Although risks to people’s safety were identified we found some risks did not have the guidance for staff on how to reduce the risks. We also found measures assessed as required for people to reduce risks were not always followed and were not were not correctly supported. On the first day of our inspection we found people were not always supported by staff in sufficient numbers to keep them safe.

People living at the service were protected from harm as the provider had robust processes in place to ensure their safety. Staff supporting people were aware of their responsibilities in relation to protecting people from abuse. They had received appropriate training to support their understanding of any safeguarding issues. The registered manager reported any issues of concern to both the CQC and the local safeguarding teams and worked in an open and transparent manner. There were clear processes in place to ensure lessons were learnt following any incidents or events.

Medicines were managed safely and people were protected from the risk of infection through good hygiene practices and staff knowledge of reducing the risks of cross infection.

People’s needs were assessed using effective evidenced based assessment tools such as nutritional and skin integrity assessment tools. These could then be used to provide clear guidance for staff to assist them gain a good understanding of an individual’s needs and offer the most effective support to people. However the care people received was not always person centred as their supporting care plans lack sufficient detail following the assessments to support staff to meet people’s individual needs.

Staff were supported with appropriate training for their roles.

People were supported to maintain a healthy diet, with staff showing good knowledge of people’s nutritional and health needs. They received support to manage their health needs through well-developed links with local health professionals. The environment people lived in was a well maintained safe environment which met their needs.

Staff sought consent from people before caring for them and they understood and followed the principles of the Mental Capacity Act, 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the documentation in relation to the mental capacity assessments lacked detail and the registered manager began to address this during the inspection.

People at the service, and relatives were treated with kindness and care by staff who supported people with respect and dignity, and developed positive relationships with people in their care.

People could maintain relationships with people who were important to them and relatives felt their views and opinions about their loved one’s care were listened to.

People were supported to take part in a range of social activities to prevent isolation. People were asked to be involved in planning regarding their end of life care so that their wishes were known. There was a complaints procedure in place and people knew who to complain to should they have any issues.

The service was well led, the registered manager was visible and supportive towards people, their relatives and the staff who worked at the service. The quality assurance systems in place were used effectively to monitor performance and quality of care. The registered manager responded positively to changes and used information to improve the service and care people received.

This inspection took place on 3rd and 4th February 2016 and was unannounced.

Clumber Court Care Centre is situated on the outskirts of the market town of Retford and is registered to provide accommodation for persons who require nursing or personal care. At the time of inspection 54 people were using the service.

When we last inspected the service in December 2014, we were concerned that there were not sufficient staff, that staff were not always fully trained and supported in their work and that there were not effective systems in place to monitor the quality of the service. During this inspection we found that significant improvements had been made and the legal requirements were met.

The service had a 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.

There were enough staff with the right skills and experience to meet people’s needs. These staff understood their role in keeping people safe. People who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse. Risks were assessed and any accidents and incidents were investigated so that steps could be put in place to avoid reoccurrence. Medicines were stored, administered and handled safely and People received their medicines as prescribed.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager had applied the principles of the MCA and DoLS appropriately.

People were cared for by staff who received appropriate training and support. People were able to choose what they ate and spoke positively about the food they received. When needed, people’s food and fluid intake was monitored so they could be assured that they had enough to eat and drink. People had regular access to their GP and other health care professionals when required.

People were supported by staff who were caring and treated them with kindness, respect and dignity. Where people showed signs of distress or discomfort, staff responded to them quickly. There were no restrictions on friends and relatives visiting their family members. People could have privacy when needed. People were supported to access an independent advocate if they wanted to.

People and their relatives were involved with the planning of the care and support provided. Care plans were written in a way that focused on people’s choices and preferences. Regular monitoring of people’s assessed needs was conducted to ensure staff responded appropriately. People were able to access the activities and hobbies that interested them. A complaints procedure was in place and people felt comfortable in making a complaint if needed.

Robust auditing and quality monitoring processes were in place. There was a positive atmosphere within the home and people were encouraged to contribute to decisions to improve and develop the service. People spoke highly of the registered manager and the improvements that they had brought about since their appointment. The registered manager had clear processes in place to manage the risks to people and the service and continually strived to improve the quality of the service that people received. The service had recently won two awards ackn

This inspection took place on 01 December 2014. Clumber Court Care Centre provides residential care for up to 64 older people, including people with dementia. On the day of our inspection 41 people were using the service. The service was split into two separate floors with different staff on each floor.

The service did not have a registered manager in place at the time of our inspection. The previous registered manager left the service on 22 October 2014. The provider had engaged a peripatetic manager to manage the service until a new manager was recruited. 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 and associated Regulations about how the service is run.

Not all of the staff knew how to keep people safe or how to raise any concerns if they suspected someone was at risk of harm or abuse. People could not rely on staff to keep them safe from the risks they could face through everyday living or to ensure their safety.

People may not receive the care they required because there was not always sufficient staff on duty to meet their needs. People could not be assured they would be given their medicines safely because when errors in administering medicines occurred the planned action to ensure this was not repeated was not completed.

People were supported by staff who were caring and respectful, however staff were not given the knowledge and skills needed to deliver appropriate care and support.

We found the legislation to protect people who lack capacity to make certain decisions, The Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS), was not always followed correctly to protect people who were not able to make their own decisions about the care they received.

People were encouraged to eat well and supported to have their required nutritional and fluid intake. People were supported with their healthcare needs, although care plans did not provide staff with the information they needed to support people appropriately.

People were supported in a kind and caring way and had their dignity respected.

People’s individual preferences to care and support were not taken into account so that care could be delivered as they preferred it to be. People knew how to raise a concern and concerns were taken seriously and were addressed.

A lack of effective systems to monitor the quality of the service resulted in people not receiving safe, effective and responsive care which met their needs.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six people who used the service and a relative and asked them for their views. We also spoke with a visiting professional, three care staff, the deputy manager, the acting manager (newly appointed), the area manager for the company and the senior operations manager. We looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to, they gave consent to their care and treatment and people received care and support that met their needs. A person told us, “I am very happy here. The food is very good, I am well looked after so what more could I ask.” Another person told us, “I have all the help I need. “

We found the staff team were supported through training. A person told us, “I think they are well trained. They treat me with the utmost respect and are always kind and considerate to my relative.”

We carried out an inspection in response to information of concern we received in relation to the numbers of staff on each shift, particularly at night. Also, concerns about the training delivered to staff.

As part of our inspection we looked at staff rota’s, staff training and policies and procedures relating to staff. We spoke with the manager, one qualified nurse, a senior carer and four carers. We also spoke with several people living at the service and one relative.

We spoke with one relative who told us, “The staff are mostly very good and seem to know what they are doing. Sometimes new staff don’t seem to have the skills they need and that can be difficult if they are on a shift.”

Staff we spoke with told us there were usually enough staff on each shift. One said, "If everyone does their share of work things go well, but there are some who don't work as hard and that affects all of us."

Staff we spoke with told us they had received training which they felt was good and enabled them to do their work confidently and competently. However, one staff member said they would like more training in dementia care and managing challenging behaviour.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with five people who used the service and two relatives and asked them for their views. We also spoke with eight care staff, two care coordinators and the registered manager. We also looked at some of the records held in the service including the care files for four people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people were respected and involved. A person who used the service told us, “I say what I think, I am pretty sure they listen to me.”

We found people did not always receive care and support that met their needs. A person told us, “These people are good, they look after me beautifully.”

We found people were safeguarded from abuse. One person said, “I have never been worried about my safety here.”

We found staff team were supported through training. A person told us “They (staff) try and are very helpful.”

We found the provider assessed and monitored the quality of the service.