The inspection took place on 28 March 2017 and was unannounced.

Kingsbury Court opened in April 2015 and provides accommodation, care and support for up to 60 people, some of whom may be living with dementia. The service is registered to provide nursing care although this area of the service had not commenced at the time of our inspection. The registered manager told us that nursing staff had been recruited and they anticipated that nursing care would be provided within the next two months. There were 34 people living at Kingsbury Court at the time of our inspection.

There was a registered manager in post who supported us during our 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.

At our last inspection on 11 August 2016 we identified five breaches of legislation relating to staffing, safe care and treatment, person centred care, complaints management and good governance. Following the inspection the provider wrote to tell us what they would do to meet the legal requirements in relation to the above concerns. At this inspection we found that improvements had been made in all areas which had made a positive difference to the people they support.

There were sufficient staff deployed to meet people’s needs safely. Staff had time to spend with people and the registered manager completed regular reviews of people’s needs and adjusted staffing levels where required. New staff completed an induction process which included shadowing more experienced staff members to help them understand their roles. Staff received regular training and supervision to ensure they had the skills required to meet people’s needs. Competency checks were regularly completed as part of staff induction and on-going supervision. Safe recruitment processes were in place to ensure people received support from suitable staff.

Risks to people’s safety and well-being were assessed and control measures were in place to help minimise risks. Staff were aware of how to support people to manage risks safely. Accidents and incidents were recorded and monitored to identify any trends and minimise the risk of them happening again. Staff were aware of their responsibilities in safeguarding people from potential abuse and any concerns were appropriately reported. The provider had a contingency plan in place to ensure that people’s needs would continue to be met in the event of an emergency or if the building could not be used.

Safe medicines practices were practised and people received their medicines in accordance with their prescriptions. Staff competency in managing medicines was regularly assessed. People’s healthcare needs were known to staff and appropriate referrals were made to healthcare professionals where required.

People’s legal rights were protected as staff were acting in accordance with the Mental Capacity Act 2005. Staff gained people’s consent prior to delivering care and understood the need to offer choices and respect people’s decisions. People told us they were involved in decisions regarding their day to day care.

People were supported by staff who knew their needs well and provided personalised care. People and their relatives told us that staff were caring and treated them with kindness. Care plans were person centred and contained details of people likes and dislikes. Staff supported people to maintain their independence and respected people’s privacy and dignity. People told us they enjoyed the food provided and choices were available. People’s nutritional needs were met and the catering staff were informed of people’s needs and preferences. People’s weight was monitored and appropriate action taken where significant changes were identified.

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Kingsbury Court opened in April 2015 and provides accommodation, care and support for up to 60 people, some of whom may be living with dementia. The service is registered to provide nursing care although this area of the service had not commenced at the time of our inspection due to a staggered approach to opening the service.

The inspection took place on 11 August 2016 and was unannounced.

There was no 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 and associated Regulations about how the service is run. A manager had recently started work at the service and supported us throughout the inspection. They told us they had begun the process of registration with the Care Quality Commission (CQC) and our records confirmed this

Sufficiently skilled staff were not provided throughout the service. There was a high level of agency staff used which impacted on the care people received. The manager told us that a number of staff had recently been recruited and were currently under-going recruitment checks prior to starting work. There was a lack of leadership throughout the service which led to staff not being deployed in an organised manner to ensure people were supported safely. Staff did not receive the induction and support they required to enable them to provide effective support to meet people’s needs. Risks to people’s safety and well-being had been identified although control measures to reduce risks were not always followed.

Care plans were completed and regularly reviewed although these were found to be repetitive and did not always provide guidance to staff in how to provide people’s care. Agency staff did not have access to people’s care plans and did not have access to personalised information about the people they were caring for. Where this information was provided we found that people received care in line with their preferences. People received health care support when required although relatives told us that communication in addressing healthcare needs had led to delays in their family members receiving the support they required. We have made a recommendation regarding this.

Suitable arrangements were not in place to ensure that medicines were managed safely. Gaps were present in some medicine recording and staff did not sign records immediately following administration. Guidance for staff in the administration of ‘as and when required’ medicines were not in place and staff told us they did not always feel confident when administering medicines to people.

People, relatives and staff told us that due to a number of changes in the management of the service there was a lack of communication and leadership. They told us the new manager appeared confident and was listening to concerns. Regular audits were completed to monitor the quality of the service provided. However, where actions were identified these were not always addressed in a timely manner.

There was a system in place to deal with people's comments and complaints however we found that a number of complaints had not investigated, recorded and dealt with in line with the provider’s policy.

Staff received trained in safeguarding adults and knew how to report any concerns. They were aware of the whistleblowing policy and how to access guidance. Accidents and incidents were monitored and action taken to minimise the risk of reoccurrence. Safety checks on the environment and equipment used were completed regularly.

The provider’s recruitment procedures were robust, which helped to ensure that only suitable staff were employed. Staff completed mandatory training to support them in their role.

People told us that the quality of food was good and a choice was always available. People were supported to maintain