We inspected Hayes Court on 23 and 24 November 2017. The inspection was unannounced. Hayes Court is a ‘care home’. People in care homes receive accommodation and 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. Hayes Court is registered to accommodate up to 56 elderly people. At the time of this inspection 52 people were using the service. Twelve of these people were living at the home on a short-term basis for reablement after a hospital discharge.

We previously inspected Hayes Court in December 2016. At that inspection, we gave the service an overall rating of "Requires Improvement". We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to there being an insufficient number of staff to meet people’s needs, the lack of effective systems to ensure people received their medicines safely, the provider's failure to follow the provisions of the Mental Capacity Act 2005, the lack of person-centred care and the lack of effective systems to assess and monitor the quality of care people received. The provider sent us an action plan setting out when the required improvements would be made. These actions have been completed.

The service had 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. The registered manager had many years experience working in adult social care.

Hayes Court is located in a quiet residential road in Kenley. On both days of our inspection, people's rooms and the communal areas were clean and free of unpleasant odours. We have made a recommendation that the provider finds out more about making adaptations, based on current best practice in relation to the specialist needs of people living with dementia.

Staff had received training in infection control. They consistently followed the provider's infection control policies and procedures which helped to protect people from the risk and spread of infection.

People felt safe from abuse living at Hayes Court. Staff had been trained in protecting adults from abuse and had good knowledge of how to recognise abuse and report any concerns. People were protected from avoidable harm because assessments completed by the clinical lead identified the risks each person faced and gave staff guidance on how to manage those risks.

Staff treated people with kindness and respect. They supported people in a way that maintained their privacy and dignity. People enjoyed living in the home and were satisfied with the quality of care they received. People told us the quality of food was good and they had a sufficient amount to eat and drink.

Staff supported people to maintain good health and access external healthcare professionals. The provider had significantly improved the systems in place in relation to storing, recording and administering people's medicines which helped to ensure people received their medicines safely and as prescribed.

The provider had a thorough recruitment process which was adhered to by the management and included conducting appropriate checks on staff before they began to work with people. There were enough staff working at the home with the right mix of skills and experience to meet people's needs. Staff were appropriately supported by the provider to provide effective care through an induction, relevant training, supervision and appraisal.

People were supported by a consistent staff team; many of whom had worked at the service for several years. They knew people well and understood people's routines and preferences. People were given choices and their wishes were l

This inspection took place on 8 and 9 December 2016 and was unannounced.

At our last inspection in August 2014 the provider met the regulations we inspected.

Hayes Court is registered to provide residential and nursing care for up to 56 elderly people, some of who are living with dementia. There were 49 people living in the home at the time of our inspection.

There was a registered manager 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.

People felt safe from abuse. Staff had a good understanding of how to identify abuse and report any concerns.

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

Staff had not received training on the Mental Capacity Act and had little understanding of how it applied to people in their care. People were deemed to not have capacity to make decisions, although an assessment of their capacity had not been completed. This meant there was a risk of people having decisions made for them when they were able to make decisions for themselves, and that they were not as involved in day-to-day decisions about their care as they could be.

People's needs had been assessed and care plans were developed. People's care plans stated how their care should be delivered, but did not take account of people’s individual preferences and social needs or interests. There was insufficient stimulation or activity for people living in the home. There were few if any opportunities for people to leave the home unless they had the support of their relatives.

People were satisfied with the quality of their meals and told us they had a sufficient amount to eat and drink. Staff supported people to maintain good health.

Staff were recruited using an effective procedure which was consistently applied. However, the provider did not employ a sufficient number of suitably qualified staff to meet people's needs. Staff received basic training in the areas relevant to their role but did not always have the training or skills to safely and effectively support people with more complex needs.

People were complimentary about the staff. Staff respected people’s privacy and interacted with people in a caring and respectful manner. However, the care provided was task driven and not person-centred. People told us staff did not have the time to have any meaningful conversations with them.

Improvements were required to ensure the service was well-led. The registered manager and provider did not have effective quality assurance systems in place to assess and monitor the quality of care people received.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to there being an insufficient number of staff to meet people’s needs, the lack of appropriate systems to ensure people received their medicines safely, the failure to follow the requirements of the Mental Capacity Act 2005 and associated code of practice, the lack of person-centred care and the lack of effective systems to assess and monitor the quality of care people received. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service.

Hayes Court is a care home which provides nursing and personal care for elderly people many of whom have complex needs and/ or are living with dementia. At the time of our inspection there were 45 people living at the home. The home had a registered manager. A registered manager is a person who is registered with the CQC to manage the service and shares the legal responsibility for meeting the requirements of the law; as does the provider.

We previously carried out an inspection of Hayes Court in March 2014. During that inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that people were not adequately protected against the risk of abuse because care workers did not have good knowledge about how to recognise abuse or know the action they should take if they suspected someone was at risk of abuse. We saw that people’s needs were regularly assessed but where a change in their needs or risk was identified, care plans and risk assessments were not always updated accordingly. We were concerned that the systems in place to monitor the quality of care people received were inadequate.

This inspection was carried out to check whether the provider had made the required improvements. The inspection was unannounced and carried out on 1 August 2014. We found the provider had made improvements to minimise people’s risk of abuse. People’s care plans and risk assessments reflected their current need and there were better systems in place to monitor the quality of care people received.

We found there were procedures and risk assessments in place that staff implemented to reduce the risk of harm to people. The manager and staff understood the main principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). People received their medicines safely and were adequately protected against the risk and spread of infection. The home was well maintained as was the equipment people required.

People were cared for by staff who were recruited through a thorough recruitment process. Appropriate checks were carried out on applicants before they began to work with people. The majority of staff were experienced care workers who had the skills, knowledge and experience to care for people safely. There was a sufficient number of staff on duty to care for people safely and effectively. Staff understood their roles and responsibilities and were supported by the management through relevant training, supervision and performance reviews.

People were satisfied with the care they received and told us they were treated with respect and kindness. People and their relatives felt involved in their care planning and in control of the care they received. There were a variety of activities for people to participate in within the home but some people felt that more could be done to support people to participate in activities outside the home. Staff ensured people received a nutritious, balanced diet and people who required it were supported to eat their meals. People were happy with the quality of their meals and said they were given enough to eat and drink.

People’s healthcare needs were met by suitably qualified staff. Regular checks were carried out to maintain people’s health and well-being. People also had access to healthcare professionals and staff liaised well with external healthcare providers. People were supported to plan their end of life care which staff delivered in accordance with their wishes.

There were systems in place to assess and monitor the quality of care people received. People felt able to express their views and told us the management and staff were responsive to their complaints and comments.

People were involved in decisions about their care and treatment and their consent was appropriately sought prior to treatment. One relative we spoke with told us that everything was checked and discussed before my mother came here. We spoke with a person using the service who said ''I was amazed when I first came here; the nurse talked with me and knew all my medications. He asked me about how I liked to be looked after and remembered everything.'' There were appropriate arrangements in place to ensure people's best interests were represented where people lacked the capacity to consent.

The care and welfare of people using the service was provided following careful documented assessment of each person's individual needs. A relative said ''They quickly had my mother’s care under control. She is so much better now. When I visit her hair is always nicely done and clothes are well cared for.''

The premises were found to be secure and well maintained. Safety checks of all the essential services such as electricity and water were routinely carried out.

There were effective recruitment and selection procedures in place to ensure peoples safety and welfare needs were met by staff that were appropriately qualified to do their job. One person said '' they (the staff) do all they can for me. I just have to ring my bell and they come.''

Records were found to be fit for purpose well maintained and stored securely to ensure they remained confidential.

People who we spoke to told us that they were happy with their daily lives in the home and that staff helped them in the way that they preferred.

The views of people who were able to comment on their experience can be summarised as follows:” The staff are good” and “They look after me well”. All the people we met appeared to be happy and looked well cared for.

We saw the satisfaction surveys that had been completed by representatives of people using the service and they were happy with the care being provided in the home. The provider had a system to assess the feedback provided in the satisfaction questionnaires and to take action where required to address areas where improvement had been identified.

We spoke with people using the service and their representatives about the quality of care. Comments we received included, "It's not like it was, the staff always seem in a bit of a hurry." "The staff are good and take care of X like I would." "Sometimes you feel like it's an imposition when you ask for something especially at night time and it doesn't always get done."

We were concerned that where there was a change in people's needs this was not always identified and where it was identified their risk assessments and care plans were not always updated on review to reflect the change in need.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.