About the service: Latimer Court is residential care home that provides personal care and nursing for up to 80 people aged 65 and over. At the time of the inspection 51 people were living at the home, some of whom are living with dementia.

People’s experience of using this service:

¿ People’s safety was promoted by staff who were trained to recognise signs of potential abuse and how to manage and report any situations in which people may be at risk.

¿ People were provided with the care they needed because the provider had systems in place, which were regularly reviewed, to ensure there were enough staff with the right skills and knowledge.

¿ People received their medicines safely and staff understood each person's abilities and health needs.

¿ People benefitted from living in a clean and well-maintained home where staff worked as a team to reduce the risks of infections spreading by using the resources and equipment provided to do this.

¿ People and their relatives told us staff knew people’s care preferences well, and supported people in the ways they preferred.

¿ People were supported with good nutrition and were able to access appropriate healthcare services when they had needed.

¿ People were supported to have control and choice over their lives and staff supported them in the least restrictive way possible.

¿ Staff had a caring approach towards people where respect was shown by staff to promote people's privacy and dignity.

¿ People were supported to keep in touch with others who were important to them.

¿ People were supported to take part in different leisure activities and the registered manager was acting to continual improve people’s opportunities to have fun and follow their interests.

¿ People, their relatives, staff and other health and social care professionals were encouraged to make any suggestions for improving the care provided and the service provided further.

¿ People and staff had noticed improvements had been made since our last inspection and how a culture had developed whereby care was now centred around each person.

¿ The registered provider maintained systems to monitor and continuously improve the quality of services provided for people.

Rating at last inspection: Requires Improvement. The last report for Latimer Court was published on 7 November 2017.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The rating has improved to Good overall.

Follow up: We will continue to monitor the service through the information we receive until we return, as part of the inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 4 July 2017 and was unannounced.

The home provides nursing and personal care for a maximum of eighty people. There were 32 people requiring support when we visited the home. A registered manager was in post when we inspected the service. 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.

The home was previously inspected on 7th October 2016 where we found concerns and the home was placed in Special Measures for six months. At the last inspection on 7 October 2016, we asked the provider to take action to make improvements to staffing levels, training and support for staff, the ways in which people’s care was planned, reviewed and monitored, their response to complaints and the overall management of the home. This action has been completed. At this inspection we found there were improvements.

People told us they felt safe and knew the staff supporting them. People felt assured that the continuity of staff meant that nursing and care staff understood their health conditions and the associated support they needed. The number of agency staff used by the provider had reduced since the last inspection and there was a permanent team in place that worked within dedicated areas of the home. Staff understood how to keep people safe and protect them from the risk of harm. Staffing levels were reviewed to ensure people’s assessed needs were met. Background checks were completed on staff to assure the registered provider of their suitability to work at the home. People received support take their medicines as they should.

People were supported by staff that had access to training and guidance to ensure they had the skills to understand people’s needs. People had confidence in the staff supporting them. People were offered a choice of food and drinks although some people had not always liked the food. The management of the home were working to improve people’s experience at mealtimes. People had access to healthcare professionals who supported them to maintain their wellbeing.

People knew and liked the care staff supporting them and valued the continuity of staff. People felt staff understood their care needs and how best to support them. Relatives knew staff and were able to get feedback from staff about how their family member had been cared for. People were treated with dignity and respect and encouraged to maintain their independence.

People’s care needs and preferences were reviewed regularly and updated so that they received care that met their expectations. People told us there had been a recent improvement in the activities available to people and that they were encouraged to take part in activities and interests they liked and. People understood that there had been changes in the staff supporting them with their activities. People felt assured their thoughts and feeling about the service were being listened to and acted upon. People were offered a number of different ways to share their thoughts about the care they received.

People and staff knew and liked the registered manager and there had recently been stability within the leadership of the home. The registered manager had made a commitment to improving staff morale and people’s experience of care within the home. The clinical lead, the activities coordinator and chef were all new to the home and were working to improve and sustain improvements within the home. The improvements made so far reflect the current reduced occupancy at the home and this will need to monitored to ensure people’s care and experience remain positive and sustainable as the occupancy increases.

This service has been in Special Measures. Services that are in Special Measures are k

The inspection took place on 7 October 2016 and was unannounced.

The home provides accommodation for a maximum of 80 people requiring nursing and personal care. There were 51 people living at the home when we visited. People living within the home lived within one of four units. The units were named the Beaufort, Grosvenor, Woodbury and Avalon Units. People with higher or nursing needs were living within the Avalon and Grosvenor Units. The Beaufort and Woodbury Units were regarded as residential units.

A registered manager was not in post when we inspected the service as they had recently left. 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. The registered provider was seeking to recruit a replacement manager. A general manager employed by the registered provider was managing the home in the interim. A further general manager was due to join the home shortly with the aim of applying to become the registered manager.

People living at the home were supported by a number of different agency staff that they were not always familiar with and who they were not certain understood their support needs. The registered manager told us they had recently begun to employ the same nurses in order to assure themselves of nurse’s competency skills. The registered provider had lost a number of key staff, including the registered manager within the recent months and this had exacerbated people’s concerns.

People and their families sought continuity of care through regular staff and a permanent registered manager. The registered provider did not ensure people had access to regular staff and there was a dependency on a number of different agency staff. Since this Inspection, the registered provider told us they had put in measures to retain the same agency staff whilst also actively recruiting permanent staff in an attempt to aid consistency.

The registered provider had established a system for people and families to contribute to care planning but this was not in operation. People and their families did not have faith in the system because people were not able to share their ideas about care planning. People did not have a named member of staff they could direct their queries to.

People did access a GP or other professionals when they required. People were also supported to make choices about the meals and the food they ate. People requiring support with their meals were offered this.

People did not always participate in activities they would like to pursue because the home had lost the services of an Activities Co-ordinator. We saw that a new Activities Co-ordinator had been recruited and had commenced work.

People and their families understood how to complain but had grown frustrated at the process. A number of key staff had left the service, including the registered manager, and relatives had instead contacted the Care Quality Commission to seek redress. People and their families did not feel there was a commitment to leadership within the home or to keeping in communication with them. A meeting with family members had been cancelled and this had added to a sense of frustration.

People living at the home had seen a number of different managers join the home and then leave after a short period of time which had caused uncertainty and anxiety. Staff sought strong leadership, support and direction but were not able to access this.

A number of systems within the home required the input from either the manager or clinical lead to ensure their effectiveness could be maintained. When the registered manager left, systems were not maintained which affected people’s care and their confidence in the running of the home.

Systems in place

The inspection took place on 10 and 12 May 2016 and was unannounced.

The home provides accommodation for a maximum of 80 people requiring personal care. There were 54 people living at the home when we visited. A manager was in post when we inspected the service and who had applied to become the registered manager of the home. 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.

People told us they felt safe at the home and that they received care and support when they required it. Whilst staff understood how to keep people safe and recorded any concerns they had appropriately, senior staff did not always escalate concerns.

People had access to support from staff when they required it. However, staff did not feel there was sufficient staffing.

People received their medications as directed and staff administering medicines knew the people they were supporting and how they required their medication. Medicines were stored and disposed of appropriately.

Staff received training that helped them to understand how to care for people.

People’s consent was obtained by staff. People who could not make decisions for themselves were supported by staff within the requirements of the law. Staff understood how people were affected and people and their families were involved in the decision making process.

People liked the staff and felt that staff understood their needs because the same staff regularly supported them. Staff included them in decisions about their care and explained what they were doing when supporting them.

People were treated with kindness, dignity and respect. Staff training had been updated and regular checks were made to ensure staff continued to care for people appropriately.

People’s individual preferences were known to staff and these had been recorded. People were supported to participate in activities. People’s care was updated in response to their changing care needs.

People and their families understood they could complain. When people had shared their concerns, these had been listened to and responded to. Complaints were logged onto the registered provider’s online system and responded to in line with their policy.

A permanent manager had been appointed to manage the home and several interim managers had also covered the vacancy. Whilst staff noted there had been improvements to the support and direction they received, staff did not always feel valued. Mistakes by staff in how some incidents had been handled were also noted whilst interim governance arrangements were in place.

Although governance arrangements had been improved, it was not yet possible to say how effective they were. As the manager had only been at the home a short time, we could not test how the manager understood and implemented the registered provider's systems for monitoring and managing people’s care.

Following the last inspection the service was rated as inadequate and placed in to special measures. At this inspection the service had demonstrated improvements and is no longer rated as inadequate in any of the five key questions, therefore it is no longer in special measures.

One inspector carried out this inspection. We spoke with four people that used the service, two relatives, seven staff, the registered manager and the regional operations manager. 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?

People we spoke with told us that they felt their relatives who used the service were safe and their needs were met by staff that knew them. One staff member also told us that they felt people were safe and their needs were met.

Following our last inspection we found that improvements had been made to how risks were managed. Increased staffing meant that any risks could be managed more effectively. For example it was easier for people to get the correct amount of support to reduce the risks of falls and injuries. Staff told us that they felt this had improved the levels of care and time that could be given to the people that used the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that DoLS for some people had been reviewed and there were proper policies and procedures in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

We checked the medicines of people who used the service. We found that medicines were stored and administered safely.

Is the service effective?

We observed that people received appropriate care to meet their physical needs and maintain their comfort. All the staff we spoke with told us about the individual needs of the people that used the service. At the last inspection it was found that at times people did not always receive care when it was needed. During this inspection we found that improvements had been made to the amount of staff on duty. This meant that people had their needs met at an appropriate time. People did not have to wait for help or support with their care. This enabled people’s needs to be met more effectively.

Is the service caring?

We observed that staff were kind and polite. We found that staff treated the people who used the service with dignity and respect. All the staff we spoke with were able to tell us about people’s individual likes and dislikes. People’s wishes had been respected. For example, we saw where one person indicated they wanted to have their food in a particular area of the home. We saw that staff respected this.

Is the service responsive?

We found that the care records showed that people that used the service saw other professionals including the district nurses and doctors when their health needs changed. The provider had acted appropriately to guidance from other professionals when people’s needs changed. People told us that they felt if their relative’s needs changed the staff were always quick to respond and contact other professionals. For example, following a change in a person’s mood we found that a referral for the community mental health team had been made to provide additional support and training around their individual needs.

At our last inspection we found that there was not an effective system in place to ensure that risks were identified and actioned appropriately. During this inspection we found that improvements had been made. There were now further checks by the registered manager and clear actions had been taken when risks or improvements had been identified.

We found that there was a complaints system in place that ensured that people were listened. We found that following any concerns or complaints the provider had taken action to ensure that complaints were resolved appropriately.

Is the service well led?

At our last inspection the provider did not have any systems in place to effectively monitor the quality of the service. For example, it was not clear how actions for improvements were monitored to ensure that action had been taken within an appropriate period of time. During this inspection we found that improvements had been made. Regular audits and clear action plans showed that the provider had taken steps to ensure that the quality of the service was constantly monitored and improved.

We found that staff felt that the management of the home was positive, and staff told us that they felt supported in their roles.

The inspection took place on 23 and 24 November 2015 and was unannounced.

The home provides accommodation for a maximum of 80 people requiring nursing and personal care. The home is also registered to provide nursing care for people who require some additional support. There were 61 people living at the home when we visited. A registered manager was in post when we inspected the service but was not available. 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.

People at the home resided in one of four units. People’s experience of care varied depending on where they lived within the home. People’s experience was also affected by the level of care they required. People who were more independent , were more likely to receive a better experience of care. People requiring more support, were less likely to receive this.

People did not always feel safe because there were insufficient staff to care for them. Of the staff that were available to them, many were agency staff who people felt did not always understand or know their needs.

People did not always receive their medication on time because the medication round took longer than necessary. Agency staff were unfamiliar with people’s needs which caused the delay and people requiring gaps between medicines did not always receive these.

Staff were not supported. Staff described an absence of supervision meetings that would have enabled them to raise issues of concerns. Although the interim manager discussed issues they needed staff to be certain of, there was no evidence to demonstrate staff could participate in two way discussions.

People’s consent was obtained by staff. People who could not make decisions for themselves were supported by staff within the requirements of the law. However, people and their families had not always been involved in the discussion making process.

People enjoyed the food and were able to choose from a menu. Although people received support to have their meals, this impacted on when people ate. Some people experienced delays in receiving their meals as they waited their turn for staff to support them with their meal.

People’s health needs had not always been assessed regularly but the interim manager described a new system of working with the GP and clinical lead which would mean people’s needs would be better understood by staff caring for them.

People liked the staff who cared for them, however people felt the inconsistency of care staff made it difficult for staff to understand their care needs. People’s privacy and dignity was not respected and people were not involved or supported to make choices about their care

Staff we spoke with told us they raised concerns that were not responded to and a formal mechanism for allowing staff to raise issues or discuss concerns did not exist.

The registered provider had not made adequate provision to ensure that they monitored how the registered manager managed the home. Staff changes meant that regular checks of the home did not happen and concerns were only raised when an interim manager took over the day to day running of the service. Gaps in monitoring the continuity of people’s care meant that people did not receive person centred care and people’s needs were not fully understood by either the registered manager or the staff.

Systems in place to assess and monitor the quality of the service provided were not effective. We found multiple breaches of the regulations. The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This

will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of

inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. You can see what action we told the provider to take at the back of the full version of this report.