We carried out an inspection of Cordelia Court on 8 March 2017. The inspection was unannounced.

Cordelia Court provides personal care and accommodation for up to 23 older people including those living with dementia. Accommodation is provided over two separate floors. There were 23 people living at Cordelia Court when we inspected the home.

A requirement of the service’s registration is that they have 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.’ A registered manager was in post.

At our previous inspection on 5 and 7January 2016, we identified improvements were needed in regards to ‘Safe’ and ‘Well Led’. Staffing arrangements were not always effective and records were not always accurate. This included records to monitor risks, care and the services provided to ensure they met the provider’s standards.

During this inspection we found sufficient action had been taken to address the concerns around staffing arrangements but there continued to be improvement needed to records related to monitoring risks, care and services.

Staff were available to people when they needed them and people told us if they had to wait for support this was not for very long and they understood staff were supporting others.

There had been ongoing work to implement person centred activities in accordance with people’s needs. The registered manager explained how people appeared much calmer and more stimulated as a result of the varied activities programme provided. There was a new activity organiser in post to support the activities programme in the home.

Risks associated with people’s care were identified on an ongoing basis and were detailed in risk assessments within people’s care plans. Staff had a good understanding of people’s needs, the importance of maintaining their independence and how to keep them safe. Staff were attentive and responsive when people showed signs of anxiety. This helped to prevent their behaviours from escalating.

People received their medicines at the times they expected and medicines were stored safely.

Staff had completed training essential to help them carry out their roles safely and effectively. Staff had also completed training linked to people’s care needs such as dementia and Parkinson’s Disease. This training helped staff to deliver more person centred care to people. The registered manager regularly checked staff had learned from their training through competency checks, supervision meetings and observations of their work.

The registered manager understood their responsibilities in relation to the Mental Capacity Act (2005) but had not consistently followed the Deprivation of Liberty Safeguarding (DoLS) referral process. Where people lacked capacity to make decisions, action had been taken to identify if a DoLS referral was required to authorise any restrictions related to their care. However, some of the authorisations had expired and had not been re-applied for. Staff understood their responsibility to seek people’s consent before they delivered care.

People told us they were satisfied with the food provided and they had enough to eat and drink. Menus were made available to people so they were aware of the choices available to them. Adapted plates were used to help people eat independently. Where people were at risk of poor nutritional health, they had been referred to a health professional. Staff followed advice given by health professionals and closely monitored people at risk to ensure they had sufficient food and drinks to maintain their health.

People were complimentary of the staff and the care provided at the home. People looked well presented wi

We carried out an inspection of Cordelia Court on 5 and 7 January 2016. The inspection was unannounced.

Cordelia Court provides personal care and accommodation for up to 23 older people including those living with dementia. Accommodation is provided over two separate floors. There were 21 people living at Cordelia Court when we inspected the home.

A requirement of the service’s registration is that they have 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.’ A registered manager was in post.

At our previous inspection on 22 and 27 July 2015, the provider was not meeting the required standards. We identified five breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two of these were breaches repeated from previous inspections. We issued a warning notice in relation to, “Good governance” and we met with the provider and asked them to take the necessary steps to ensure the required improvements were made. We asked the provider to improve staffing arrangements, the care provided to people, the arrangements for safeguarding people from risks and abuse and to ensure people’s privacy and dignity was maintained. The provider was also required to develop systems and processes to check and improve the quality and safety of the care and service people received. The provider sent us an action plan which stated all of the required improvements would be undertaken by the 30 November 2015.

During this inspection we checked improvements had been made. We found sufficient action had been taken in response to the breaches in regulations and the warning notice issued. However, there were some areas where further improvements were required. The provider had plans in place for on-going improvements to be made.

Overall, staff were available at the times people needed them. Since the last inspection staffing arrangements had been reviewed and additional staff were available to support people during busy periods. However, a further review of this was needed to ensure that there were enough staff to support people in the lounge at the required times.

Risks associated with people’s behaviours had reduced. People were calmer and staff were more attentive and responsive when people showed signs of anxiety. This helped to prevent their behaviours from escalating. Risks associated with people’s care were mostly detailed in risk assessments within people’s care plans. However sometimes written guidance for staff about how to manage these risks was not clear. Despite this, staff had a good understanding of people’s needs and how to keep people safe. People received their medicines as prescribed and medicines were stored safely.

Staff had completed further training to help them carry out their roles more safely and effectively. This included training linked to the care needs of people in the home such as dementia and managing behaviours that were challenging to them and others. This training had supported staff to deliver more person centred care to people. The registered manager regularly checked staff had learned from their training through competency checks, supervision meetings and observations of their work.

The registered manager understood their responsibilities in relation to the Mental Capacity Act (2005). Where people lacked capacity to make decisions, the correct action had been taken for restrictions in people’s care to be authorised. Staff understood their responsibility to seek people’s consent before they delivered care.

People told us they were satisfied with the food provided and they had enough to eat and drink.

We inspected Cordelia Court on 17 December 2014 as an unannounced inspection. Cordelia Court is divided into two separate floors and provides personal care and accommodation for up to 23 older people, including people living with dementia. There were 19 people living there when we inspected the service.

A requirement of the service’s registration is that they have 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 and associated Regulations about how the service is run. There was not a registered manager in post at the time of our inspection. This was because the previous registered manager had left the service in November 2014. The provider had immediately recruited a new manager, who was working at the service when we inspected in December 2014. The new manager is in the process of becoming the registered manager for the service. We refer to the new manager as the manager in the body of this report.

At our previous inspection in September 2014 we found there were two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008, we issued compliance actions to the provider for Regulations 10 and 20. We asked the provider to send us an action plan to demonstrate how they would meet the legal requirements of the regulations. The provider returned the action plan in the allocated timeframe telling us about the improvements they intended to make. On this inspection we checked to see whether the improvements had been made. We found that quality assurance procedures had improved, and there were no breaches in the legal requirements of regulation 10. We found that record keeping under regulation 20 had improved since our previous inspection, but further improvements were still needed.

There was not always enough staff to meet people’s preferences and needs. The manager was implementing a staffing tool to determine the numbers of staff needed at the home.

Infection control procedures required improvement at the home to ensure people were protected against the risk of infection. The manager was implementing new cleaning schedules and infection control procedures at the time of our inspection.

We saw that some improvements were required to the maintenance of the premises. An improvement plan had been drawn up to implement changes at the home.

Medicine administration procedures were in place to ensure medicines were managed safely and were administered only when required.

Staff did not always have the skills they needed to support people, as staff had not received up to date training to meet people’s needs. A new training provider had been contracted to bring staff training up to date.

We spent time in communal areas and saw interactions between people and staff. In most of the interactions we observed staff were respectful and kind towards people living at Cordelia Court. However, a member of staff did not always act appropriately with people. We brought this to the attention of the manager during our inspection.

We found that people’s privacy and dignity was not always respected. People were not always offered choices that met their preference.

People’s care records were not always up to date. This meant staff did not always have the information they needed about people’s care needs. The provider had introduced new care records, which included risk assessments and mental capacity assessments. All people at the home were having their care records transferred to the new care records by the end of March 2015.

We saw a range of meetings took place to gather views from people, their relatives and staff. Information gathered from people helped the manager and the provider to analyse the quality of the service, to drive forward improvements. The provider was analysing the feedback they received, and was acting appropriately to respond if there were concerns.

The manager had sent notifications to us about important events and incidents that occurred at the home. They were aware of their responsibilities in notifying regulatory bodies and authorities about important events at the home.

The manager completed audits to ensure the quality of the service developed. Improvements to the service were made where issues were identified.

You can see what action we told the provider to take at the back of the report.

We carried out this inspection to assess whether or not improvements had been made following our last inspection visit to the service in April 2014. At that inspection we found improvements were required to the quality monitoring and assessing of the service and records.

We made compliance actions in relation to these areas and received a report from the registered manager that told us what they intended to do to achieve compliance.

We followed up on these areas of non compliance by undertaking an inspection on 9 September 2014. During this inspection we spoke with some people who lived in the home, visiting relatives, members of care staff on duty the registered manager and the provider. We also looked at two sets of care records for people and other records as appropriate. We found that the areas of non compliance identified at the previous inspection had been partially addressed but the service remained non compliant in both areas.

People and relatives we spoke with told us they were happy with the care and support they or their family member received. We were told, "We prefer this home for my mother here, this is a small home so staff can work closely with individuals.”

We saw care records for people had been reviewed following our visit in April 2014. There was no evidence to demonstrate that these had been regularly evaluated following the reviews. We found information was out of date and not applicable to people's needs.

Staff we spoke with were knowledgeable about people's care needs and we saw good examples of care and staff interactions with people during our visit.

Work had not been undertaken to review the quality surveys that were completed prior to our last visit. Resident and relatives meetings had not been held, therefore the service was not able to demonstrate people's views were taken into consideration to improve the service provided.

Records were not always up to date or readily available. People's personal confidential information was stored securely.

When we visited Cordelia Court in January 2014, we found improvements were needed in four areas. These were ‘care and welfare of people who use services’ ‘cleanliness and infection control’ ‘safety and suitability of premises’ and ‘records’. During this inspection we found sufficient improvements had been made in three of these areas. Records continued to need further improvement as well as a new area ‘assessing and monitoring the quality of service provision’.

Many of the people who lived at Cordelia Court were not able to share opinions about their care and support. We therefore observed these people in the two lounges at the home to find out what their experiences of the service were like. We spoke with two people and two relatives of people who used the service about the home. We also spoke with the manager and care staff. The evidence we collected helped us to answer five key questions, these being: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations, our discussions with people, staff and relatives and the records we looked at.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People we spoke with told us they felt safe living at Cordelia Court. We saw staff had a caring approach towards people.

Staff knew people’s likes and dislikes and what they needed to do to maintain people’s needs and keep them safe. We saw some of the care plans and risk assessments were not up-to-date. This meant people could be placed at risk of not receiving safe and appropriate care.

A senior member staff told us she had recently completed external training on the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS). They had a good understanding of principles linked to depriving someone of their liberty to be able to apply them at the home. The manager told us all staff had completed some basic training on the MCA and there were plans for this training to be further enhanced. This meant staff would have a better understanding of how to support people who lacked capacity when decisions about their care and treatment needed to be made. At the time of our visit, no applications for DoLS had been made.

We saw systems in place to ensure the cleanliness of the home was maintained. On the day of our visit there were no unpleasant odours and the home was clean.

We saw health and safety checks had been carried out within the required timescales to ensure equipment and the premises were safe for people.

Is the service effective?

People and visitors we spoke with told us, “It is very good.” “There have been positive changes.” “The thing I like most is I can come any time I like without telling them. That to me is a big bonus.”

We saw healthcare professionals were involved in people’s care to support staff in meeting people’s needs.

Action had been taken to develop consent forms to help staff provide support in accordance with people’s wishes. They were not all completed at the time of our visit.

Staff we spoke with told us they were implementing new records into the care plans. This was so information was more detailed and could demonstrate more clearly how people’s needs were being met. We saw the new records had not been fully completed at the time of our visit.

Is the service caring?

We saw people were supported by caring staff. People and relatives we spoke with told us, “The carers here are the best.” "Staff are busy, it’s nice they are in the lounge with the residents.”

We saw care staff were patient with people and did not rush them when assisting them with care. We saw staff inform people of tasks they were about to carry out to make sure they agreed to the task. For example, when staff were supporting people to eat they checked the person was ready for the next mouthful before bringing the spoon or fork to their mouth.

Visitors we spoke with told us they worked closely with staff to ensure their relative's received the care they needed.

Is the service responsive?

We saw staff asked health professionals to visit people when they had concerns about their health.

We saw charts were in place to monitor people’s health although we could not be confident information on charts was always acted upon. For example, one person’s nutrition charts showed on some days they had minimal food and fluids. We could not see action had been taken to respond to the risks associated with this.

Is the service well led?

We found the service had been effective in carrying out most of the required improvements following our last inspection. We found there continued to be improvements needed with record keeping. This was because some of the records were not up-to-date, accurate or had not been fully completed.

People and relative’s experiences of care at Cordelia Court were positive. They told us, “Everything is alright.” “I am quite happy with X here.” “Overall I do not have any complaints.”

We saw new audit processes had been implemented at the home to identify where the quality of care and services may need to be improved. We found sometimes audit processes were not fully effective in identifying the required actions and in managing risks.

We saw there were plans for the ongoing improvement of the premises. This included replacing some of the old furniture, improving the garden and redecorating bedrooms.

Action had been taken to seek people's views of the home through a quality survey and resident/relative meeting. The resulting information had not been fully collated at the time of our visit to determine any actions needed.

We visited Cordelia Court on 2 January 2014 to follow up on non-compliance with regulations relating to care, the environment and records that we found in June 2013. On the day of our visit there were 23 people living in the home. We were unable to speak with most of these people in any detail about their care due to them having varying levels of confusion and dementia.

We saw the home had been decorated with Christmas decorations. People were watching the television during the morning and listened to music for the rest of the day. Two people we spoke with told us they liked living at Cordelia Court. They were positive about the staff.

We looked at care plan files for three people and observed how people were being cared for. We found there continued to be some people whose care needs were not being met effectively.

We walked around the premises to check they were safe and suitable for the people living there. We saw some improvements had been made to the environment since our last visit but more were needed.

We found many areas of the home were in need of cleaning. This included people’s bedrooms and walking aids.

We found records had not been sufficiently updated and reviewed.

As a result of ongoing non compliance being identified, contact was made with the provider with a view to imminent actions being taken to address our findings.

At the time of our inspection all the people living at Cordelia Court had a diagnosis of dementia. Two people we spoke with told us: “It’s very good.” “It’s very nice, what could be better than this bit here (referring to sitting out in the patio area of the garden.” A visitor told us “I have been very pleased, there have been so many good improvements here.” “X is happy here.”

On the day of our visit some people were seated in the lounge and others in the garden. Staff were on hand to supervise people to make sure they did not come to harm. Staff we spoke with had a good knowledge of the people they were supporting. We observed staff to be friendly and approachable.

We found there were improvements needed in relation to the provision of care and care records. This applied in particular to those people who had problems with their skin such as sore areas or ulcers. Records were not sufficient to demonstrate changes in risks and to show how people’s care was being managed.

We looked at how medicines were managed and found people had received their medicines as prescribed. The one exception to this had been followed up by the manager.

We walked around the premises to check they were safe and suitable for the people living there. We found environmental changes were needed to help support people with dementia. We also found attention was needed to the décor of the home and maintenance of the garden. We found several areas in need of cleaning.

We carried out this visit to follow up on improvements required in relation to: involving people in their care, staff training/support and management of records. During this visit we found that sufficient improvements had been made for the service to be compliant.

We saw that the care files of people living in the home had been reviewed. These contained information about how people’s needs were to be met. Families had been approached to obtain background histories of people as well as information of their hobbies and interests. This information had been incorporated into care plans to support the service in delivering more person centred care.

There were risk assessments in place where risks to people’s care had been identified. These included risks of people developing pressure sores to the skin and falling.

People were positive about the service. One person told us: “I have no complaints about this place at all. It is run very well. I like it here I have met some wonderful people here.”

Staff told us they had been attending more training. Training records confirmed that almost all staff had completed the statutory training required. This included manual handling, safeguarding people and infection control. Staff had also attended dementia care training and half had attained a National Vocational Qualification (NVQ) in care. Staff supervision schedules confirmed this was taking place regularly to identify any staff training and development needs.

We spoke with five people living at the home and two visitors. Due to the dementia diagnosis of many people living in the home it was difficult to establish their views on care, treatments and support options available to them. Those people that we did speak with were complimentary of the care they were receiving they told us: “It’s ok, I would like to be at home with my own family but I have not been well so I don’t think I can.” “It’s quite nice, the rooms are nice. I know some people grumble.”

We observed that staff were friendly and supportive towards people. People we spoke with were positive about the care staff. They told us: “Quite nice and pleasant.” “They are lovely people they seem most obliging I like it, I enjoy it.”

People told us they liked the meals and were given a choice. We saw that people had access to some social activities. People told us: “I go places and do things and then forget what I have done.” “I usually sort things out for them to sing. I talk to people to see what they like.”

We did not see that people’s choices and preferences had been fully assessed and considered so that people were spending their day in a way they would choose.

We saw that some areas of the home had been redecorated since our last visit. This included the corridor areas. We observed that there was a lack of signs around the home to assist those people with dementia in locating the toilets and their rooms independently.

The people living at Cordelia Court, and relatives who were regular visitors, were very positive in their comments about the home, the staff and the manager. ‘The staff are very good’, ‘It’s a lovely home’ were typical comments. Several people commented on the difference having a new manager, after a period of uncertainty: ‘Jackie’s very approachable’, ‘things have improved.’

Several commented on improvements in the well-being of people since they moved to Cordelia Court, with better diet and medication management, and improved mobility being singled out for praise.

The only negative comments from relatives focused on the perceived lack of things to do at times. One relative commented that they felt people didn’t get out as much as they ought to. Staff we spoke with expressed frustration that, without additional staff, they were too busy doing basic care tasks to have time to spend or organise additional activities to stimulate and engage residents. There were also comments concerning the fact that most of the residents now had dementia, and the fact that the décor, environment and resources did not yet fully reflect this.

We carried out an inspection of Cordelia Court on 22 and 27 July 2015. The first visit was unannounced and the second visit on 27 July 2015 was announced.

Cordelia Court provides personal care and accommodation for up to 23 older people including those living with dementia. Accommodation is provided over two separate floors. There were 21 people living at Cordelia Court when we inspected the service.

A requirement of the service’s registration is that they have 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 and associated Regulations about how the service is run. There was no registered manager in post at the time of our inspection. This was because the previous registered manager had left the service in November 2014. The provider had recruited a new manager, who was in the process of applying for their registration.

At our previous inspection in December 2014, we found three breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. Two of these breaches were carried forward from our September 2014 inspection due to insufficient improvements being made.

Following our inspection in December 2014, we met with the provider and asked them to take the necessary steps to ensure the required improvements were made. These improvements were to ensure there were accurate records kept about people so they were not placed at risk of unsafe or inappropriate care. To make sure there were sufficient numbers of suitably qualified, skilled and experienced persons employed at the home, and ensure people’s privacy, dignity and independence were maintained. The provider sent us an action plan outlining how these improvements would be made.

During this inspection we found there had been some progress in addressing the actions required following the last inspection but sufficient improvements had not been made. The manager told us that when she started working at the service there had been improvements needed in a number of areas and she had taken steps to implement a number of these. However, we found that these improvements had not ensured people were consistently safe and their care needs met. The manager had identified she needed additional support to enable the on-going improvements to be made and maintained. The provider had responded to this need by identifying a member of staff to  provide administration support to the manager for 16 hours per week.  The staff member appointed confirmed they had recently taken on this role and were providing this support.  

Risks associated with people’s care were not always being identified and managed to keep people safe. This included the management of risks associated with people’s behaviours that were sometimes challenging.

People told us they received their medicine when needed but there were some improvements required regarding medicines management. Night staff were still to be assessed as competent to enable them to administer medicines at night. This meant people who may need medicines during the night such as for pain relief may not receive them in a safe or timely manner.

There were not always enough suitably trained staff to keep people safe and meet people’s preferences and needs. An increase in the number of people needing close monitoring and support from staff had not resulted in a review of the staff skills and numbers to ensure their needs could be met.

Staff training had been improved in that most staff had completed basic training essential to support them in their role. However, staff had not completed all of the training linked to people’s care needs so they had the skills needed to support people effectively. Their competencies following their training had not been assessed to ensure they carried out their roles safely and effectively. We identified staff had not completed training in ‘challenging behaviours’ to support them in managing people with behaviours that were challenging. This is despite a number of people living at the service with this specific care need.

We spent time observing care interactions in communal areas over the course of the day. Staff were friendly in their approach towards people but most interactions were linked to delivering care and support. We found that people’s privacy and dignity was not being maintained despite this being an issue that we had identified previously as needing improvement. There were some social activities provided but these were limited and were not always in accordance with people’s interests and preferences.

There had been some improvements carried out in regard to the maintenance and refurbishment of the premises. However these were on-going and there remained areas where improvements were needed.

People’s care records had improved following our last inspection but some had not been updated regularly and lacked the detail required to support staff in delivering care.

The manager had set up regular ‘resident’ meetings and had implemented a satisfaction survey for people and their relatives to gather their views of the service. The manager used meetings to discuss any areas of concern and provided feedback on changes being implemented in the home. However, it was not always clear that issues people had raised had been addressed.

We found when we looked at the records of accidents and incidents that had occurred at the service there had been some that had not been reported to us as required. This meant we had not been able to check appropriate actions had been taken to keep people safe when they had occurred.

The manager completed a number of audits to monitor the service but recognised these needed to be further developed to make sure people received the quality of care and services required to meet their needs.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.