The inspection took place on 17 and 23 May 2018 and was unannounced. Dudley Court Care Limited 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 care home accommodates up to 22 people in one adapted building. At the time of our inspection there were 20 people living at Dudley Court Care Limited.

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 on annual leave at the time of our inspection. The assistant manager assisted our inspection process. We met the nominated individual at the beginning of our visit on 17 May 2018 and spoke with them over the phone after the inspection.

People told us they felt safe. Staff showed understanding of how to recognise and report abuse although they had not all received safeguarding training. Staff were suitably recruited, and people’s identified risks were not consistently safely managed by staff who knew them well. Systems and records were not robust to ensure consistently safe practice.

The inspection was prompted in part by notification of an incident following which a person using the service absconded. This incident was not reviewed and learned from to improve the safety of the service. We have made a recommendation about how incidents are reviewed and learned from.

People told us they received their medicines as needed however, records were not always accurately maintained to ensure people were always supported safely. We received mixed feedback around whether there were enough staff to meet people’s needs, and systems were not in place to check staffing levels remained safe. Improvements were required to checks of the health, safety and cleanliness of the premises and to people’s equipment.

Some people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, however this was not a consistent experience for all people. Policies and systems in the service did not support this practice. The provider had not met our previous recommendation to ensure people living with dementia would be supported as far as possible to make decisions.

People and relatives told us people were generally well supported. We saw examples of this and that some staff knew people well. Staff told us they felt supported. However, staff had not received training required for their roles to ensure people were always supported safely and in line with current good practice. Improvements were required around how some people were supported with their communication needs and in response to behaviours that may have challenged. The provider had not accessed current guidance around the design and décor of the home.

People were supported to eat and drink enough to maintain a balanced diet. People were supported to access healthcare support if they were unwell.

Feedback from people and relatives reflected positive experiences and we saw some caring interactions. However, some people’s feedback suggested staff did not always respond appropriately, and engage well with people. We saw staff did not often communicate with people outside of care tasks. Systems did not ensure people were always supported to be involved in decisions and discussions about their care as far as possible.

People did not have consistently good access to activities although we received positive feedback about the group activities that took place. We saw good examples of how people’s individual needs were met however this was not consistent for all. People and relatives told u

We carried out this unannounced inspection on 6 and 7 September 2016. Dudley Court Care Home provides care and accommodation for up to twenty two people many of whom live with dementia. At the time of the inspection twenty people were living at the home.

The service has a registered manager who was present throughout 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.

At our last inspection in August 2015 we found that the provider had breached regulation in relation to not having robust systems in place to manage risks to people and in monitoring the quality of the service. We also found that the service needed to improve in staff deployment, involving people in their care and consideration of people’s cultural needs. Following this inspection the provider sent us a plan detailing what they would do to address the breach. At this inspection we found that improvements had been made in many aspects of the service and the provider was no longer breaching regulation. People and their relatives were happy with how the service was managed. The registered manager had made improvements to the systems in place to monitor the quality and safety of the service although we found that further improvements were needed to ensure these systems were fully effective and robust.

People felt safe living at the home. People had support from staff who understood appropriate action to take should they have concerns about a person’s safety and had received training to aid their knowledge.

People were supported to stay safe as the provider had systems in place to reduce and monitor the risks associated with people’s care. People were happy with the support they received with their medicines and we saw that this was carried out safely.

There were sufficient staff available to support people when they needed help. Staff were deployed effectively in communal areas of the home and spent time speaking with people or providing reassurance or assistance where needed. Staff felt supported in their role and received support from the registered manager and from other members of staff in the team.

People were supported by staff who had some knowledge of the Mental Capacity Act (2005) and could explain how they involved people in making choices about their care.

A number of people at the home were living with dementia. Staff were confident in supporting people with this condition but there were limited aids to support people in making decisions. We have made a recommendation about accessing information and resources to support people living with dementia to make decisions.

People had their healthcare needs met and the service was quick to respond and seek advice when healthcare needs changed.

People told us they felt cared for and our observations confirmed that staff were kind and caring in their approach. Care was planned with people and their relatives to ensure the care provided met people’s preferences. Staff knew the people they were supporting well and could explain how each person liked to be supported.

Care was reviewed with people at regular intervals although this wasn’t currently recorded. People had been supported to sustain relationships with people who were important in their lives.

Activities occurred on a regular basis based on people’s known interests.

There were systems in place for people to raise concerns and complaints and people knew how to do this. People had the opportunity to feedback their experience of care at the home and the provider responded appropriately when people raised concerns.

On the day of our unannounced inspection, we found that twenty two people were living at this care home. We subsequently spoke to eight people who lived there, five of their relatives, three members of care staff and the manager of the home. We found that some people were not able to give us their views on the service because of their complex needs and health conditions.

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 caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

This is a summary of what we found:

Is the service safe?

We spoke to several people who lived at Dudley Court Care Home. People told us they felt safe. Comments included, “I only have to pull the cord (call alarm) and they are there” and “I feel safe here, the staff are very kind and trustworthy.” Relatives of people who lived at the home also told us that they thought the care home was safe and the care staff were honest and trustworthy.

People were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We found that the home’s safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been made under this legislation for any person living at Dudley Court, we found that the manager and staff understood their responsibilities in relation to the law.

We checked people’s care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

We found that care was provided in an environment that was safe, accessible, clean and adequately maintained.

Is the service effective?

People told us that they were happy with the care they received and the care staff who supported them. We found that care staff knew the people they supported very well.

Staff training records showed that care and catering staff had received appropriate training in a number of relevant topics including: food hygiene, dealing with dementia, moving and handling and infection control. This meant that staff had the appropriate skills and knowledge to ensure that people received safe, appropriate and effective care.

People’s needs were assessed and care and support was planned and delivered in line with their individual care plans. We saw that people had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians.

We checked a person’s care plan and saw that it had been reviewed on a monthly basis by the manager of the home. The written entries made on the care record (following each review over the past three month period) recorded that there had been no changes to that person’s mobility. However when we checked the home's accident records we noted that this person had fallen recently on several occasions. This meant that the review process had failed to acknowledge the change in this person's mobility.

We concluded that the provider did not always have an effective system to regularly assess and monitor the quality of service that people received. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to these concerns.

Is the service caring?

People were supported by kind and attentive staff. It was apparent to us during our observations that care staff were attentive, polite and sought consent before providing care and support. We saw that care staff were patient with the people they were supporting and treated them with respect and dignity. People commented, “Staff are very helpful and kind, I have no problems with them” and “The staff are all very nice.”

We spoke to relatives of people who lived at the home. They were also very complimentary about the standards of care being delivered and the competence of staff delivering care and support. Comments included, “My mom is very well cared for here and I have every confidence in the manager of the home” and “Staff are very good and we are always kept informed and made to feel very welcome when we visit.”

We concluded that people have a good experience of care and support which is delivered with compassion and respects their dignity and human rights.

Is the service responsive?

Records showed that meetings were held between staff and people using the service to discuss on-going concerns and improvements at the home including; meals, activities, laundry and areas of improvement.

We found that care staff had regular one to one supervision meetings and team meetings with the manager of the home. This meant that care staff had the opportunity to discuss their training and development needs, welfare and any concerns they might have about the people they were caring for.

Dudley Court Care Home has a comprehensive complaints policy. This policy provided clear guidelines as to how complaints would be recorded, investigated and responded to.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We noted that as a consequence of a concern being raised, some procedural changes and new documents had been introduced to improve care and safety. This meant that the manager of the home was responsive to concerns and complaints and took action and made changes when this was considered appropriate.

People living at the care home and their relatives told us that they would have no hesitation in telling the manager and staff if they were unhappy or had any complaints about the service they received. We were told that the manager and staff were approachable and helpful and where they had made requests or raised minor concerns, these matters had been responded to promptly and to their satisfaction.

Is the service well-led?

We found that the registered manager had worked at this care home for several years and was experienced and knowledgeable. We saw that the owners of Dudley Court were involved in the home’s supervision and management on a daily basis and were visible and well known to the people who lived there.

People who lived at the home and their relatives were very complimentary about the manager. Comments included, “The manager is really approachable, we have a good working relationship with her.”

Care staff employed at the home told us that the manager and the owners of the home were approachable and that they enjoyed working there.

We concluded that there was effective leadership at Dudley Court which ensured that safe, effective and responsive care and support was provided.

On the day of our unannounced visit 21 people were living at this care home. We subsequently spoke to seven people who lived there, four of their friends and relatives, the manager and three care staff.

People were complimentary about the care staff who supported them and their living environment. Comments included, “I’m very comfortable thanks, my bedroom is fine.” Relatives and friends of people living at the home were also complimentary about the service being provided. Comment’s included, “They give good support to mom, the staff are very diligent.”

We examined care plans and found that people’s needs were properly assessed and that care and support was planned and delivered in line with their individual care plans. From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support.

We looked at staffing levels and concluded that people were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that care was provided in an environment that was safe, accessible and suitably designed and adequately maintained.

We concluded that Dudley Court was a safe, caring, comfortable and well maintained care home.

On the day of our unannounced visit we found that 22 people were living at Dudley Court Care Home.

We subsequently spoke to five people who lived at the care home including one person who was staying there on ‘respite’ care. People were very complimentary about the care staff who supported them. Comments included, “The staff are really nice” and “They really look after us, the food is excellent.”

We examined care plans and found that people’s needs were properly assessed and that care and support was planned and delivered in line with their individual care plans.

We saw that since our last inspection of this care home that the manager had introduced a new policy in relation to ‘quality assurance’. This document set out how they intended to improve services at Dudley Court and obtain accurate feedback from those who lived there. We also found that risk assessments had been updated (and were now current) and ‘re-positioning’ charts (for those at risk of developing pressure sores) had been completed regularly.

We concluded that the minor concerns identified at our previous visit had been rectified and that Dudley Court Care Home now had effective systems in place to regularly assess and monitor the quality of service that people received.

On the day of our unannounced inspection we found 19 people residing at Dudley Court care home. We spoke to four people who use the service and three relatives.

People told us, “I feel safe and well looked after" and "I've enjoyed it here, they have been very good to me."

Relatives of people using the service also made complimentary comments about the home. We were told, “My relative is happy here” and “This place is very homely.”

Our inspection confirmed much of the feedback we had received. Our observations and conversations with people using the service confirmed that the staff were attentive, polite and that the manager was approachable and responsive to suggestions and feedback. It was also clear that the staff had a good knowledge of all of the people who lived at Dudley Court and were familiar with their preferences and health conditions.

We found that medicines were handled safely and people experienced safe and appropriate treatment which met their needs. We also found that people were cared for and supported by, suitably qualified, skilled and experienced staff and protected from the risks of inadequate nutrition and dehydration.

Our inspection revealed that the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

People living at Dudley Court Rest Home told us that they were happy with the care they received. One person told us they “Had nothing to grumble about.” Relatives we spoke with told us it was “Wonderful. Staff went the extra mile.”

People’s needs were met in a personalised way respecting their individual preferences. Relatives had been involved in planning care and were kept up to date about people’s health needs.

People were happy with the food they received. Choices were available. Relatives were welcome to eat with people and commented that the food was homely.

Care workers responded well to people assisting them to eat and diverting their attentions when they started to show anger. Relatives were pleased that there was a group of care workers who had got to know people and their needs.

Some improvements could be made to the management of medicines in the home. Some staffing vacancies were making it difficult to complete the quality audits of the home.

People living at Dudley Court Rest Home told us that they were happy with the care they received. One person told us they “Had nothing to grumble about.” Relatives we spoke with told us it was “Wonderful. Staff went the extra mile.”

People’s needs were met in a personalised way respecting their individual preferences. Relatives had been involved in planning care and were kept up to date about people’s health needs.

People were happy with the food they received. Choices were available. Relatives were welcome to eat with people and commented that the food was homely.

Care workers responded well to people assisting them to eat and diverting their attentions when they started to show anger. Relatives were pleased that there was a group of care workers who had got to know people and their needs.

Some improvements could be made to the management of medicines in the home. Some staffing vacancies were making it difficult to complete the quality audits of the home.

We inspected this home on the 12 and 13 August 2015. This was an unannounced inspection. Dudley Court Care provides accommodation for a maximum of 22 adults who require personal care. There were 21 people living at the home when we visited. The home is set out over three floors with a lift to provide access to all floors. All of the rooms were single bedrooms each with its own sink. Shared shower-rooms and toilets were located on each floor of the home.

At the last inspection in June 2014 we found that the provider had breached the Health and Social Care Act 2008 in relation to the assessing and monitoring of the quality of the service. Following that inspection we asked the provider to send us an action plan informing us of the action they would take to address the breach. The provider responded to the last inspection report with some detail of audits that had been requested. At this inspection we saw that although some improvements had been made they were not comprehensive. The changes had failed to address concerns relating to management of risk and improving quality aspects of the home.

There was a registered manager at the service. 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.

People living at the service told us they felt safe. Staff knew how to recognise when people may be at risk of harm and were aware of the provider’s policy for reporting any concerns.

People, relatives and staff we spoke with told us there were enough staff to meet people’s needs. However, we observed that staff were not always deployed effectively in order to meet people’s needs. After the inspection we were informed that staff were usually available to sit and engage with people living at the home. Staff received training to enable them to provide safe and effective care that met people’s individual needs. Robust recruitment checks were in place to ensure new staff were suitable to work at the service.

People had received their medication safely. We observed people being supported with their medication in a dignified and sensitive way. The majority of medication was safely and securely stored, and prompt action was initiated to obtain a separate medication storage fridge.

Staff we spoke with had received training on the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). However we found that there was a lack of understanding amongst staff and the registered manager about how to support people in line with this legislation.

People had their healthcare needs met and when people’s needs changed the service was pro-active in seeking advice from the appropriate healthcare professional.

People were happy with the care they were receiving and spoke highly of the staff. People were treated with respect and kindness.

Care plans included people’s preferences and care was reviewed and changed as people’s needs changed. However, people were not always involved in these care reviews. Although some aspects of people's cultural needs were met, people’s cultural diversity had not been fully recognised in relation to how they would want to receive their care. Following this inspection assurance was provided that the issues of cultural needs had been addressed with individual people living in the home.

People and their relatives felt able to raise any concerns they had with the registered manager and felt assured that any concerns would be resolved quickly.

Systems to monitor the quality and safety of the service were not robust. Although there were some systems in place they were not sufficient in measuring the quality of the service people were receiving.

The provider was not meeting the requirements of the law in respect of some regulations. You can see what action we told the provider to take at the back of the full version of this report.