in a caring and compassionate manner. When staff supported people they first sought their consent then explained what they were going to do.

People's preferences, interests and diverse needs were respected. People were able to spend their time how they wanted. An activities coordinator provided people with meaningful and stimulating activities.

People who used the service and their relatives had opportunities to be involved in discussions and decisions about their care and support. People were encouraged to give their views about their care and support and their views were respected.

People's privacy and dignity were respected and promoted. People were able to go to their rooms when they wanted to. People who shared a room with another person had wanted to. Rooms that were shared had a privacy curtain that was used to divide a room when people received individual care and support.

Is the service responsive?

People were supported to be involved, as much as they were able, in the assessment of their needs and their care and support. People's care plans were person centred. People's care plans had been regularly reviewed.

People who used the service and their relatives were encouraged to share their views about the service. People's views had been acted upon. Concerns and complaints had been investigated and used as an opportunity for learning and improvement.

Is the service well-led?

The service had a system for monitoring the quality of service. This included audits of the quality of care, documentation and records and observations of care worker's practice. Audits had identified areas that required improvement, and action plans had been implemented. Staff meetings took place at regular intervals. We saw from records of those meetings that the manager had shared information about the outcome of monitoring activity.

The service had procedures for reporting of accidents and injuries. We saw that reports were reviewed and analysed and that action had been taken to reduce the risk of the same type of accident occurring again.

The provider regularly sought the views of people who used the service and their relatives. Their views had been acted on. The provider had also sought the views of staff. At the time of our inspection there had been a two month delay in the analysis of staff feedback.

We spoke with eight people who used the service, ten members of staff and one visitor to the service. We also reviewed five care records and four staff files.

One member of staff told us: “It is everyone’s right to choose. We try to persuade people but if they decline then we respect people’s choices.”

We also spoke with a number of people who used the service and asked them their views in relation to the care they received. All spoke with high regard for the quality of care and kindness displayed by the staff.

All the staff we spoke with had received training in safeguarding the vulnerable adult. Many of the staff were able to give examples of when they had reported concerns to management.

We saw risk assessments were conducted for people who used equipment. We also saw that a moving and handling assessment was undertaken in conjunction with the equipment risk assessment.

A Disclosure and Barring Service (DBS) check had been completed prior to the person starting their employment in the service in three out of the four records reviewed. We found evidence that one check had been requested but the outcome of the check had not been received.

We spoke with staff and asked how the quality of the care and support they gave was monitored. All told us regular spot checks and competency checks were carried out.

We spoke with four people who used the service, one relative of a person who used the service and five members of staff. We also reviewed five care records.

We also spoke with a number of people who used the service and a relative of a person who used the service and asked them if they had been included in discussions about their care and they were in agreement with their individual plan of care. All replied they had.

The care records we reviewed contained detailed needs assessments and appropriate risk assessments. We also found that the risk assessments were supported by appropriate guidance for staff.

We saw documented evidence that eighteen appraisals and thirty two supervision sessions had taken place since our last visit.

We spoke to eight people who used the service, nine members of staff and one relative of a person who used the service. We also reviewed five care records and three staff files.

All the people we spoke with were happy and contented with their care. However none were able to confirm that they had taken part in discussions about their care and treatment.

The majority of the care records we reviewed included dependency risk assessments and plans for managing the identified risks. However there were inconsistencies in our findings and we found one care record contained risk assessments that were either partly completed or not completed at all.

Members of staff administering medicines wore a red tabard indicating that they should not be disturbed. Two members of staff were involved in the medicine round

We saw that supervision sessions had taken place however there was inconsistencies in the regularity of these sessions and none of the staff files we reviewed contained evidence that annual appraisals had taken place in the last three years.

People who used the service and their relatives were asked for their views about their care and treatment. We saw evidence of completed surveys from February and March 2013.

During our visit we were able to talk with seven people who were living at the service, three visitors and seven members of staff.

People told us that they were able to visit the service before moving in to check that it was the right place for them. One person told us, “I came and looked around, it seemed nice”. Another person explained, “my sister came and looked around, we came on recommendation”.

We were told that on the whole, staff were supportive and carried out their duties in a kind and patient manner; however, two people told us that some staff were better than others. One person told us, “one or two of the carers are excellent, one or two, not so”. Another person explained, “the staff are good, if I need something from my room, they will take me”.

People told us that there wasn’t much to do during the day. One person explained, “they come and talk sometimes [care staff] when there not to busy”. Another person told us, “there’s no stimulation, but at least the music is on today”.

People told us that overall they were satisfied with the care and support they received. One person explained, “it’s not bad at all, they treat me well”. Another person told us, “sometimes the care is extremely good, sometimes it’s mediocre, it depends which staff are on”.

We were told that the food served at Bosworth Court was good, and the meal served on the day of our visit looked nutritious and appealing. One person told us, “the food is very good, and there’s plenty of it”. Another person explained, “the meals are lovely and you can have what you like”.

People who use the service were generally happy with the standard of care provided by staff on duty.

People said they receive their medication on time and have their health needs met.

People are offered a good choice of meals.

People said they felt safer and confident that their wishes are respected.

People said they felt confident to approach staff and felt the majority of staff respond to their requests.

The Local Involvement Networks (LINks) members were consulted about this home and received one response. They indicated that their bedroom was kept clean and tidy and they knew who to speak with if they were unhappy or wanted to make a complaint.

This inspection took place on 21 and 22 September 2015 and was unannounced. At our last inspection on 18 August 2014 the provider was meeting the regulations.

Bosworth Court Care Home is a registered care service, providing accommodation, nursing and personal care for up to 47 older people. There were 36 people using the service at the time of our inspection. Accommodation is arranged over two floors and there is a passenger lift to assist people to get to the upper floor.

The service should have 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. However at the time of our inspection there was not a registered manager in post. The last registered manager had left the service 12 months ago. The provider was in the process of recruiting to the registered manager’s post and interviews were scheduled to be held within a few weeks of our inspection. The acting manager who was in post at the time of our inspection had been covering the role since August 2015.

Staff had a good understanding of the types of abuse and how they were able to report them. There was a safeguarding policy in place that provided definitions of abuse and the process both internally and externally for reporting for staff to follow.

There were systems in place to ensure that people received their medicines as prescribed, but medicines were not always stored safely to protect people from risks.

Staff had received relevant training to enable them to fulfil their roles. Some staff did not have sufficiently detailed knowledge of the Mental Capacity Act 2005 or the Deprivation of Liberty Safeguards to help them to care for people in accordance with the legislation. We saw that appropriate referrals had been made to the local authority where people lacked the capacity to consent to restrictions relating to their care.

Staff understood how they were able to ensure that people’s privacy and dignity was respected but we observed that this was not always carried out. We observed some positive interactions from staff members towards people and concern for people’s well-being. We also heard some remarks and comments from staff that concerned us.

Staff had a good understanding of people’s preferences and life histories. We saw that life story booklets were completed but the information was not used to inform people’s care plans.

People told us that they felt able to raise any concerns but relatives did not always feel assured that they would be acted upon. We found that complaints that had been received had been investigated and responded to by the service.

We found that records relating to people’s personal care and requirements were stored in a communal area and were accessible to anybody within the service.

We found that audits that were in place had failed to identify the inappropriate storage of creams. We saw that records were not being accurately maintained for people.

There were not sufficient staff on duty to meet people’s needs. People’s requests for assistance were not met as staff were too busy to be able to respond. Inadequate staffing levels had an impact on the care and treatment that people received.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.