About the service:

The service provides accommodation and personal care for up to 35 older adults and people living with dementia. There were 35 people living in the service on the day of our inspection.

People’s experience of using this service:

• Systems and processes were in place to ensure that people were safeguarded from the risk of abuse. There were sufficient qualified and competent staff to care for people. Medicines were well managed; systems and processes were in place to support this. The home was clean. Accidents and incidents were recorded and measures were taken to improve and reduce risk?

• People’s needs were assessed and desired outcomes were met. The food was nutritious and of good quality.

• Staff received the training they need to do their job well. Training opportunities for staff to develop were good.

• The service being delivered was caring and was delivered by a staff team who were kind, compassionate and thoughtful.

• The values of the organisation were clearly visible and staff actions reflected the values well.

• People were given the opportunity to express their views regularly and were involved in the planning of their care. Privacy and dignity was maintained to a high standard.

• People were receiving care that was responsive to their needs.

• Care planning captured people’s wishes and care was delivered by staff who understood the needs of the people they are supporting.

• People knew how to complain and raise concerns and were listened to.

• The registered provider had a clear vision and a strong set of values. This was embedded in the team by strong leadership who were visible, accessible and led by example.

• Processes were in place to ensure that the delivery of care was monitored and checked regularly. Governance systems identified areas for improvement and comprehensive plans were developed and actioned.

• The manager and the staff team worked in partnership with other health and social care professionals and in the community.

The service met the characteristics of Good in all areas that we inspected. More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated Requires Improvement and was published on 17 October 2017.

Why we inspected:

This was a scheduled inspection based on previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

The inspection took place on 12 July 2017 and was unannounced.

The home provides residential care for up to 36 people some of whom may be living with dementia.

There was a registered manager for the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the last inspection the home was rated as good.

At this inspection the home is still rated as requires improvement.

The provider had calculated the staffing levels needed to provide safe care to people. However, staff sickness meant that occasionally people did not receive their care in a timely fashion. The provider had systems in place to check if the staff they employed were safe to work at the home. They were in the process of improving these systems to ensure they collected a full work history when people applied to work at the home. Staff received appropriate training but assessments of skills were not always completed in a timely fashion. In addition, supervision meetings with staff had not been held on a regular basis.

Risks to people were identified and care was planned to keep people safe. However, incomplete admission assessments meant that people could not always be sure that all risks were immediately identified. People’s ability to eat safely was assessed and when needed modified textured food and supportive equipment was available. Medicines were safely stored and administered and accurate records were kept.

Audits were in place to monitor the quality of care provided and they were effective at identifying concerns. However, the improvements needed were not sustained and so similar concerns were reoccurring.

People’s ability to make decisions were evaluated and where needed people had been appropriately referred to have a Deprivation of Liberty Safeguards assessment. People were supported to make choices about their everyday lives and were offered choices with their meals and drinks.

Staff knew how to support people’s dignity and their independence was encouraged. Where people had special communication needs these were identified and staff knew how to maximise their communication abilities.

Care plans accurately reflected people’s needs and staff knew how to support people in line with the information supported in their care plan. However, care was not always recorded in people’s daily records or their monitoring charts. People were supported to access healthcare professionals when needed.

People had their views of the home gathered and the registered manager used this to improve the quality of care provided.

This was an unannounced inspection carried out on 06 May 2015. OSJCT Digby Court provides accommodation for up to 36 people who require residential or nursing care and also supports people living with dementia. There were 32 people living in the service when we carried out our inspection.

At the time of our inspection the service had a registered manager. 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 new manager had started at the service in March 2015. An application had been submitted to have their current registration with the commission updated and this location added.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves. At the time of our inspection the registered provider had made referrals to the local authority, however, no one was currently subject to an active DoLS.

People generally received their care in a timely way, however, three people said that they had to wait on occasions for their care and that staff did not have time to talk. Due to externally funded beds, the service had become increasingly busy and this had impacted on the staffing levels. The registered provider had taken action to increase staffing levels to reflect the activity. Staff knew how to recognise and report any concerns in order to keep people safe from harm. People had been helped to stay safe by avoiding accidents. Background checks had been completed before new staff were employed. People’s medicines were managed safely.

Staff had been supported to care for people in the right way and had received appropriate training. People were helped to eat a nutritious diet and drink enough to stay well. People could see, when required, health and social care professionals to make sure they received appropriate care and treatment.

People said that staff were caring, kind and compassionate and we saw good examples of this. However, on occasions we saw that staff were abrupt with people and were not kind and caring in their approach. People were not always addressed by their preferred name and were referred to as ‘sweetheart and darling’. This did not promote people’s dignity. There was a homely and welcoming atmosphere in the service and people could choose where they spent their time.

People’s care records were person centred and reflected their needs. People had been supported to access service in the local community and were involved in social activities in the service. People and their relatives knew how to raise a concern or complaint if they needed to and the registered provider had arrangements in place to deal with them.

The service was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. The manager and the registered provider assessed and monitored the quality of the service provided for people. The service had established links with local community groups which benefited people who lived in the service. People had been asked for their opinions of the service so that their views could be taken into account. Staff felt well supported by the manager.

We spoke with six people who used the service. They told us that they were happy living in the service. One person said, “They do a marvellous job.” Another person said, “I am very well provided for, it is really nice here. They (staff) do the best they can for us." Another said, "I'm looked after, fed well, nice room (bedroom), nice outlook (view from the lounge), nice staff.”

We looked at the care records of three people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights. Before people were provided with care, they were asked for their consent. We found that the service worked with other professionals involved in people's care which ensured that they were provided with a consistent service that met their needs.

We looked around the service and found that people were provided with a clean and hygienic environment to live in. Equipment used in the service was regularly checked and serviced to ensure that it was fit for purpose and safe to use.

We looked at four staff personnel records which showed that staff were trained to meet the needs of the people they supported. We saw that the appropriate checks were made on staff before they started to work in the service to ensure that they were able to work with vulnerable people.

Records seen, including people's care records and staff records were accurate and up to date.

As part of our inspection we spoke with a number of people who lived at Digby Court. They spoke positively about the care and support they received. They told us they liked living there and staff supported them to make choices and decisions about their care and treatment.

We conducted a Short Observational Framework for Inspection (SOFI 2) at lunchtime. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us as some people living in the home had a dementia.

We asked people if they were involved in decision making about their care. People told us staff had always asked them what they wanted to do. One person said, “I’m going Christmas shopping today.” Another person said, “They always find us things to do.”

We observed staff giving safe care to people. We did not see any evidence of restriction or restraint. People were spoken with in a polite manner. We saw care staff respected people at all times.

People told us they were happy with their care and staff understood their needs. One person said, “Staff treat me well.” Their relative who visited regularly said, “They have very good staff.”

People told us they felt valued and staff listened to them. We asked them if they knew how to complain if they were not happy. One person said, ”I would speak with the manager.”