We carried out an unannounced inspection of the service on 31 January 2017. James Hince Court Residential Care Home for Older People is registered to accommodate up to 45 older people who require nursing or personal care. At the time of the inspection there were 30 people using the service. The majority of these people were staying at the home for short periods of time on respite or were receiving rehabilitation support for physical conditions. A small number of people were living at the home for full time.

On the day of our inspection there was 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.

Staff could identify the potential signs of abuse and knew who to report any concerns to. Risks to people’s safety were continually assessed and reviewed although a small number of these required updating. There were enough staff to keep people safe and to meet their needs. People’s medicines were managed safely, although the way people liked to take their medicines was not recorded. Protocols for the safe administration of ‘as needed’ medicines were in place for most but not all of these medicines.

People were supported by staff who completed an induction prior to commencing their role. They had the skills and training needed and their performance was regularly reviewed to enable them to support people effectively.

The principles of the Mental Capacity Act (2005), including Deprivation of Liberty Safeguards, had been followed when decisions were made about people’s care. People were supported to maintain good health in relation to their food and drink and the majority of people liked the choices that were available for them. People’s day to day health needs were met by staff and referrals to relevant health services were made where needed.

Staff were kind, caring and compassionate and responded quickly to people when they showed signs of distress or had become upset. Staff understood people’s needs and listened to and acted upon their views. People’s privacy and dignity were maintained. People felt staff treated them with respect. People were involved with decisions made about their care and were encouraged to lead as independent a life as possible. This included extensive physiotherapy sessions to improve independence for people who were planning to return home. People were provided with information about how they could access independent advocates. People’s friends and relatives were able to visit whenever they wanted to.

There were limited opportunities for people to take part in the activities that were important to them. People living at the home had detailed person centred care plans in place that recorded their preferences and likes and dislikes. For people on shorter term stays this information was limited. People’s care records were reviewed, but some had not been updated as regularly as others. People were provided with the information they needed if they wished to make a complaint and they felt their complaint would be acted on.

The registered manager led the service well and was respected and well-liked by all the people we spoke with. People were encouraged to provide feedback about the quality of the service and this information was used to make improvements. The continued development of staff and the registered manager’s performance was a key aim of the provider. Quality assurance processes were in place to ensure people and others were safe in the home.

We carried out an unannounced inspection of the service on 3 March 2016. James Hince Court Residential Care Home for Older People is registered to accommodate up to forty five people who require nursing or personal care. The home provides long and short term accommodation as well rehabilitation services for people who require support before returning to their own homes. At the time of the inspection there were thirty four people were using the service.

On the day of our inspection there was not a registered manager in place, however an application had been received for the manager to become registered with the Care Quality Commission. A registered manager is a person who has registered with the 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.

During our previous inspection we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to a lack of robust quality monitoring processes in place to identify and act on risks to people using the service and records relating to the running of the service were not always up to date. During this inspection we saw improvements had been made.

There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided. The quality of the records used in the running of the service had improved and in the majority of cases were now up to date.

The manager was new to their post but had the experience and skills from previous roles to manage the service effectively. Staff understood their roles and responsibilities and enjoyed working at the home. Attempts had been made to involve people with the development of the service. People and relatives felt the manager was available when they needed them.

The risk to people’s safety was reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. However, some staff needed to attend refresher courses for this training. Accidents and incidents were investigated and used to reduce the risk to people’s safety. Regular assessments of the risks to people’s safety, the environment in which they lived and the equipment used to support them were carried out. However, access to the home was possible through two unlocked doors. Hot ovens used to store people’s food prior to meal times and were placed in each of the four units for up to two hours at a time, placed the safety of people at risk. People had personal emergency evacuation plans (PEEPs) in place.

People were supported by an appropriate number of staff. Appropriate checks of staff suitability to work at the service had been conducted prior to them commencing their role. People were supported by staff who understood the risks associated with medicines. People’s medicines were managed safely; however, when medicines were being administered, a member of staff, at times, left the trolley unlocked and unattended.

People were supported by staff who completed an induction prior to commencing their role and had the skills and training needed to support them effectively. However, some staff required refresher training to be completed.

The manager ensured they had recorded how the principles of the Mental Capacity Act (2005) had been applied when decisions had been made for people. The appropriate processes had been followed when applications for Deprivation of Liberty Safeguards had been made. Staff knowledge of DoLS was poor.

People spoke highly of the food and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by staff and external professionals. Referrals to relevant health services were made where needed.

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We carried out an unannounced inspection of the service on 18 June 2015. James Hince Court Residential Care Home for Older People provides accommodation for persons who require personal care, for up to a maximum of 45 people. Some of the people were living with dementia or other mental health conditions. On the day of our inspection 22 people were using the service.

On the day of our inspection there was not 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.

An application to become registered had not been received at the time of inspection. The manager in place at the time of the inspection did not work at the home full time. A team leader managed the home in their absence. We have spoken with the provider of this service and have been assured that an application will be submitted as a matter of urgency. We will monitor this until it has been completed.

People did not always have appropriate care plans or risk assessments in place to ensure staff were aware of any risks to people’s safety and how they should reduce these. Accidents and incidents were investigated. The environment people lived in and the equipment they used was monitored to reduce the risk to people’s safety.

People told us they felt safe. The risk to people experiencing abuse at the home was reduced because the staff had received training on safeguarding of adults, knew how to identify different types of abuse and who to report concerns to. There were enough staff to meet people’s needs. People told us staff responded to their requests for support quickly. People’s medicines were managed, stored and administered in a safe way, although some care plans did not always reflect the way people currently received their medicines.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Mental capacity assessments and best interest decisions had been recorded appropriately in some, but not all, cases. Applications for DoLS had been made for the majority of people where required, although there were some examples where the applications had been completed but not submitted to the authorising body.

People were supported by staff who were trained and knowledgeable. However some staff required refresher training in some areas, such as moving and handling. People and their relatives spoke positively about the staff and the food provided. Staff understood how to ensure people received a healthy, balanced diet that met their needs. People were able to access their GP and other external healthcare professionals. External healthcare professionals spoke positively about the care provided by the staff.

People were treated with kindness and respect by the staff. People’s dignity was maintained and where people became distressed staff responded to them quickly and offered reassurance.

People were provided with the information they needed to access independent advice from advocacy services. People felt able to make choices about their care. People’s privacy and dignity was maintained at all times. There were no restrictions on people’s friends or relatives attending the home.

Prior to people attending the home they or their relatives discussed how they would like the care and support to be provided. There were limited activities at the home. Some people felt encouraged to follow the activities that interested them whilst others did not. People’s care plans were not always reviewed effectively or in a timely manner. A complaints procedure was available for people and staff responded to complaints raised by people in a timely manner.

People, relatives and staff were encouraged to contribute to the development of the service via meetings and informal discussions although a survey to gain people’s views had not been conducted since 2013/14. The risks to people and the service as a whole were discussed with staff and they were aware of how they could contribute to reducing those risks. The manager and the team leaders conducted audits to assess the quality of the service that people received, however they did not identify the issues that were raised within this report.

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

We previously inspected this service on 23 January 2013 where we identified concerns with regard to care planning and risk assessment for people living at the service.

We received an action plan from the provider that told us the steps they would take to rectify the identified problems.

At this visit we looked at a sample of six people's care plans in order to ensure that the correct procedures were being followed with regard to care planning and risk assessment.

We used a number of different methods to help us understand the experiences of people using the service, including talking with them and an examination of their care planning documentation. We also held discussions with visitors to the home, the registered manager and members of the care staff.

People who used the service told us that they were satisfied with the care, treatment and support programmes they received. We found that people using the service had not had their needs assessed effectively in all instances.

Records showed that people received assessment and treatment from NHS health care professionals when required.

People who used the service told us that they were encouraged to undertake a range of social activities within the home and felt their social needs were being met.

People said they were safe in the home and felt the staff would always promote their safety and welfare.

People who used the service were provided with the opportunity to comment on the quality of service provision at residents meetings and were also able to discuss any issues which were important to them with the management team.

We found that the organisation had an effective recruitment process in place which adhered to current legislative requirements. We also found that the support staff had received a training package to ensure they were competent and confident in performing their duties.

We carried out this responsive inspection because we had concerns that this service had not been visited since 2010. During our visit we spoke with a number of residents who told us that they were happy with the care and support they received from staff. One resident told us: “Staff are like friends here, this is the best place in England to live.” Another resident told us: “Staff will do anything for you; they make my visitors very welcome.

Residents told us the quality of food was good. One resident told us: “I am a picky eater, the staff always find me something to eat.” Another resident told us: ”The food is very good it always tastes nice.”

Some of the residents we spoke with told us there were limited activities they could get involved with. One resident told us: “I sometimes get bored.”

One resident told us the staff had been very supportive when their partner had died. The resident told us staff had been very sensitive and caring in their approach.

The provider had a number of ways in which residents could give feedback about the services they received. When we asked residents about this we received a mixed response.. One resident told us: “The staff regularly ask us how things are going and what needs to improve.” Another resident told us: “I have not been invited to any meeting to talk about improvements.”

We carried out this responsive inspection because we had concerns that this service had not been visited since 2010. During our visit we spoke with a number of residents who told us that they were happy with the care and support they received from staff. One resident told us: “Staff are like friends here, this is the best place in England to live.” Another resident told us: “Staff will do anything for you; they make my visitors very welcome.

Residents told us the quality of food was good. One resident told us: “I am a picky eater, the staff always find me something to eat.” Another resident told us: ”The food is very good it always tastes nice.”

Some of the residents we spoke with told us there were limited activities they could get involved with. One resident told us: “I sometimes get bored.”

One resident told us the staff had been very supportive when their partner had died. The resident told us staff had been very sensitive and caring in their approach.

The provider had a number of ways in which residents could give feedback about the services they received. When we asked residents about this we received a mixed response.. One resident told us: “The staff regularly ask us how things are going and what needs to improve.” Another resident told us: “I have not been invited to any meeting to talk about improvements.”