The inspection took place on 25 and 26 January 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming. We last inspected the service in December 2016 and at that time identified breaches in three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were related to safeguarding, consent to care and good governance.

We took action by requesting the provider send us an action plan stating how and when they would achieve compliance. During this inspection we found there had been improvements made in line with the provider's action plan. As a consequence of these improvements the service was no longer in breach of the regulations detailed above.

Corbrook Park 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.

Corbrook Park accommodates up to 80 people across two separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of the inspection there were 68 people receiving a service.

There was 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.

We found improvements had been made and where necessary any safeguarding concerns had been identified and reported to the local authority. Policies and procedures were in place to safeguard people from abuse. Staff we spoken with had received safeguarding training and were able to tell us of the different types of abuse that someone could encounter. They told us how they would report any poor practice or abuse to the registered manager.

People felt safe and told us that they received the support that they needed, in a way that respected their wishes. We found sufficient staff to meet people’s needs in a timely way. We were informed that if short staffed, agency staff could be used. The organisation also had a pool team of staff from across a number of locations to provide cover if necessary. The registered manager had recently recruited a number of new staff.

Medicines were managed safely. Staff who administered medicines had completed training and we saw that competency assessments were carried out to ensure staff remained safe to administer medicines.

We saw that mental capacity assessments were being undertaken and these were decision specific. We found that improvements had been made to the process followed when administering medication on a covert basis (when food is hidden in food or drink). In the care files reviewed, we found that the Mental Capacity Act 2005 had been followed correctly.

People were positive about the food available at Corbrook Park and we found that people’s nutritional needs were met effectively.

We found that staff were skilled, knowledgeable and well trained. They received an induction when they began their employment at the service and received on-going training updates. However, whilst some staff had received supervision this had not occurred as frequently as required by the organisation.

We saw that people were well cared for and comfortable at the service. The people and visitors who we spoke with were very complimentary about the care that they received and told us that the staff were kind and caring. We observed that staff were skilled and patient, treating people with dignity and respect. People were able to make choices about the way that they were supported.

People told us they received care that was tailored to meet their individual needs. Care p

This inspection took place on the 20 and 21 December 2016 and was unannounced.

Corbrook Park is a large manor House situated on the outskirts of Audlem. Within Corbrook Park there are two units, Corbrook Court and Cedar Court which provide nursing and dementia care. The home is registered to provide a service for up to a maximum of 80 people. During our inspection there were 69 people living at the home.

The last inspection took place on the 11 August 2015 and we found at that time that all the legal requirements were met.

During this inspection, we identified three breaches of the relevant legislation, in respect of safeguarding, good governance and consent. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in place at the time of the inspection. 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. A Manager had been appointed and was in the process of registration at the time of the inspection. The manager told us that he was focused on making improvements to the home and had identified areas where actions would be taken.

Staff knew the importance of keeping people safe, including being safe from abuse and harassment. We saw that the provider’s safeguarding policy and procedure was available to staff. However we found that whilst the majority of safeguarding concerns had been reported to the local authority we identified some incidents which had not been appropriately reported. This meant that we couldn't be sure that people were fully protected.

Staff had received appropriate training to administer medicines and their competency was checked on a regular basis. However we found that there were some short falls in the recording and management of medicines. For example there were no protocols in place for "when required" medications and stocks of controlled drugs had not always been balanced as per the provider's policy. Not all of these issues had not been identified through the provider's quality assurance systems.

Prior to our inspection the local authority raised some concerns about the home’s use of and recording around covert medicines. The provider had a policy in place which followed the principles of the MCA, but staff had not followed this policy robustly enough. During the inspection we found that the principles of the MCA had not always been followed in ensuring people's rights were protected. Actions were now being taken by the management team to address this.

We found that there were sufficient staff to meet the needs of people within the service. People told us that there had been a high turn over of staff and people found that they were not always familiar with the staff. The management team had focused on the recruitment of new staff and we saw that a significant number of staff had been employed and were undertaking induction training.

We saw that staff received a thorough induction and regular training was provided. All staff had been encouraged to develop their skills through the use of external qualifications.

We found that people’s nutritional needs were being met. People’s views on the quality of the food were mainly positive. Overall people told us that there was plenty of food available and they were able to choose from a menu.

People and their relatives told us that staff were kind and caring in their approach. People were treated with dignity and respect.

The management team were focused upon the development of people’s care plans, they contained sufficient information to enable staff to meet people's needs but we found that these could be improved. People spoken with told us that they were given choices about the way their care

Throughout this report we refer to the location as Corbrook Park. This is because although the home was called Corbrook Court when we originally inspected it has since changed its name to Corbrook Park.

We carried out an unannounced comprehensive inspection of this service on 22 and 30 January 2015 at which a breach of legal requirements was found. This was because sometimes people who lived in the home had to wait too long for a member of staff to respond to their call. We served a warning notice and required the registered provider to comply with the relevant regulation by 1 May 2015.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 11 August 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Corbrook Park’ on our website at www.cqc.org.uk.

Corbrook Park provides accommodation for up to 45 people who require support with their personal care. The home mainly provides support for older people and people living with dementia. There were 28 people living at the home at the time of our inspection.

The home did not have a registered manager at the time of our last inspection. The manager has since registered with the Care Quality Commission. A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

At our focused inspection on 11 August 2015 we found that the provider had followed their plan which they had told us would be completed by the 1 May 2015 and legal requirements had been met.

People who lived in the home told us that the response to call bells had improved and they did not find themselves having to wait as often as before. We saw that the provider had made improvements to the call bell system so that it had become easier for staff to become aware of calls and to respond to them more promptly. Staff we spoke with welcomed the change.

We saw that the registered manager was monitoring performance in answering calls and investigating any instances of delays. We were able to review electronic logs of call times and found these improved on what we had found at the last inspection.

The registered provider monitored the level of need of the people living in the home and related this to the level of staffing. We saw that over the last months since our inspection the level of staffing had remained stable whereas the level of need had decreased. This meant that there was more staff time available for the people who lived in the home.

We undertook a responsive inspection of Corbrook Court Nursing Home on 11 July 2014 because we had received information of concern from a whistle blower regarding the poor care being offered to people and the fluctuating staffing levels.

During the inspection we spoke with the manager, five staff members on duty in the home. We also spoke with eight of the people who lived in the home.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people, the staff supporting them and from looking at records.

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

Is the service safe?

The Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) are legal requirements that need to be followed to ensure decisions made about people who do not have capacity are made in their best interests. They are designed to ensure that people who are unable to give consent for certain aspects of their care and welfare receive the right type of support to make a decision in their best interest. We spoke with two staff and asked about their understanding of the MCA and DoLS and what they would do if a person was not able to give their consent. The staff were unclear about the processes that would need to take place to support the person safely.

We looked at the rotas for the previous six weeks and we saw that staffing levels fluctuated significantly. We looked at the rota for the week that our inspection took place and saw that levels were as low as five care staff on a shift and as high as nine care staff on a shift. We raised concerns with the manager about these changing levels. We also raised concerns that on the day of our inspection there were nine care staff and two nurses on duty in the home and the needs of the people who lived in the home were not being met. We asked if the manager thought that staff were being deployed properly and they told us that they were not. The manager told us that the home had recognised the problems, held a meeting with staff and were making improvements to the staffing levels and the deployment of staff.

Is the service effective?

We looked at five people's care records. We saw that they were very vague and only contained very basic information. We spoke to the manager and they told us that they had identified during their month in post at the home, that the care plans needed updating and required more personal information and information about people's choices.

Is the service caring?

During our inspection we spoke with eight people who lived in the home. Three of these people were happy with the care and support that was being provided. These people were physically able to carry out some care tasks for themselves. We also spoke with some people who had high care needs and they were much more dependent on the staff to help them. These people were all very concerned about the standard of care that they were currently receiving and the amount of time that they were having to wait for assistance. One person told us; "All I do is wait, wait, wait. I'm always waiting for something here." Another person said "I get fed up waiting all the time."

Is the service responsive?

We spoke to one person in their bedroom at 11:25am. They were in bed waiting to get washed and dressed. They told us that they could not get out of bed unsupported. We saw that their call bell was behind the bed out of their reach so they had no means to call for staff to help them. They told us "They have not got to me yet. I've been fed but I can't get up until they get to me." We alerted staff to this person. At 12:05pm we noted that this person was still in bed waiting. We looked at this person's care records and saw that it had been recorded that their preferred time to get up was 9:00am.

We spoke with another person who was sitting in the lounge in their nightwear at 11:30am. They told us "I'm fed up of waiting for someone to help me." At 11:45am we observed a member of staff offering to support them to get washed and dressed. We looked at this person's care records and saw that it had been recorded that their preferred time to get up was 8:00am.

Is the service well led?

We asked the manager about the staffing levels. They told us that the levels had been fluctuating but that they had resolved this by introducing a rolling rota for the care staff. They told us that they had met with the staff and the Chief Operations Officer of Morris Care Limited and heard their concerns about the staffing levels and had very recently increased the staffing. They showed us a memo that had been sent to all staff on 04 July 2014 that informed staff about the increase and was requesting that staff work extra shifts until new staff could be recruited.

We looked at the rotas for the previous six weeks and we saw that staffing levels fluctuated significantly. We looked at the rota for the week that our inspection took place and saw that levels were as low as five care staff on a shift and as high as nine care staff on a shift. We raised concerns with the manager about these changing levels. We also raised concerns that on the day of our inspection there were nine care staff and two nurses on duty in the home and the needs of the people who lived in the home were not being met. We asked if the manager thought that staff were being deployed properly and they told us that they were not. The manager explained that the home had recognised the issues and had held a meeting with staff and were taking action to make improvements.

We spoke to two relatives, four people who used this service and five staff members. We reviewed five care plans. We saw care plans contained information about people's care needs and preferences. Each care plan contained a personal profile called ‘This is me’ which was the most current way of collecting service user’s social history. It included information about the person’s family, what was important to the individual and how best to support them. We saw this was completed on admission.

We saw evidence of staff weighing people on a regular basis and were told they informed the GP of any weight loss. Staff were able to tell us how they increased someone’s calorie intake and monitored their daily intake of food and drink. We also saw malnutrition screening tools were used to calculate the service user’s risk of malnutrition. We saw people who were currently under the care of the dietician and required supplements; we saw these were given as prescribed.

The home had recently been taken over by new management. When asking staff if they felt the manager would deal with issues of abuse they all said they felt she would deal with incidences promptly. They all commented that she was a “very approachable” and was very kind. All staff commented that she had an ‘open door’ policy and they felt they could raise concerns at any time.

We looked at ten medication charts, we saw all medicines were given as per their prescription. When asked, staff were aware of the risks and side effects associated with certain medication, for example, anti-coagulants and anti-depressants.

This inspection took place on 22 and 30 January 2015 and was unannounced.

Corbrook Court Nursing Home is a large manor house which is situated on the outskirts of Audlem. The home provides day care and general nursing care and can accommodate up to 45 people. There were 29 people living in the home at the time of our inspection. The home’s statement of purpose identified that the home was able to provide care for older and younger adults, as well as people with a disability and people who were living with dementia.

One of the conditions of registration for the home was that it must have a registered manager. At the time of our inspection there was no registered manager in place. 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 registered provider told us that they had just started the process of registering the current manager.

At the last inspection on 11 July 2014 we asked the provider to take action to make improvements to arrangements for consent to care and treatment, the care and welfare of people who used the service and staffing levels. The provider sent us an action plan and said that they would comply with the relevant regulations by the end of October 2014.

At this inspection we found that the provider had taken some action around these areas including offering additional training and recruiting additional staff. However we also found that responses to call bells could be lengthy and people told us they had been left waiting to go to the toilet, which had caused them some discomfort. The registered provider had failed to take steps to ensure that the planning and delivery of care met the service user’s individual needs. This was in breach of regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is being followed up and we will report on any action when it is complete.

At this inspection we found that staff working in the service understood their obligations in respect of safeguarding people and that the registered provider took steps to make sure that they were suitable to work in the home. Staff were well trained including in their obligations towards people who might not be able to give consent to their own care.

Staff knew the people who lived in the home and the people who lived there told us that staff were caring and relatives confirmed this. Activities were available in the home for those who wished to participate in them and a series of audits meant that the standard of service in the home was monitored. However we did not always see action resulting from these audits. People were divided in their opinion of the standard of food in the home.