This inspection was carried out on 05 and 06 November 2018 and was unannounced. Our previous comprehensive inspection of the home in April 2018 had placed the home in special measures and had rated the service as ‘inadequate’. We carried out this inspection as we needed to check that improvements had been made to the quality and safety of the service.

James Nugent 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. James Nugent Court is a modern-purpose built home. It has 56 bedrooms with en-suite accommodation situated over three floors. Each floor has a lounge, dining and kitchen area. The building had hairdressing facilities, coffee shop and landscaped gardens and car parking is provided at the front of the building. At the time of inspection James Nugent Court was providing care for 46 people.

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 service did not have a registered manager in post. However, a ‘turnaround’ manager was in post and a nominated individual who was the providers representative was heavily involved in the home.

At our last comprehensive inspection of the home in April 2018 we found a number of breaches of the Health and Social Care Act 2008, which were related to consent, safe care and treatment, good governance and staffing. We had also identified a breach of Regulation 18 the Care Quality Commission Registration Regulations regarding notifying of significant events. We found that improvements had been made in the majority of these areas but further improvements were required. However, in response to the improvements that had been made we took the home out of special measures.

During our last inspection we found that the medication procedures were not managed effectively as there were medications not administered correctly as prescribed. At this inspection we found that although there were improvements in some areas of medication management, there was still significant concerns.

This is a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 12 safe care and treatment.

During our last inspection we found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. At this inspection we found improvements had been made in regard to mental capacity assessments, DoLS and consent. The manager was also holding best interest meetings for those people who needed them.

During our last inspection we also found concerns regarding risk assessments, personal emergency evacuation plans, care plans and health monitoring information. At this inspection we found improvements had been made in each of these areas and they were now person centred and the information held was up to date and regularly reviewed. However, we identified that staff held knowledge about people’s care that was not recorded in the care plan and in some cases the monitoring information had not been fully completed.

During our last inspection we had identified that staff support such as induction, training and supervision was inadequate. At this inspection we found improvements had been made and staff were receiving support to carry out their work, however we saw that although mediation training had taken place we could not be certain of the effectiveness of this training due to our findings in relation to medication management

We had previously found that accidents, incidents and complaints had not been managed appro

We carried out an unannounced inspection of James Nugent Court on 23 and 26 April 2018.

James Nugent 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. James Nugent Court is a modern-purpose built home. It has 56 bedrooms with en-suite accommodation situated over two floors. At the time of inspection James Nugent Court was providing care for 49 people.

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 manager in post was going through the process of registration with the Commission.

During our inspection, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulations 11 consent; 12 safe care and treatment; 17 good governance and 18 staffing. We also identified a breach of Regulation18 the Care Quality Commission Registration Regulations regarding notifying of significant events. You can see what action we told the provider to take at the back of the full version of the report.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. We saw that mental capacity had not always been assessed appropriately, consent had not always been sought, covert medication processes had not been followed and DoLS conditions that were to be applied by the home had not been carried out.

The medication procedures were not managed effectively as there were medications not administered correctly as prescribed. Equipment was not monitored to ensure it was working appropriately.

Accidents, incidents and complaints had not been managed appropriately. Audits of the service were ineffective and in some cases not carried out.

People received support with their health care. However care plans and risk assessments had not been updated accurately and in some cases contained contradictory guidance that if followed would pose a risk to people's health and safety. People’s personal emergency evacuation plans did not match their risk assessments.

Monitoring information for peoples care such as fluids and nutrition intakes had not always been completed and in some cases had been duplicated with differing information. Information from other professionals such as dieticians had not been transferred into care plans.

We saw no evidence of a robust induction process into James Nugent Court and we questioned the effectiveness and validity of the training staff had received as we identified serious concerns with the service. Supervisions and appraisals had not regularly taken place.

The manager had reduced the number of agency staff being used however feedback we received from people using the service, relatives and staff all indicated there were still issues regarding staffing levels.

People we spoke with told us they felt safe at the home and they had no worries or concerns. People’s relatives and friends also told us they felt people were safe. We observed staff to be kind and respectful towards people. The home provided a range of activities to occupy and interest people

Infection control standards at the home were good and these standards were commented on by both people living in the home and their relatives.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powe

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

People had been cared for in an environment that was safe as the building was newly built and well maintained. There was the opportunity for people living at the home and others to express their views and opinions of the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. During the inspection we saw evidence that the correct procedures had been followed in ensuring that an individual who lived in the home had been detained under a Deprivation of Liberty order.

Each person living at the home had a Personal Evacuation Plan detailing how they could be moved out of the building quickly in an emergency and this was kept in their care file.

A member of the management team was available on call in case of emergencies.

Is the service effective?

People had access to a range of healthcare professionals some of which visited the home. They were referred correctly to the appropriate professionals when their needs changed

Relatives who we spoke with of people who lived at the home and others told us that they were happy with the care provided and felt the needs of the people who lived there had been met. It was clear from what we saw and from speaking with staff that they knew the people living there well.

Is the service caring?

People were supported by staff who were kind and respectful and we saw evidence of this during the inspection. An example was explaining to people what they were going to do and working at the pace of the individual. One relative told us that they were always kept informed when their relation had been seen by the G.P. Others told us that ''The staff are absolutely brilliant and they go the extra mile.'' and '' Staff have been very involved in settling my relative in to the home.''

Is the service responsive?

Before moving in to the home the manager or a senior member of staff visited with the individual to determine if they could meet their needs and respond to their health needs and preferences for their everyday lives such as taking a nap and sleeping with a light on. We saw that people were appropriately referred to relevant health professionals when their needs had changed.

Is the service well-led?

The home had a registered manager in post which indicates that the person is of good character, is physically and mentally fit and has the necessary qualifications, skills and experience.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People were asked for their feedback on the service and staff told us that they felt well supported to deliver good care.

This inspection took place on 07 and 08 January 2016 and was unannounced.

At our last comprehensive inspection of this service on 07 and 08 January 2015, we found breaches of legal requirements. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to medicines management, meeting nutritional needs and consent to care and treatment. At this inspection we saw these actions had been completed.

James Nugent Court is a modern, purpose built home in Liverpool close to many local amenities including Sefton and Princes Parks and public transport links. It has single bedrooms with en-suite accommodation situated over two floors and includes hairdressing facilities, coffee shop and landscaped gardens. Car parking is provided at the front of the building. Residential care is provided for older people including those who have dementia and the home is registered for 56 people. At the time of our inspection, there were 47 people living in the home.

The home required a registered manager and the current registered manager had been in post since February 2015. 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 atmosphere in the home was warm and pleasant and both the people living there and the staff told us that the home had improved a lot in the last year.

Staff were recruited with safe recruitment processes and received safeguarding training. Medication administration was improved but we saw that the medication trolley was left unlocked and that keys to the medication room were used by staff who gave them to other staff not entitled to have them.

People and relatives told us that the home was caring and we saw that staff treated them with courtesy and respect.