The inspection took place on 12 and 14 July 2017 and was unannounced. The service had previously been inspected twice in 2016. Once on 16 and 17 February 2016 when we found several breaches of our regulations, in particular we had serious concerns in the way the service managed, recorded and stored people’s medicines. We asked the providers to take immediate action to safeguard people from harm in regards to the medication. On 26 May 2016 our pharmacy inspector visited the service to check whether they had taken sufficient action. We found that the service had taken action and people’s medicines were managed safely.

However, there were still outstanding breaches in other areas reported in the report resulted from the inspection done on 16 and 17 February 2016, so the overall rating of the service remained requires improvement. Those concerns included there were not always enough staff on duty. Nor was the service proactive in managing everybody’s health needs and people’s dignity was not always protected. During this inspection we found that the service had taken the necessary action to be rated as a good service.

The service provides accommodation and nursing care for up to 60 people, some of whom are living with dementia. At the time of our inspection there were 37 people living in the service. The service was divided into four almost identical wings. One wing was a nursing unit, which the providers had closed to enable the service to focus on bringing the service up to standard. They had found it difficult to recruit nurses. The service was in the process of actively recruiting to open the nursing wing.

At this inspection of 12 and 14 July, people who lived in the service told us that they felt safe and well cared for. They believed that the care workers knew what support they needed and that they were trained to meet those needs and to keep them safe. There were enough staff on duty, including senior staff, catering and housekeeping, to protect people from harm. Risks to people were assessed and steps had been put in place to safeguard people from harm without restricting their independence unnecessarily. People’s medicines were managed safely.

People were asked for their consent by staff before supporting them in their day to day care. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required. 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.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

We saw many examples of positive and caring interactions between the staff and people who lived in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints. They took steps to investigate complaints and to make any changes needed.

The service was well led by the registered manager who felt they were well supported by their line manager, the regional director and the organisation. People using the service and the staff they managed told us that the registered manager was open, supportive and had good management skills. There were systems in place to monitor the quality of service the organisation offered people. 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

We carried out an unannounced comprehensive inspection of the service on 16 and 17 February 2016 in response to some concerns which had been raised with us. That inspection identified a number of breaches of regulation, the most concerning of which was a breach relating to the unsafe management of medicines. Given that our previous inspection, which was carried out on 20 January 2015, had also identified a breach of regulation with regard to the unsafe management of medicines we were not assured that the service had made the required improvements in the intervening period. For this reason we issued a warning notice which required the service to ensure they met the legal requirements of Regulation 12 (1) and (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by 22 April 2916.

We carried out this focused inspection on 26 May 2016 to check that the service had met the 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 Davers Court on our website at www.cqc.org.uk.

Davers Court provides accommodation for up to 60 people, some of whom are living with dementia, who require care or nursing care.

The service is currently without 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 of the Health and Social Care Act and associated Regulations about how the service is run. The recently appointed manager is planning to register with CQC.

At our focused inspection on 26 May 2016 we found that the provider had made the required improvements and was no longer in breach of the regulation with regard to the management of medicines.

We looked at how information in medication administration records and care notes supported the safe handling of medicines.

Medicines were being stored safely for the protection of people who used the service. Audits were in place to enable staff to monitor and account for medicines. Records showed people were receiving their medicines as prescribed and there were clear records showing why people did not receive their medicines for any reason.

Medicines which were given on a when required basis needed some further information in place to help guide staff to clearly know the expectations of the provider.

The inspection took place on 16 and 17 February 2016 and was unannounced. The service had previously been inspected in January 2015 when it was found to be in breach of regulations related to the management of medicines and the obtaining of consent.

The service provides accommodation and nursing care for up to 60 people, some of whom are living with dementia. At the time of our inspection there were 56 people resident. The service is divided into four almost identical wings. One wing was a nursing unit and had ten designated beds for people who had been discharged from West Suffolk Hospital for temporary care.

The service had had six managers since opening in August 2014. A registered manager was not in post at the time of our 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.

Medicines were not always well managed and some medicines had not been administered as people were asleep or refused. Records related to medicines were not accurate. We also found that stock control methods did not monitor tablets accurately which meant any administration errors would not be obvious to staff. Staff altered records related to medicines which meant they did not represent an accurate and contemporaneous record.

Staff were trained in safeguarding people from abuse and they understood their responsibilities with regard to keeping people safe and reporting suspected abuse.

Risks were assessed but the service was not always proactive about managing risk. The service carried out audits to monitor health and safety but we had been previously informed of an incident in which a section of coving had come down causing injury to a person who used the service. We have found that several sections of coving had fallen since the service opened and we are continuing to investigate this matter.

There were not enough staff who had the required skills, knowledge and experience. Agency and newer staff did not demonstrate that they knew people well, although permanent staff were found to be skilled and competent.

Staff received the training and induction they needed to carry out their roles effectively but some agency staff did not receive a comprehensive induction.

We saw that staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards DoLS) and the service acted in accordance with them. The MCA ensures that people’s capacity to make decisions is assessed. Where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People who used the service were not always positive about the food and the service had worked hard to engage with people and improve this aspect of the service. People identified as being at risk of not eating enough were referred to the dietician and monitored to ensure no further unplanned weight loss. People were also supported to access other healthcare professionals when they needed them although we had concerns about one person who we observed did not receive prompt healthcare support during the course of our inspection.

Staff were caring, passionate about their work and committed. We saw that some staff demonstrated innovative practice and acted as excellent role models for newer members of staff. People were treated respectfully and their dignity was maintained in most cases but we did also see some examples of very poor practice that impacted on the dignity and wellbeing of two people in relation to personal care needs.

People we

The inspection took place on 21 January 2015 and was unannounced. The service has not been inspected before as it opened in August 2014.

The service provides accommodation and nursing care for up to 60 people, some of whom are living with dementia. At the time of our inspection there were 37 people resident. The service is divided into four almost identical wings. Only three were being used and each unit led on to a communal area with a café and other communal facilities.

A registered manager was 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.

Medicines were managed well for most people but we were concerned as some medicines had not been administered. This placed people at risk and no investigation had taken place to discover why this had happened. We also found that stock control methods did not monitor tablets accurately which meant any administration errors would not be obvious to staff.

Staff were trained in safeguarding people from abuse and they understood their responsibilities with regard to keeping people safe.

There were sufficient numbers of suitable staff on duty and risks to people’s health and wellbeing were assessed and measures put in place to reduce them.

Staff received the training and induction they needed to carry out their roles effectively. Staff demonstrated a good knowledge of the people they were supporting and caring for.

We saw that although staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards DoLS) the service did not always act accordance with them. The MCA ensures that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

People who used the service were very positive about the food and were able to exercise choice about their meals. People identified as being at risk of not eating enough were promptly referred to the dietician and monitored to ensure no further unplanned weight loss. People were also supported to access other healthcare professionals when they needed them

Staff were caring and committed and we saw that people were treated respectfully and their dignity was maintained. The atmosphere was of a friendly and happy place and the good relationships between staff, the people they were supporting and visiting relatives were observed throughout the service.

People were involved in assessing and planning their care but some people’s end of life wishes had not been recorded.

People were supported to follow a wide range of interests and hobbies but some people living with dementia had little stimulation or activity.

Formal and informal complaints were managed well and to people’s satisfaction. People who used the service, and their relatives, felt they were actively involved in developing the service.

Staff understood their roles and were well supported by the management team. People were very positive about the registered manager and praised the open culture of the service.

The transition from people’s former service to Davers Court had been planned and managed well by the manager and new admissions were being carefully spaced out to ensure staff had the time they needed to become familiar with people’s needs.

We found breaches of regulations which relate to the management of medicines and consent to care and treatment. You can see what action we have told the provider to take at the back of this report.