This inspection took place on 19, 20 and 21 June 2018. This was an unannounced inspection on the first day. We previously inspected the service on 23 January 2017. The service was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that staff had not received appropriate support, training and appraisal to enable them to carry out the duties they were employed to perform. We found during this inspection the provider had made improvements and were now meeting this regulation. However, we found the service was in breach of other regulations during this inspection. This was in relation to good governance and consent. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions in effective and well led to at least good.

Icknield Court 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.

Icknield Court accommodates 90 people in one adapted building. The service accommodates people across two floors, each of which have separate adapted facilities. There were six ‘houses’ or ‘units’, three of which specialised in providing care to people living with dementia. At the time of our inspection 87 people resided in the service. Four people received respite care.

The service did not have 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. However, a new manager was in the process of applying to become the new registered manager.

People were kept safe at the service. Staff had received training in safeguarding people from abuse and staff told us they would not hesitate in reporting any concerns regarding people’s welfare to the relevant authority.

We observed there were sufficient staff to support people at the time of our inspection. We saw that staff treated people with kindness and compassion. Comments included, “We all seem to be looked after properly here”, “They do come quickly if you press your buzzer”, “It is as close to being in your own home as it can be”.

Staff told us they felt supported and had received supervisions from their line manager. Appraisals had been carried out in line with the providers policy and procedures.

Risk assessments had been carried out for people with an identified risk, for example, repositioning for people with frail skin and fluid monitoring for people at risk of dehydration. However, the charts we saw were not always completed and some charts had not been completed at all.

We saw that recording of incidents such as bruising or skin tears were recorded in the handover record. However, it was not clear how these incidents were monitored. The service did not have an effective system relating to recording when bruising or skin tears occurred.

Medicines were mainly well managed. We observed the administration of medicines during our inspection and found people were safe from harm. Where medicine incidents occurred, these were investigated and address to prevent further occurrences. We saw that where people required regular pain relief to manage their pain a monitoring chart was not in place to establish the effects of the medicine. However, the manager told us this is something they will be addressing.

The service did not follow the requirements of the Mental Capacity Act 2005 (MCA). We found recordings of consent and best interest decisions were not always in place this meant the service did not comply with the MCA codes of practice. We did not find

This inspection took place on 23, 24 and 30 January 2017. It was an unannounced visit to the service on the first day.

We previously inspected the service on 14 April 2015. The service was meeting the requirements of the regulations at that time.

Icknield Court provides care for up to 90 people, including people with dementia. Eighty people were living at the home at the time of our inspection. The building was divided into separate units or ‘houses.’ Three houses provided specific care to people whose primary care needs were associated with dementia.

The service did not have 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. A new manager was in post; they were in the process of applying to become registered.

People were kept safe at the service. Thorough recruitment processes were used when appointing new staff. The premises were well maintained; appropriate checks were made to ensure it was kept in good order. There had been a satisfactory fire inspection in November 2016 and the service had been awarded the highest, five star rating for food hygiene practices.

There were enough staff to support people at the time of our visit. We observed staff treated people with empathy and warmth; people we spoke with were complimentary of staff. Comments included “The staff are really lovely, very kind,” “Everyone is ever so kind to me. I love it, I really love it” and “ The staff are lovely.” A relative said “I couldn’t have found a better place. The staff are lovely. I’ve got no worries at all.” They added their relative was “Always clean, never wet. If I go away I have no worries.” They told us “What I like is the staff sit down with them at mealtimes and eat with them.”

Staff received supervision from their line managers, to look at how they were working and discuss their development. However, they did not always receive support in other areas. For example, we found gaps to training records where courses had not been undertaken or were overdue for renewal. Annual appraisals had last been carried out three to four years ago in the files we checked. This meant staff had not received support in line with the provider’s expectations for developing workers.

People’s nutritional needs were met and appropriate measures were in place where people were at risk of weight loss. People received the healthcare support they required. There was good partnership working with GP surgeries and community specialists to keep people healthy and well. Two healthcare workers told us the home supported people well at end of life. One commented “I have also been impressed with the care they have offered families in the immediate aftermath of a patient passing away such as explaining the process after death, allowing relatives time to be with their loved ones for some time afterwards and just approaching the whole situation in a very professional way.”

People’s needs had been recorded in care plans. These outlined the support people required and took into account their preferences. Relatives or partners had provided information about people’s likes, dislikes and their backgrounds, to help ensure staff provided individualised care.

We found staff were responsive to people’s changing needs. Care plans were kept under review to help keep people safe and independent. Appropriate action was taken when people became unwell.

People were supported to take part in a range of activities to provide stimulation, enjoyment and social contact. The home had a team of activity staff and local volunteers who provided a programme of activities. There were also good links with the local community to help people keep in touch with their surroundings.

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We carried out an unannounced inspection of this service on 18 and 28 November 2014. A breach of legal requirements was found. This was because the home did not have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users or those persons who can lawfully give consent on their behalf.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

Icknield Court is a 90 bedded care home without nursing, which provides support to older people and people with dementia.

The home had a registered manager in place. 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.

During our visit on 14 April 2015, we found the provider had followed their plan to make improvements at the home. Copies of legal documents had been obtained to verify that relatives or other persons had been given powers to make decisions on people’s behalf, where they could not do this for themselves. This followed the principles of the Mental Capacity Act 2005, and helped ensure the right people were consulted and made decisions about people’s care and treatment.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Icknield Court on our website at www.cqc.org.uk

When we visited the service on 15 March 2013, we had concerns about how this standard was being managed. This was because there were sometimes insufficient numbers of staff to meet people’s needs. We set a compliance action for the provider to improve practice.

We returned to the service on 22 August 2013 to check whether improvements had been made. We found arrangements had been put in place to ensure there were enough skilled and experienced staff to meet people’s needs.

Rotas and shift planning records showed the home was appropriately covered at all times. We saw more relief staff had been recruited since our last visit. This meant there were more staff who were able to cover gaps on the rota. For example, if other staff were on sick leave or annual leave.

We received positive feedback about staff. One person told us, “Staff are excellent, I feel I’ve fallen on my feet.” A relative said, “I can’t praise staff enough, I think they’re brilliant.” A visitor told us staff responded appropriately if their relative was ever unwell. They added, “I can leave here knowing they will ring me if there’s anything wrong.”

We were satisfied the home had taken sufficient action to become compliant with this standard.

When we visited Icknield Court, the people who lived in the home told us that they were very happy with their care. They told us that the staff where very kind and caring. We spoke to eight people who were using the service. All people spoke positively about the service they received. One person said “I’m happy here and its home.” There were some negative comments related to the number of staff available at times, which people using the service noted.

We spoke to five staff and they demonstrated their knowledge about people's needs and had a clear understanding and awareness of how they should be met. We observed staff interacting with people, listening to them and responding to them in a polite and courteous way, ensuring that they gave people time to ask questions and respond at their own pace.

Staff had access to training and development and were supported through supervisions and performance reviews. At times the staffing levels were not as high as was desired, which impacted on staff and service users.

There were systems in place to monitor the quality of services provided. Records were completed and managed safely and securely.

People that we spoke with said they were treated with respect by staff. They said they were free to spend time in the communal areas of the building or their rooms. They told us they can decide when to get up and go to bed. People said there were choices at mealtimes. Relatives told us they were encouraged to bring in items to personalise people's rooms to make them look homely and familiar. People that we spoke with said meetings were held at the service if they wanted to raise any issues, including complaints about their care.

One person that we spoke with told us his needs were being met at the service and that he was happy there. He, and other people, told us there were activities arranged and things to do. Relatives that we spoke with commented positively about people's care.

People that we spoke with said there were staff around when they needed them. One person told us he liked to spend time in his room and that he could always ring the call bell if he needed any help. He said staff responded in reasonable time when he called for assistance.

Staff that we spoke with felt there were sufficient staff to meet the needs of the people they were caring for. They confirmed that additional staffing was in place where this had been identified as part of action plans to manage behaviour and other issues. One member of staff said she was happy working at the service and that there was a good manager at Icknield Court.

Icknield Court is a 90 bedded care home without nursing, which provides support to older people and people with dementia. The home is divided into five groups, known as ‘houses’. Each house has its own lounge, kitchen and dining area with people’s bedrooms and shared bathrooms close by. Each bedroom has en-suite facilities. Eighty seven people were receiving support at the time of our visit.

The inspection took place on 18 and 28 November 2014 and was unannounced.

We previously inspected the service on 21 August 2013. The service was meeting the requirements of the regulations at that time.

The home had a registered manager in place. 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.

Several people’s care plans indicated they had a court-appointed attorney in place. This was because they lacked capacity to make decisions and the court had granted permission for other people to act on their behalf. There were no records at the home to verify who people’s attorneys were and what they could make decisions about. This meant that the right people may not be involved in making important decisions about people’s care and welfare.

The provider responded appropriately to safeguarding concerns and reported these to the relevant agencies. Staff had received training on safeguarding, to be able to identify and respond appropriately to abuse.

The building was well maintained and complied with gas and electrical safety standards. Equipment was serviced to make sure it was in safe working order. Evacuation plans had been written for each person, to help support them safely in the event of an emergency.

There were enough staff to meet people’s needs. Appropriate checks were undertaken when recruiting staff, such as a check for criminal convictions and uptake of references.

We received positive feedback from healthcare professionals about how the home met people’s health needs. We found staff followed safe practice in relation to management of medicines.

New staff received appropriate induction, training and support to provide them with the skills and knowledge to meet people’s needs. Staff were clear about their roles and told us they felt supported.

People were supported to eat their meals in a gentle and unrushed manner. There was mixed feedback about standards of food. Some people said they enjoyed the meals and provided comments such as “Very good food. We have a choice of two options, I’ve nothing to grumble about” and “The food’s quite good.”

There was positive feedback about standards of care. Comments included “Everybody gets wonderful attention,” “It’s a marvellous place, friendship and kindness from everybody,” “They (staff) are good, kind, I am well fed with good food and kept warm” and “Very good staff interactions, not just talk, they care.”

Staff respected people’s privacy and dignity; sensitive information was kept confidential and only shared with those who needed to know.

There were regular residents’ meetings where people were asked for their views and kept up to date with developments.

Care plans had been written for each person, detailing the support they required and their preferences for their care. A social care professional provided positive feedback on the reviews they had conducted for 30 people this year.

There were varied and regular activities. People told us there were always activities available to them and we saw posters around the building informing people what was on offer.

People had access to the procedures for providing feedback and their complaints and concerns were handled appropriately.

There was regular monitoring and auditing of the service. Senior managers visited the home each month to assess the quality of care and there were also themed audits on topics such as medicines practice, infection control and care, treatment and support. Additionally, a comprehensive annual quality assurance audit had been carried out in July this year by the provider.

Records were well maintained at the home and those we asked to see were located promptly. Staff had access to general operating policies and procedures to provide up to date guidance.

The registered manager had made appropriate notifications to us about incidents and from these we were able to see what action had been taken.

We found a breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was in relation to gaining consent from people. You can see what action we told the provider to take at the back of the full version of this report.