Fives Court is a care home which provides accommodation and personal care for up to 31 older people, some who are living with dementia. At the time of our inspection 24 people were living at Fives Court.

This inspection took place on 14 and 15 March 2017 and was unannounced.

There was a 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 2008 and associated Regulations about how the service is run.

At the last comprehensive inspection in October 2015 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection the provider sent us an action plan to address these issues.

People told us Fives Court was a good place to live. Comments included, “I have lived here three years and can’t think of any improvements” and “I like living here".

Relatives told us staff were always welcoming. Comments included “When we first came here, they were so good. They explained everything to us” and “There is always staff around. It is nice. You can visit anytime”.

People received care from staff who had got to know them well. We saw that people were treated with kindness and compassion in their day to day care.

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

Care and support plans were detailed but not always person centred. People’s needs were reviewed regularly and as required. The registered manager had identified this and had planned how to improve the care plans.

People had a range of activities they could be involved in. In addition to group activities staff provided individual support as required.

Staff had a good understanding of how to keep people safe and their responsibilities for reporting any concerns they had. Risk assessments were in place to protect people from the potential risk of harm or abuse.

There were safe medicine administering systems in place and people received their medicines when required. People’s care records showed relevant health professionals were involved with people’s care. People’s changing needs were monitored to make sure their health needs were responded to promptly.

Staff were aware of people’s dietary requirements. Where required people had access to specialist diets and guidance was in place to ensure staff met these needs accordingly.

People were supported by staff who received training and support to maintain their skills and knowledge. The service followed safe recruitment practices to ensure staff were of good character and suitable for their role.

There were quality assurance systems in place which enabled the provider and registered manager to assess, monitor and improve the quality and safety of the service people received. A system was in place for people and their relatives to raise their concerns or complaints. Any complaints were investigated promptly by the registered manager.

This inspection was undertaken earlier than scheduled, as we received some information of concern about the care being provided at the home.

People told us they were happy with the care they received.

People looked well cared for. Their rights to privacy, dignity and choice were promoted.

Staff spoke to people in a caring and respectful manner and were attentive to their needs.

People had good support from local health care professionals and were very much part of the local community.

Staff administered people’s medicines in a safe manner.

Exisiting staff members and agency staff were covering staff vacancies so there were sufficient numbers of staff on duty at all times.

Records in terms of the day to day management of the home were ordered and well maintained.

The home was without a registered manager. The head of care was managing day to day matters and a registered manager from another care service within the organisation was spending two days a week at the service. The area operations manager told us they contacted the service on a daily basis to ensure all areas were running satisfactorily.

We spoke with six people and one visitor during our visit. We also observed care given to eight people in the lounge areas. People told us they liked living in the home and were respected by staff. One person told us “I just say what I want” about the care they were given, another “you find me somewhere better” about the home and another “when I ring for assistance, they come fast”. People said they liked the staff. One person told us “the staff are wonderful to me”. We observed staff cared for people respectfully, including people who showed complex behaviours. Records about care reflected what we were told and what we observed.

The home has effective systems for ensuring quality of care. All of the home was clean and where improvements were needed in the home environment, there were plans in place to show when these improvements would be made. We spoke with five of the care workers, a laundry worker and a maintenance worker. Staff told us they were supported to provide people with the care the needed. One member of staff told us about training “every subject you do is useful” and another described their dementia care training as “really interesting”.

Fives Court is a purpose built single storey care home service, registered to provide personal care and accommodation for up to 31 older people. The service is part of The Orders of St John’s Care Trust; a large provider of care services.

The inspection was unannounced and took place over on 20 and 21 October 2015.

The service had a registered manager who was responsible for the day to day running 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 2008 and associated Regulations about how the service is run.

Effective arrangements for people who were able to give consent were not always in place.

The MCA sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected in relation to consent or refusal of care or treatment. CQC is required by law to monitor the application of the MCA and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require care home providers to submit applications to a ‘Supervisory Body’; the appropriate local authority, for authority to do so.

We found that the service had not  made some of necessary applications to the local authority for DoLS authorisations to protect people from being deprived of their liberty without lawful authority.

Refrigerated medicines were not stored safely at the time of the inspection; otherwise management of medicines was safe.

There was also a system for auditing incidents and accidents the purpose of which was to improve the quality and safety of the service. However, we found that the analysis of accident and incidents did not show a reasonable level of investigation and action.

Although risk assessments and management plans were in place they did not always contain up to date information or provide clear guidance to staff on the support people needed. This may have impacted on people’s safety and well-being.

The service did not always have individualised protocols in place to guide staff on how to support people with specific health conditions such as diabetes.

Staff were aware of their safeguarding responsibilities and showed positive attitude to this, and also to whistleblowing.

The premises were safe, clean, homely and well maintained. There were sufficient numbers of staff to meet people’s needs.

There were effective management systems in the home that provided staff with clear lines of responsibility and accountability. The service had systems in place to keep staff up to date with best practice and to drive improvement and promote safety.

We have made a recommendation about more specific auditing of compliance with the MCA and analysis of accident and incident reports which can be found in the full version of this report.

There was a complaints procedure in place; the service had received no complaints and many compliments this year which reflected people’s very high level of satisfaction with the service.

Staff acted in a caring manner; we observed they treated people with warmth and humour; they spoke to people with respect, and asked before carrying out care. People who use the service were helped to make choices and decisions about how their care was provided.

Each person who uses the service had their own personalised care plan which promoted their individual choices and preferences. People were assisted to go out into the community to enjoy leisure time and also to attend health appointments.