This comprehensive inspection was unannounced and took place over two days, on the 6 and 7 December 2017.

Colonia Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Colonia Court provides care for up to 123 people including nursing care across four, purpose built bungalows each with its own specialism. Paxman house provides nursing care support for up to 35 people. Mumford House accommodates up to 28 people who have a non-nursing need who are living with dementia for long term or respite care. Blomfield house accommodates up to 30 older people who require non-nursing residential care for long term or respite care. Amber Lodge provides specialist-nursing care for up to 21 people diagnosed with Huntington’s Chorea. Within Amber Lodge a designated wing of the bungalow, known as Catchpool provides care and support for up to nine people living with dementia who also require nursing care. At the time of our inspection there were 105 people living at the service.

At our previous inspection in July 2016, the service was rated as Requires Improvement. We found staff were not appropriately monitoring or completing food and fluid charts for people who had been assessed at risk of inadequate food and fluid intake. This meant the provider was not fully meeting the requirements of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found some improvement had been made with systems now in place to ensure the safe management of people's nutrition and hydration needs were met. Risks to people’s health and wellbeing were assessed and regularly reviewed. However, whilst people’s fluid input was recorded we noted that for people diagnosed with Huntingdon’s Chorea their fluid output was not always monitored. This meant that there were ineffective systems in place to identify any deficits or circulatory (fluid) overload.

During this inspection we recommended the provider review the way in which they determine their staffing levels to ensure that people receive effective and meaningful engagement at all times and throughout the service. During our visit people were supported by sufficient numbers of care staff. However, staffing levels were allocated according to occupancy as opposed to being flexible according to assessed need. Due to designated activity staff absences we found insufficient hours allocated to provide people with group and personalised activities. This meant that people in particular those living with dementia, were left unoccupied lacking stimulation for significant periods of time.

We also recommended a review of the current arrangement whereby senior staff on individual units do not have easy access to IT equipment and resources they need to carry out their roles in a safe, timely and effective way.

There was 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.

Staff were trained to identify signs of abuse and supported by the provider's processes to keep people safe. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm.

The service had a robust recruitment process which ensured that staff were recruited safely and an induction programme was in place to support new members of staff when they starting working at the service.

There were safe systems in place for the management of people’s medicines. People were supported to receive their medicines as prescribed. Staff administering medic

Colonia Court Residential and Nursing Home provides accommodation, personal care and nursing care for up to 123 older people, some of whom are living with dementia. The service is divided into four separate bungalows: Amber Lodge, Paxman House, Mumford House and Bloomfield House. At the time of this inspection there were 98 people living at the service.

The service was last inspected on 23 October 2013 and was fully compliant with all the outcomes inspected.

The service had 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.

Staff had received training in safeguarding people from abuse and understood their responsibilities to report concerns to the manager and outside agencies.

Risk assessments provided staff with guidance about how to support people living in the service and effective procedures were in place to monitor the safety of the environment and ensure that people received their medicines safely. However, we found that there were not always sufficient staff on duty to provide safe, person centred care and staff told us that at times they felt rushed and that the care provided was task focused.

The service had a robust recruitment process which ensured that staff were recruited safely and an induction programme was in place to support new members of staff when they joined the service.

Staff were provided with training and support to help them carry out their roles and increase their knowledge about the health conditions of the people they were caring for.

We found that the service was not consistently working within the principles of the Mental Capacity Act (MCA) 2005 and that where restrictions were in place for people the least restrictive option was not always taken. The MCA and Deprivation of Liberty Safeguard (DoLS) ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements.

People had access to a varied and healthy diet. Nutritional assessments had been completed for people and we saw that where appropriate staff supported people with their eating and drinking. However, we had some concerns that staff were not recording the food and fluid intake of potentially vulnerable people.

People had prompt access to healthcare professionals and relatives were pleased that changes in people’s wellbeing were communicated well.

We observed some very caring interactions between people living at the service and staff. Staff were warm in their interactions, communicated well and in general we saw that people were treated with dignity and respect.

There were not always enough activities available to meet people’s needs and activities were not personalised. We found that some people had access to a variety of activities and choices of how to spend their day. However other people, especially those who were nursed in bed or who chose to remain in their rooms did not have such a positive experience.

People and their relatives knew how to raise concerns or make a complaint and were confident that they would be responded to appropriately.

Quality assurance systems were in place to monitor the delivery of the service and we saw that where concerns had been raised the service had taken action to resolve the problem and mitigate the risk of reoccurrence.

Staff described the manager as approachable and supportive and told us that they felt valued by the management team. There was an open and honest culture at the service and it was clear that the registered manager was pivotal in maintaining this and creat

We found that in the majority of cases that people were treated with respect were and involved in the planning of their care. People living at the service and their relatives were complimentary about the staff and the care they received. One relative told us “I would say the staff and the care here are second-to-none. My relative is treated well, and we still feel very much part of their life. They are very good at keeping us informed, and we are welcomed at any time of the day.”

A small number of staff and practices we saw did not reflect the overall standard of care provided. Shortfalls were noticed in staff practices and care management.

Staff were trained to the appropriate level for the role they performed. There were sufficient numbers of staff on duty. The documented rota's seen during our visit supported this. A staff member told us, "It’s a happy home, and we work well together as a team."

People who lived at Colonia Court had a range of needs including those associated with Huntington ’s chorea and dementia. The home is made up of four units and we visited all four units.

We found that people living in the home were happy to interact with us and were comfortable in the company of the staff. People who were able to speak with us were all positive about the care and support they received. One person told us: “On the whole staff are very good, when you ring the bell they come. I go out in the bus, I have a choice of food and if you don’t like it they will always get you an alternative. I have joined the painting class.” Visitors told us that they were involved in their relatives care and support.

We found that substantial improvements had been made to address concerns raised at our last inspection in February 2013.

People had up to date and detailed care and support plans in place that guided staff as to the care and support they needed.

The staff team and management worked well with other healthcare professionals to ensure people’s healthcare needs were met. We found that the people living at the home were cared for by staff who received a good level of training and support from the provider and manager.

We found some parts of the environment and equipment in the home needed attention and we were given assurances from the manager that these were being addressed.