Collingwood Court Care Home provides accommodation and nursing care for up to 80 older people, some of whom had dementia. There were 56 people living in the service at the time of the inspection.

We last inspected the service on 29 February and 2 March 2016, where we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 relating to medicine management, safeguarding people from abuse and unsafe treatment, dignity and respect, and good governance. The service was rated requires improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Collingwood Court Care Home’ on our website at www.cqc.org.uk. The provider sent us an action plan on how they would make the required improvements.

We undertook an unannounced comprehensive inspection on 22 June 2017. At this inspection, we found the provider had made the required improvements from our previous inspection and met the legal requirements. We rated the service Good at this inspection.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 received their medicines in line with their prescription. Medicines were managed and stored securely to ensure they were safe. Controlled drugs received additional security audits to ensure they were not misused. Risk assessments identified issues that could pose risks to people’s health and safety, and management plans were in place to promote people’s health well-being.

People were safeguarded from the risk of abuse and improper treatment. Staff had received training on safeguarding and they were knowledgeable on the procedure to follow if they had any concerns. There were sufficient staff available to meet people’s needs safely. Staff knew the procedure to follow to respond to emergency situations and events. Recruitment practices were safe. Applicants underwent checks before they were allowed to work at the service.

People consented to their care and support. People’s relatives and, where needed, professionals were involved in best interest decisions. The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff had been trained in these areas and understood their responsibilities.

People’s nutritional needs were met. People were supported to eat and drink as required. They were given choices of what to eat and drink and they had access to food and drinks throughout the day.

Staff were trained, knowledgeable and had sufficient experience to provide good quality care to people. They understood the needs of people and how to care for them. Staff received regular support and supervision to carry out their duties effectively. They liaised with various healthcare professionals to meet the needs of people. Healthcare professionals told us staff followed recommendations they gave.

People told us staff were kind and caring. We observed that staff treated people with respect and promoted their dignity. Staff communicated to people in the way they understood. They demonstrated an understanding of people’s likes and dislikes and preferences. Staff also provided care to people in line with their preferences and choices. People at the final stages of their lives were supported in line with their wishes and were cared for in a dignified way.

People were kept occupied and encouraged to participate in activities. There were a variety of activities available at the service to occupy people. People were supported to maintain their religious and cultural beliefs.

People had their individual needs assessed and their care planned in a way t

Collingwood Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom had dementia. There were 79 people living in the service at the time of the inspection.

This inspection took place on 29 February and 2 March 2016 and was unannounced. We last inspected the service on 8 and 9 June 2015 when we identified shortfalls and breaches of the regulations. We found that staff did not receive appropriate support and supervision to enable them carry out their duties effectively and that accidents and incidents were not recorded and reported appropriately. The service received an overall rating of requires improvement.

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.

People were not always protected from abuse or the risk of harm. Accidents and incidents were not always recorded and the system to identify their occurrence was not robust. The service did not always raise safeguarding concerns appropriately.

People were not protected against the risk of unsafe medicine management We found errors in recording medicines administration and in stock control. However, medicines were stored safely.

People were supported by sufficient numbers of care staff and registered nurses to ensure their needs were met. The service carried out comprehensive recruitment checks prior to staff commencing employment.

Care records directing staff to use restraint were not written in line with the provider’s policy because health and social care professionals had not been involved, consent or best interests had not been considered and staff had no training in remaining techniques.

People were supported to make informed decisions. The service worked in accordance with the mental capacity act 2005 to seek authorisation for deprivation of liberty safeguards.

The service was not always caring and some people’s bedrooms were not a place of privacy. Several people living at ground floor level could be viewed by the public outside because the service had taken away their net curtains several months before and not replaced them.

We observed staff providing people with kind and sensitive support. Confidential and personal information was stored appropriately.

People were involved in the development of their personalised care plans which reflected their preferences for care and support. These were regularly reviewed. People were supported to participate in a range of activities.

Staff were unsettled by the high turnover of managers at the service. Conflict existed between staff at the service which was described as ‘bullying’ and which had not been dealt with by the registered manager. The registered manager did not feel supported by the provider to address their concerns about the attitude of some staff.

Quality and safety audits failed to identify errors in medicines, care records, accident reporting and safeguarding.

Two inspectors carried out a planned inspection and gathered evidence against the outcomes we looked at to help answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed people being supported appropriately with mobility aids and equipment.

We saw sufficient staff were provided to deliver people’s care needs and they received the training they needed to provide appropriate care and support however some relatives of people using the service expressed concern about staff numbers telling us, "there are not enough staff to spend time talking to people."

People’s care records detailed information about risks and how these should be managed.

The provider did not have an effective system in place to analyse accidents and incidents in the home. This meant any learning from such matters was not always shared and improvements identified were not always acted upon. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service caring?

We observed people were mostly but not always treated with respect and dignity by the staff. For example, toilet doors were not always closed when people were using the facilities. In their discussions about people using the service, staff did not always refer to individuals in a respectful manner. We also observed people being supported appropriately and sensitively by staff. People told us they felt safe. We saw care workers showed patience and gave encouragement when supporting people. One person using the service told us, "they (the staff) always help me when I need something."

Is the service effective?

People’s health and care needs were assessed with them, but there was limited evidence to show they were always involved in agreeing their care plans. This meant that people may not always have been supported according to their individual choices. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support they needed.

Is the service responsive?

We observed people were supported by kind staff however we saw some people were left unattended for long periods and staff were seen engaged in social discussion with one another rather than with people using the service. We found complaints were not always investigated and responded to in a timely manner.

We found the provider appropriately monitored people's weight and responded to changes in people's nutritional needs with regular input from a dietician. People's general health was regularly monitored and the provider ensured appropriate action was taken (such as calling an emergency doctor or ambulance) if a person had developed an infection or become unwell. However, the provider did not always ensure people had regular access to an optician or dentist. This meant people may have been at risk of developing eye or oral health problems.

We found staff were unclear about actions to take in the event of a fire and nearly half of all staff had either never or not recently undertaken fire safety training. This meant people may have been at risk of harm if a fire had occurred as some staff were unsure of the fire safety procedure.

Is the service well led?

We found that monitoring and reviews of the service were carried out however highlighted actions were not always completed in a timely manner. This meant the quality of the service could be not be assured by people living at Collingwood Court, their relatives and staff.

We found the service had recently had several changes in management. This meant we had concerns that systems and processes in place could not always be effectively monitored on a sustained level.

Staff told us they felt supported by the deputy manager. Comments included, “She (the deputy manager) always listens to concerns.”

At our previous inspection on 26 July 2013 we found that it was unclear from the records whether a person had been assessed as having the capacity to consent to decisions about their care and therefore it was unclear as to whether they had been appropriately involved in their care choices. During this inspection on 10 December 2013 we found that a person’s capacity to consent to decisions about their care had been reviewed and it was clear from their records as to which decisions they had been involved in. If a person lacked the capacity to consent to decisions about their care we saw that the provider acted in accordance with legal requirements.

One relative told us they felt their husband was safe and secure at the service, and well looked after.

We observed that people were given a choice about aspects of their care and staff acted in accordance with their wishes. However, it was not clearly recorded as to whether people had the capacity to consent.

People’s care and support needs were clearly identified. The care records we reviewed contained a range of assessments and care plans outlining how to support people using the service. The care plans contained assessments of a range of risk factors and how to manage them.

The staff worked with other providers, for example physiotherapists and occupational therapists, to ensure that people’s health needs were met.

Medication was safely stored and administered. All medication administered was recorded on a medication administration record.

The complaints process was accessible to people using the service. We saw a record of complaints made and found that they were responded to and action was taken to improve service provision.

Residents told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They told us that the quality and choice of food and drink available was good.

Comments from residents were generally positive, and indicated that staff were kind and helpful. People were observed to be treated with respect by staff and to have their privacy and dignity respected.

A resident spoke of the confidence in the service and said, “I am able to see my doctor as often as I need, my health has improved, there is always someone close by to answer my calls quickly ".

Another resident said, “Staff are jovial and brighten our day, nothing is too much trouble for them".

We observed that staff were warm and caring, and adopted a professional approach to their work.

Stakeholders spoke of the stability experienced by people that were placed at the home. They felt that individuals had flourished as a result of the support and encouragement from skilled and experienced staff.

People who use the service told us that they liked the the staff, and found that they treated them well and that they were respectful of their needs.

A person spoken to said that he feels the care and support he received was appropriate for his needs.

Another person that has lived at Collingwood Court for some time said, "Staff are good here, they cannot do enough for us, when I need help they answer the call bell promptly".

Our observations overall were that the home provides a range of activities that are appropriate for those that are able to engage and that are not limited by cognitive impairments. We saw that people less able to engage and express themselves were at a disadvantage as appropriate stimulation was not available. Some staff were not actively engaging with or explaining to people as they carried out tasks.

Collingwood Court Nursing Home provides accommodation and nursing care for up to 80 older people, some of whom had dementia. There were 77 people using the service at the time of this inspection.

This unannounced inspection took place on 8 and 9 June 2015. The last inspection of Collingwood Court took place on 24 July 2014. We found the service was not meeting the regulations relating to the care and welfare of people, respecting and involving people, assessing and monitoring the quality of service, and complaints. We asked the provider to take action to make improvements. They sent us an improvement plan. At this inspection, we found that the provider had made some improvements.

The service did not have a registered manager. The position was currently vacant. 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.

Staff were not properly supported and supervised to ensure they were effective in their roles. Staff morale was low and staff told us that they did not have leadership and management support.

Record of incidents and significant events were not always maintained. Feedback we received from professionals raised concerns in the way referral forms for DoLS we completed. They did not always include relevant information which raised concerns about the level of staff knowledge on Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The service obtained feedback from people about the quality of service provided. However, an action plan was not in place to address areas for improvement identified. Complaints were managed and responded to appropriately.

Systems in place to monitor and assess the quality of service did not always identify areas were improvements were required.

People received care and support in a safe way. The service identified risks to people and had appropriate management plans in place to ensure people were as safe as possible. Medicines were kept securely and people received their medicines as prescribed. Staffing levels were sufficient to safely meet the needs of people at the service

Staff were knowledgeable in recognising the signs of abuse and knew how to report it by following the provider’s safeguarding procedures. Allegations of abuse were appropriately investigated and followed up on.

Staff had been trained in the Mental Capacity Act 2005 (MCA). People’s capacity to make decisions had been assessed and best interests decisions were in place where required. People were not unlawfully deprived of their liberty.

People had their individual needs assessed and their care planned to meet them. People received care that reflected their preferences and choices. Care plan reviews were held to ensure that the care and support people received reflected their current needs.

We observed that people were treated with dignity and respect by the staff. People told us they enjoyed the food provided and their nutrition and hydration needs were met.

Training programmes had been developed to ensure staff had the skills and knowledge to provide care to the people they looked after.

There were planned activities that took place to keep people occupied. People were encouraged to do as much as possible for themselves.

At this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

We have made a recommendation about support and training for staff in relation to reporting, and recording.