We carried out an unannounced comprehensive inspection of Stradbroke Court on the 11 and 19 October 2017. This was in response to our previous comprehensive inspection on the 20 and 28 April 2017, where we rated this service as inadequate and placed it in ‘Special Measures’.

During our inspection on 20 and 28 April 2017 we found there were six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Improvements were needed regarding safe management of medicines, infection prevention and control systems, staffing arrangements, safe care and treatment, person centred care and good governance.

We undertook enforcement action placing two positive conditions on the provider’s registration. One condition was to restrict admissions to the service and the other condition was for the provider to submit to CQC a monthly report of the actions taken to improve the quality of the service regarding safe management of medicines and infection prevention and control.

Following our inspection on 20 and 28 April 2017, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, caring, responsive and well-led. The provider submitted an action plan to us about the measures they were taking to address the concerns found at the previous inspection. This included unsafe management of medicines, inconsistent staffing arrangements, shortfalls in records, poor infection prevention and control systems, ineffective oversight and governance arrangements, not responding appropriately to people’s feedback including concerns, ineffective systems to reduce the risks of dehydration and poor quality of care provided. We received the provider’s monthly progress reports in relation to medicines and infection prevention and control measures. We also received regular updates on the provider’s action plan which told us the provider was making the improvements needed.

This service had been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall. Therefore, this service is now out of Special Measures.

At this inspection on 11 and 19 October 2017 we found no breaches in regulations, and the necessary improvements had been made. The key questions, safe, effective, responsive and caring were rated as good. Well-led has been rated as requires improvement as the measures in place to address the previous shortfalls and to provide people with a safe quality service need to be fully embedded and sustained within the service to be rated as good. In the six months since our last inspection we were encouraged by the progress made by the management team to turn the service around and have rated this service overall good and removed the positive conditions placed on the registration of Stradbroke Court.

Stradbroke 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. Stradbroke Court accommodates up to 43 people who require support with their personal care needs, some of whom are living with dementia. At the time of this inspection there were 15 people using the service.

A registered manager was 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.

There was visible leadership in the service. Systems and procedures had

Stradbroke Court provides accommodation and personal care for up to 43 people, some living with dementia. There were 28 people living in the service when we inspected on 20 and 28 April 2017. This was an unannounced inspection on both days.

At our last inspection 8 December 2016 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were concerns with safe care and treatment, person centred care, staffing and good governance. We rated Stradbroke Court ‘requires improvement’ overall. We told the provider to submit an action plan to us to let us know how they intended to address the concerns we raised. At this inspection we found that the provider had not made satisfactory improvements to ensure that they were consistently delivering a high standard of care and that the standards of care had actually declined.

Due to a number of concerns raised about the service we brought forward this scheduled inspection so we could check that people were receiving safe care. At this inspection, we found people's safety and well-being was being compromised in a number of areas.

There have been several changes of manager since our last inspection. Currently there is a manager in place but they are not registered with CQC. 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.

This inspection identified serious concerns regarding the management and leadership of the service, safe management of medicines and infection prevention and control. People were being put at risk of harm and there was insufficient governance and oversight to monitor the service. Due to management changes there had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service.

We found the home was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Four of these regulations were continued breaches from the last inspection 8 December 2016. You can see what action we told the provider to take at the back of the full version of the report.

Risks to people's health, safety and welfare were not managed effectively which placed people at risk of harm.

The systems in place to monitor the service provided were not robust enough for the service to independently identify shortfalls and address them. The service had received support from health and social care professionals and was working to address the concerns they had identified. To assist in making improvements in the service the provider’s nominated individual had recently employed the services of an external company.

Improvements were needed in the management of medicines. The service were working on addressing shortfalls identified by a health professional. In addition we identified that guidance provided to staff relating to medicines that were prescribed ‘as required’ PRN did not hold sufficient information to ensure that the risks to inappropriate use of these medicines were minimised. Medicines that were prescribed in variable doses, for example one or two tablets were not always recorded.

Improvements were needed in infection prevention and control systems. The service were working on addressing shortfalls identified by health professionals. Despite this there had been two recent outbreaks of sickness and diarrhoea in the service. In addition we identified areas within the service that were not hygienic and presented a risk to people.

There was a task led culture in the service. Improvements were needed in the deployment and organisation of staff to meet people’s needs safely and effectively. Recruitment processes were not robust.

The qu

Stradbroke Court is a residential care home for up to 43 people. The service provides care and support to people with a range of needs which include; people living with dementia and those who have a physical disability. There were 37 people living in the service when we inspected on 8 December 2016. This was an unannounced inspection.

The registered manager was no longer in post but an application to cancel their manager’s registration to CQC had not been received. Following our inspection we received confirmation the provider had submitted an application to CQC to cancel the registered manager’s registration. 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. A new manager had been appointed by the provider to run the service and was in the process of registering with the CQC.

The provider has been registered for Stradbroke Court since 4 September 2015. During this time there have been significant management changes and prior to this inspection we received a high level of concerns relating to the safety and quality of the service from different stakeholders.

Where appropriate we made safeguarding referrals or asked the provider to investigate and report back their findings In addition we chaired a multi-agency meeting with the provider’s nominated individual and the manager to discuss information of concern received about the service from a number of stakeholders. These included insufficient staffing levels, ineffective leadership and governance arrangements, unsafe medicines management and poor moving and handling practices. In addition we were made aware of serious shortfalls regarding Legionella arrangements and health and safety procedures within the service, following a visit from the food/environment safety team. At the meeting the manager shared with us their development plan for addressing the shortfalls and improving the service. We decided to inspect the service to ensure risk was being mitigated and people were safe living in the service.

During the inspection we found there were shortfalls and inconsistencies across the service which impacted on the quality of care provided. Where breaches were identified you can see what actions we have told the provider to take at the end of this report.

Infection control measures were not robust. We observed maintenance contractors carrying disconnected sluice fittings past and over people eating their lunch time meal. The care staff were not alert to the risk of infection and did not challenge or re-direct the workmen. In addition the cistern of a toilet in one of the communal bathrooms was not secure presenting a risk of infection.

There was a task led culture in the service resulting in a lack of cohesion and team work amongst staff. Improvements were required in the deployment and organisation of staff to meet people’s needs safely and effectively.

Improvements were needed to people’s care records. We were not assured that information was accurate, reflected people’s needs and their preferences.

Although staff routinely gained consent before providing care, people’s care plans did not demonstrate a clear understanding of the Mental Capacity Act (MCA) and assessment process.

The atmosphere within the service was not calm. Internal door alarms, call bells and staff communicating to each other via internal radio’s created an unsettling and disruptive environment, making it difficult for staff to hear people calling out. However we observed that call bells and requests for assistance were responded to in a timely manner.

The environment of the service required attention. Internal paintwork within the four units was peeling and chipping and the communal carpets were sticky and stai