The inspection of Eden Court took place on 12 December 2016 and was unannounced. The previous inspection in April 2015 had rated the home as requires improvement in all domains and there was a breach of the regulations in relation to staffing. During this inspection we checked to see if improvements had been made.

The home provides residential and nursing care for up to 40 people. Bedrooms are situated on both the ground and first floor with communal lounges and a dining room on the ground floor. During our inspection there were 36 people living in the home, 30 of whom required nursing care. Two bedrooms were being kept free due to a planned refurbishment programme.

There was a registered manager in post on the day of 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.

People and relatives told us they felt safe and we saw evidence of appropriate care delivery, in line with people’s needs. Risks were managed in the least restrictive manner, ensuring people were supported as needed but could also make choices about their care.

Staffing levels had improved since the previous inspection and people had their needs attended to promptly. Medicines were managed safely and were stored appropriately.

We found staff had all received supervision and training which enabled them to function well and a team identity was obvious.

The home was operating in line with the requirements of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards. People were supported to make decisions as far as they were able, and for those who lacked capacity decisions were made according to those authorised to do so.

People were supported throughout the day with their nutritional needs and offered regular drinks. Where extra assistance was required this was delivered discretely and following recommendations from other health professionals such as the Speech and Language Therapy Team.

Staff were caring, showing they knew people well and treated everyone with a high degree of respect. Privacy was protected and staff operated with discretion.

Care records were person-centred and comprehensive providing staff with clear guidelines to enable them to support people safely and effectively.

Complaints were investigated in depth and learning from them shared with staff in their regular meetings and group supervisions.

We found the home was well run with a competent registered manager who had developed multiple systems of support and scrutiny to ensure care was delivered to the highest possible standard. The auditing system was robust and showed a responsive service which was keen to tackle any deficiencies swiftly and effectively.

This inspection took place on 2 April 2015 2015 and was unannounced.

Eden Court is registered to provide residential care for up to 40 older people. Bedrooms are situated on both the ground and first floor with communal lounges and a dining room on the ground floor. There were 40 people living at the home at the time of our inspection.

At the time of our visit the person managing the service had only been in post for seven weeks and was in the process of submitting their application to the Care Quality Commission for registered manager status. 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 told us they felt safe and staff knew how to maintain people’s safety. Personal emergency evacuation plans were in place. However there were not enough staff available to meet people’s needs safely or in a timely manner.

Staff required further training to support them in meeting people’s needs. This was particularly relevant to make sure staff worked within the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

People enjoyed the food at the home but better monitoring of people’s nutritional intake was needed.

Staff treated people with kindness and patience. However their ability to provide care in line with people’s preferences was restricted by insufficient staffing.

Care was not planned or delivered with a person centred approach. The manager had identified this and was addressing it.

Activities were provided but these were not always accessible to all of the people living at the home. This was affected by insufficient staffing numbers.

Complaints and concerns were listened to and managed well.

People who lived at the home and staff had confidence that the new manager was putting systems in place to improve the service.

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

At this visit we found that medicines handing had improved. Arrangements for the management of medicines were safe. Clear records of medicines administration and for the disposal of unwanted medicines were maintained. The two people we spoke with did not raise any concerns about their medicines with us. One person told us they, “wouldn’t change a thing”.

During the inspection we had the opportunity to speak with people who used the service, the manager, carers, relatives and other staff members.

The people who used the service told us they were looked after well and felt safe with the care and treatment provided. Their comments included: "It’s wonderful here", “They are all very friendly” and “It’s wonderful being here”.

We found that service had appropriate systems in place to ensure consent was gained before staff proceeded with personal care.

We saw that there was an appropriate system in place for listening to and acting on people’s comments and concerns.

We spent time observing the lounge and dining areas during the day of our inspection. We looked at how people spent their time and how staff interacted with people. The interactions we saw between staff and people who used the service and visitors were respectful.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

People who use the service told us that they were happy with the care they received and made their own decisions and choices. They made comments such as, “The carers treat me with respect and listen to what I ask of them” And “I don’t always want to get up too early. They (staff) just say ‘whatever I want to do is my choice’.”

We also found that relatives were happy with the care and felt that the home was well run.

The staff told us that they had regular training and support from the management team at the home.

The home had completed an extensive refurbishment programme, which had improved the quality of the environment for everyone. The home had new flooring and furniture and we received many positive comments about the environment from the people who lived at the home and their visitors. We did however feel that the noise levels within the home were unduly stressful and did not always consider the comfort of people living at the home.

People told us that staff treated them with dignity and respect, and staff were seen responding to peoples needs in a dignified manner.

They said, “The staff are lovely and I can have a bit of fun with them.” The same person said that she liked to stay in her room and have her own company but the activities person would come and “cajole “ her out to join in which she enjoyed. She mentioned that staff were sensitive to her needs and knew the care that she needed. She also said that she was hoisted in and out of bed and that staff were careful when they did this.

Another person also said that the staff were lovely and knew her needs. She said that she had seen a number of changes over the last few months and these were for the better. This person said that on one occasion, due to staffing problems and the use of agency staff she was left in bed until late morning. She said that they she was offered breakfast and a drink but as she did not like breakfast was satisfied having a drink and a cigarette. She said that, “It was the agency staff that had blundered but they have been replaced.”

People told us there were adequate numbers of staff on duty to offer them support with personal care at a time appropriate to meet their needs.

They said that they had come to know a number of the staff very well and that all the carers were trained. One person said, “Things have improved since the new manager and deputy started and continue to improve.” The same person also said that, “I feel staff are relaxed and know what they are doing.” At the same time the person pointed to two carers in the same room and said, “Those two know what they are doing and they are trained.”

A second person said that the home had been using agency staff for a while however, the use of these staff had reduced and there had been a lot of new staff whom they were getting to know.

Staff observed had good relationships with people who use the service and light hearted banter was seen.

People who use the service were relaxed and receiving good outcomes of care. Staff were polite, courteous at all times and people spoke positively about the care they received.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with seven people living in the home, three relatives and seven members of staff. These are some of the things they told us:

“The staff are angels, every single one of them.”

“The night staff are very good they know I don’t sleep well and come and offer to get me a cup of tea.”

“I am very satisfied with the care my relative is receiving.”

“The staff are brilliant it’s like a family.”

“I enjoy working here we have a good staff team.”

We saw that staff were respectful and were mindful of people’s dignity. All of the people we spoke with were very happy with the staff that were caring for them.

We found that care plans were in place that gave staff information about the care and support people required. However, we found that there were not sufficient numbers of staff to deliver this support consistently.

We found that the medication system was not being managed safely.

We saw there was a complaints procedure in place and people we spoke with told us they would feel able to raise any concerns. However, we found that the complaints procedure had not been followed and two people had not received responses to their complaints.