This inspection took place on 19 and 20 June 2018 and was unannounced.

At the last inspection of the service in February 2017 we found that improvements were needed.

We found people were at risk of receiving unsafe and ineffective care and treatment because care records relating to the management of risk were incomplete and not reflective of people’s needs.

We also found that systems in place to monitor and improve the service people received were not always effective in addressing shortfalls or sustaining improvements.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions safe, effective and well led to at least good. At this inspection we found improvements had been made in all areas identified as requiring improvement.

Cooksons 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.

Accommodation for people was provided in three separate units. Bramley provides care and accommodation to people who have basic nursing care needs. Russet accommodates people who have more complex nursing needs. Pippin is a specialist unit, run in partnership with the local NHS trust, to provide people with re-enablement support to facilitate hospital discharge and enable people to regain independence to return home.

Cooksons Court accommodates up to 65 in a purpose built home. At the time of the inspection there were 57 people living at the home. This included 18 people staying for re-enablement following discharge from hospital before returning to their own homes.

There is 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.

The management team and the provider had worked hard to ensure shortfalls in the service were identified and addressed through their quality monitoring systems. Action plans were put in place which were monitored to make sure changes made led to sustained improvements in the care people received.

People we spoke with praised the standard of care they received and said they would recommend the home. One person said, “Very nice. Couldn’t wish for better. Excellent in fact.” Another person commented, “I feel very lucky to be here and I’m very fussy.”

People felt safe at the home and comfortable with the staff who supported them. One person said they felt, “Safe and content.” Staff we spoke with were confident that any concerns raised would be dealt with promptly to make sure people were protected from the risks of abuse.

People were supported by staff who were kind and friendly. Staff received appropriate training to make sure they were able to care for people with varying needs and abilities. There were sufficient numbers of staff to effectively support people and ensure their safety.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff worked in accordance with up to date guidance to make sure people’s legal rights were protected.

Assessments of people’s care needs took account of their individual beliefs, culture and lifestyle choices. People were able to make decisions about their day to day care and their views were sought regarding the running of the home.

People’s healthcare needs were monitored by trained nurses and they had access to more specialist healthcare support to meet their specific needs. The staff worked in partnership with other professionals to p

This inspection was carried out on 7 and 8 February 2017 and was unannounced. It was carried out by one adult social care inspector on the first day and two adult social care inspectors on the second day of the inspection.

This was the first inspection of the service since it was registered with the Care Quality Commission in September 2015.

Cooksons Court is a purpose built home which can accommodate a maximum of 65 people. Accommodation is arranged over three floors and divided into three units. Bramley unit is situated on the ground floor and provides nursing care for up to 23 people with basic nursing needs. Russet unit is situated on the first floor and provides nursing care to up to 24 people who have more complex needs. The Pippen unit on the second floor has 18 beds and provides a reablement service for people who are moving from hospital back to their own homes. Bedrooms are for single occupancy and all have the provision of en-suite toilet and shower facilities. There are pleasant accessible gardens and parking.

At the time of this inspection there was no 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.

In the absence of a registered manager the service was being managed by one of the provider’s experienced peripatetic nurse managers. They had over 20 years experience as a registered nurse, and prior to joining the peripatetic team at Cooksons Court had been the Registered Manager of one of the provider’s other nursing homes for over 10 years. This person had a handover from the previous registered manager and took over immediately they left.. They were supported by a deputy manager and clinical manager. One of the provider’s operations managers regularly visited and monitored the quality of the service provided. A new manager had been appointed and is due to start at the home. They will make an application to the Care Quality Commission to be registered manager.

People who had been assessed as being at high risk of malnutrition and of developing pressure sores and those who were being treated for a pressure sore were not fully protected from receiving unsafe or inappropriate care. This was because care records did not demonstrate people received the care and treatment as detailed in their plan of care.

There were systems in place to monitor and improve the quality of the service provided. However these were not always effective in identifying and improving shortfalls.

People felt safe at the home and praised the staff who supported them. One person said “I am very content with everything. The staff and the other residents all seem very nice.” Another person told us “Couldn’t feel safer.”

People were satisfied with the choice and quality of food provided and people received meals in accordance with their needs and preferences. However the mealtime experience and arrangements for serving soft diets for people who lived on the Russet unit needed some improvements.

People had access to appropriate healthcare professionals to make sure they received effective treatment when required. One person who lived at the home told us “The staff notice if you are a little off colour and they will always call the doctor if needed.” People received their medicines when they needed them and medicines were stored securely. A person who lived at the home said “They [the staff] make sure I get my tablets when I need them. They regularly ask me if I need any painkillers. They want to make sure you are comfortable.”

People were supported to be as independent as they could be. One person on the reablement unit (Pippin) said “They [the staff] have helped me get my life back. I can do things that I never thought I’d