This inspection took place on 3 and 4 April 2018 and was unannounced. A second day of inspection took place on 4 April 2018 and was announced. Shortly after our visit the provider of the service had a name change from Embrace (Geffen) Limited to Sanctuary Care (Geffen) Limited. however they remain the same organisation. The service also changed its name from Dalby Court to Dalby Court Residential Care Home.

Dalby Court Residential Care Home 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.

The service provides personal care for older people, older people living with dementia and people with learning disabilities. The home is a detached 68 bed purpose built care home in Coulby Newham. Accommodation is provided over two floors. The ground floor of the home accommodates people living with a dementia and people with a learning disability. At time of our inspection there were 45 people using the service.

At our last inspection in December 2015 the service was rated ‘Good’ overall. At this inspection we found the service was now rated 'Requires Improvement' overall. This is the first time the service has been rated as 'Requires Improvement'.

At this inspection we found a breach of Regulation 18 (1) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Staffing. This was because we found that staffing levels were not always sufficient to meet people’s needs.

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

The service has 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.

Policies and procedures such as safeguarding and whistleblowing were in place to protect people from harm. Staff knew how to identify and report suspected abuse. People and their relatives felt the service was safe. Safe recruitment practices were in place. Pre-employment checks were made to reduce the likelihood of employing staff who were unsuitable to work with vulnerable people.

Records showed that maintenance and equipment checks were undertaken to ensure the environment was safe. Emergency contingency plans were in place. Robust infection control practices were in place.

Care plans and risk assessments were in place, these were comprehensive and had been reviewed regularly.

Staff received training that the provider considered mandatory in most key areas. However it was evident that some staff would benefit from further knowledge in the area of learning disabilities. We have made a recommendation that staff training is reviewed to ensure staff are able to apply their learning in their day to day practice. We have made a recommendation that staff training is reviewed to ensure staff are able to apply their learning in their day to day practice.

Staff had regular supervision and annual appraisals. Staff felt they were well supported by the manager.

Medicines were managed safely. People had access to a range of healthcare such as GPs, hospital departments and dentists. People’s nutritional needs were met and people enjoyed a varied, nutritional diet that met their preferences.

The registered manager told us that lessons were learnt when they reviewed accidents and incidents to identify any themes or trends.

The premises were spacious, clean and tidy however they required some redecoration and the Sunflower Unit for people with learning disabilities was not self-contained.

People were supported to have maximum choice and control of their lives and staff supported them in the leas

We inspected Dalby Court on 30 December 2015 and 14 January 2016. The first day of the inspection was unannounced which meant the staff and registered provider did not know we would be visiting. The second day of the inspection was announced.

Dalby Court provides purpose built accommodation for up to 68 older people and / or older people living with a dementia. The service also accommodates (recently) people who have a learning disability. Accommodation is provided over two floors. The ground floor of the home accommodates people living with a dementia and people with a learning disability. The unit on the first floor of the home accommodates people requiring residential care. There are communal lounges and a dining areas on both floors. Bedrooms have en-suite toilet and hand wash basin facilities. There is an enclosed garden.

The home had a 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 manager was not present for the first day of the inspection; however they were present on the second day of the inspection.

We received mixed comments to determine if there were sufficient staff on duty to meet people’s needs. At times during the inspection and particularly at meal time on the ground floor unit there were insufficient staff to support those people who needed help and interact with others. Call bells were not always answered in a timely way. The registered manager said they would carry out an immediate review on staffing levels.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff had been trained and had the skills and knowledge to provide support to the people they cared for. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. However, care records needed improvement to ensure that best interest decisions were clearly recorded.

We saw evidence to inform that people had been involved in developing their plan of care; however some care plans required review and update to ensure peoples changing needs were recorded.

People were involved in activities and outings. However at the time of the inspection these had been limited as the service was in the process of recruiting an activity co-ordinator.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments covered areas such as moving and handling, falls and the use of bed rails. This enabled staff to have the guidance they needed to

The inspection team was made up of two inspectors. We set out to answer our five 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, speaking with people using the service, and 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?

Care plans and risk assessments were in place and were updated as people’s needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt safe.

We found that nutritional screening had been carried out for people who used the service. This meant that people received timely and appropriate intervention if they lost weight. People were supported to have adequate nutrition and hydration.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents, concerns, complaints, whistleblowing and investigations. This helped to reduce the risk of harm and ensured that lessons were learnt from mistakes.

We saw that regular checks were carried out on equipment used at the home to make sure that it was safe for use.

Is the service effective?

People’s health and care needs were assessed and where possible people and their relatives were involved in writing their plan of care. Specialist dietary and mobility needs had been identified in care plans. Care and support plans were reviewed and updated on a regular basis.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people.

People who used the service, their relatives and friends completed satisfaction surveys. Where shortfalls or concerns were raised (however small) these were taken on board and dealt with.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. We looked at the record of complaints and saw that investigations had been completed in line with the complaints policy. Discussion with the manager and deputy manager during the inspection confirmed that any concerns or complaints were taken seriously.

People took part in a range of activities both in and out of the home. This helped to keep people involved in their local community.

Is the service well led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us that they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and all senior staff understood and shared the responsibility of quality assurance processes. This helped to ensure that people received a good quality service at all times.

What people told us.

During the inspection we spoke with eight people who used the service and two relatives. We also spoke with the manager, deputy manager, cook and to care staff. People who used the service told us that they were happy with the care and service received. One person said, “I am very contented. I was at hospital yesterday and couldn’t wait to get back home.” Another person said, “I’m more than happy. I couldn’t ask for better.” Relatives we spoke with told us that they were always made to feel welcome and that they were happy with the standard of care provided.

Everyone we spoke with told us that they liked the food that was provided and that there was a plentiful supply of snacks and drinks. We were told that there was a good variety, that food was well presented and that portion sizes were sufficient. One person said, “All meals are very tasty and if you don’t like what’s on offer you can have something else.”

People and relatives told us that they felt comfortable in speaking with staff or management should they need to raise a concern. We were told that communication was good, people were listened to and that any concerns / complaints were taken seriously and acted upon. One person said, “All of the staff and especially the manager are approachable. I can talk to them about anything no matter how small it seems.”

During the inspection we spoke with five people who used the service and one relative. People spoken with were very happy with the care and support that they received. Comments made included:

"The staff are wonderful and very kind."

"The food is good. I have cereal and toast with marmalade for breakfast. You could have a poached or fried egg if you wanted. We then have a cup of tea and a biscuit at about 10am. They give you a choice of what you can have for lunch, today I'm having braised steak."

"I have improved since I came here. I can walk so much better."

"It's good and it's handy for the cathedral. I like to go over every day."

"The staff are very good. You can have a good chat and a joke."

We asked people if they thought there were enough staff on duty. One person said, "The staff are there when you need them. You can have a bath any time you want."

The relative spoken with during the inspection was also complimentary of the care and service provided and said, "We are pleased. The staff are good. He/she is in much better health."

During the inspection we sat in an area where we could see both staff and people who used the service. We saw that staff treated people with dignity and respect. Staff took time to listen to people and to determine their needs. Staff responded quickly when they saw that one person was unwell. People were singing whilst others read the newspaper. On the day of the visit we saw people join in a quiz, do gentle exercise and play games. Those people who were able were free to move about the home as they pleased.

During our visit we spoke with six people who used the service and four relatives. People who used the service expressed satisfaction with the care and service that they received. One person said, "We get really well looked after." Another person said, "I'm happy with the care and the laundry is excellent." Relatives spoken with during the visit said, "All the staff are very good and friendly. This is a really good home where all of his/her needs are met." People who used the service and relatives commented on the lack of activities in recent months. The manager told us that she had been without an activity co-ordinator, however this would be resolved and a full schedule of activities would commence over the coming weeks.

We spent a period of time sitting with a group of people in a lounge. We were able to observe people’s experiences of living in the home and their interactions with each other and the staff. Throughout the observation we saw all staff treat people with respect and courtesy.

We saw one staff interaction that could have been handled more appropriately. One staff member was observed to take a full cup of tea away from a person without asking if they had finished.

During the inspection we spoke with thirteen people who used the service and four relatives. We also spoke with the manager, care staff and the activity co-ordinator. People and relatives told us that they were happy with the care and service received. One person said, “Everybody is really kind. I’m well looked after.” Another person said, “Staff were very considerate when I was feeling ill, they checked me regularly and would sit and talk to me.”

We used a number of different methods to help us understand the experiences of people who used the service, because some people who used the service had complex needs which meant they were not able to tell us their experiences. We spoke with four relatives who said, “Care staff are pleasant and kind and could not do more.” Another relative said, “The care here is very good and I would come here if I had to.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive and interacted well with people. We saw that people had their needs assessed and that support plans were in place.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

We saw that staff were supported and trained to provide care to people.

We saw that regular audits were carried out to assess and monitor the quality of the service.