About the service: De Bruce Court provides personal and nursing care for up to 46 people. At

the time of our inspection there were 21 people living at the home, some of whom were living with a dementia.

People’s experience of using this service: Medicines were not always managed safely. Improvements had been made to the recording of topical medicines and guidance on ‘when required’ medicines, but further improvements were needed.

Staff training and supervisions had improved. Staff turnover remains a concern; plans were in place to address this.

Care plans had improved but further improvements were needed to ensure staff had sufficient information about people’s specific needs.

Issues the provider had identified through checks on the quality and safety of the service were

being addressed at the time of this inspection.

At this focused inspection we found some improvements had been made but further improvements were needed. There is no longer a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, but there is an ongoing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. While some improvements had been made we could not improve the overall rating from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Rating at last inspection: Requires Improvement (report published 1 November 2018).

Why we inspected: At the previous inspection we found breaches of Regulations 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because: medicine records for 'when required' medicines lacked detail; records relating to the administration of topical creams were not always accurate; care records were not always clear and up to date; staff had not completed training specific to people's individual needs; staff supervisions were not up to date; and the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support.

Following the previous inspection we asked the provider for an action plan which said what they would do to meet legal requirements in relation to the above issues. We undertook this focused inspection to check they had met legal requirements and to confirm they had followed their action plan and made improvements to the service. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for De Bruce Court on our website at www.cqc.org.uk.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 18 September 2018 and was unannounced. A second day of inspection took place on 20 September 2018 and was announced.

De Bruce Court is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. De Bruce Court provides personal and nursing care for up to 46 people. At the time of our inspection there were 15 people living at the home who received personal or nursing care, some of whom were living with a dementia.

A registered manager was not in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

This service first registered with the Care Quality Commission on 9 October 2017; this was the first inspection of this service.

During this inspection we found breaches of Regulations 17 (good governance) and 18 (staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This was because: medicine records for 'when required' medicines lacked detail; records relating to the administration of topical creams were not always accurate; care records were not always clear and up to date; staff had not completed training specific to people’s individual needs; staff supervisions were not up to date; the provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and to ensure people received appropriate care and support; and the provider had failed to notify the Commission about significant events in a timely manner.

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

People had mixed views whether they felt safe or not. Most people said they felt more staff were needed but we saw people’s needs were attended to in a timely way, which meant there were enough staff. However, we did notice call bells continued to ring when staff were already in attendance, which could cause some people to become anxious or upset.

A high number of agency staff were being used daily due to the number of staff vacancies. People tended to speak more positively about the permanent staff and less positively about the agency staff.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service. Identity and background checks had been completed which included references from previous employers and a Disclosure and Barring Service (DBS) check.

Accidents and incidents were recorded and dealt with appropriately, but there was no regular analysis to look for trends which may have reduced the risk of future accidents and incidents.

The environment was clean and well-furnished but it was not consistently dementia friendly.

People had 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 told us they enjoyed the food available. The meal time experience needed improving to make it more pleasant.

Staff were not always caring as sometimes they concentrated more on the task rather than the individual they were supporting. People gave us mixed feedback about the standard of care provided.

People did not always have access to important information about the service, including how to complain and how to access independent advice and assistance such as an advocate.

People's risk of social isolation was incre