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Inspection carried out on 3 October 2017

During a routine inspection

Britten Court is a care home registered to provide care to 80 older people, some of whom may be living with dementia. The service is registered to provide nursing care. The service is split into four units, two providing nursing care and the other two providing residential and dementia care.

At the last inspection on 19 May 2016, we asked the provider to take action to make improvements to the service. These included improvements to the staffing level, the personalisation of care records and the way the service monitored the quality and safety of the care people received. At this inspection we found that these actions had been completed.

At this inspection the service had made significant improvements and was no longer in breach of any Regulations. The rating for this service is now ‘good’.

The service had a registered manager in place. 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.

People and their relatives told us they felt safe and secure living in the service. Staff knew how to keep people safe and plans were in place to reduce risks to people.

Medicines were managed, stored and administered safely.

People and their relatives told us there was enough competent staff to provide them with support when they required it. The service was working on strategies to reduce the use of agency staff and increase the number of permanent care staff.

Staff had received appropriate training and support to carry out their role effectively. Staff were given opportunities to develop and improve upon their skills.

People received appropriate support to maintain healthy nutrition and hydration. They told us they had appropriate access to support from other health professionals such as GP’s, chiropodists and dentists.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Some improvements were required to ensure that capacity assessments and best interest’s paperwork were completed consistently.

People and their relatives told us the staff were kind, caring and respectful towards them. This was confirmed by our observations. People and their relatives were given the opportunity to feed back on the service and their views were acted on. However, some improvements were needed to ensure that people’s views on their care were documented in care planning and review records.

Staff we spoke with knew people on an individual basis. Care records contained enough information about people for staff to fully understand them. People had access to meaningful activities and were supported to follow their interests.

People and their relatives told us they knew how to complain and felt they would be listened to if they wished to make a complaint.

The registered manager, deputy manager and senior management team created an open, transparent and honest atmosphere within the service. People, relatives, staff and other professionals were invited to take part in discussions about the service and feed back their views.

There was a thorough and robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

Inspection carried out on 19 May 2016

During a routine inspection

The inspection took place on 19 May 2016 and was unannounced.

Britten Court provides accommodation, nursing and personal care for up to 80 people, some living with dementia. At the time of our inspection, there were 78 people living in the service.

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 inspection on 30 April 2015, we asked the provider to make improvements in how the service protects people in relation to medicines management, and this action has been completed. Despite this there were still some areas in the management of medication that could be improved.

There was an open culture in the service, which ensured that staff were able to speak up, however, some staff lacked confidence in the registered manager and their ability to take action when needed. The management team were implementing new systems and processes to improve care, but this was being undertaken too quickly, leaving some staff feeling uncertain of their roles and responsibilities. Although there was a registered manager in post the provider had put in a relief manager to ensure that changes were implemented effectively.

During this inspection we found there were significant variations in the quality of the care being provided across the service. Whilst in some areas the service was actively improving, in others people received inconsistent care which did not always consider or fully meet their needs. The registered provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to ensuring people throughout the service were consistently supported by the skills and deployment of sufficient numbers of staff, providing care which was individualised, and ensuring that the governance and oversight was effective at improving the overall quality of the service. Governance systems were being improved, but they were still not robust enough to demonstrate how they supported the leadership to make improvements needed to provide a consistent service.

People did not always receive the time and attention they needed to fully meet their needs. At times care was task focussed and hurried with staff unable to respond to people as quickly as they would like or perform their role effectively. This also had an impact on staff’s ability to provide care which was consistently dignified and respectful.

Staff were not always sure how to support people with when they were anxious, and further training was needed to help staff be more confident when supporting people with specific needs. Care records did not always provide appropriate guidance to support staff in how their needs should be met. We have made a recommendation about the specialist needs of people living with dementia.

Care records did not reflect people’s personal preferences and were incomplete in some areas. Risk assessments also contained contradictory or incomplete information, putting people at risk of harm.

Though improvements were seen in the way the service managed medicine systems and processes, people did not always receive their medications in a timely manner due to staff being interrupted on medicine rounds.

Activity provision was not consistent throughout the service, and we observed that it was difficult for care workers to find the time to provide this in addition to their other duties.

Staff were able to recognise abuse and knew how to report concerns if they suspected a person was being abused. Systems were in place to discuss potential safeguarding issues so they were escalated appropriately.

Inspection carried out on 30 April 2015

During a routine inspection

Britten Court provides accommodation and personal care for up to 80 older people who require 24 hour support and care. Some people are living with dementia. The building is made up of four units, Sole Bay, Lighthouse, Seagull and Heron, all of which we visited during our inspection.

There were 73 people living in the service when we inspected on 30 April 2015. This was an unannounced inspection.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 a manager in post who told us that they intended in making a registered manager application with CQC.

Improvements were needed in how the service protects people in relation to medicines management.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

There were procedures and processes in place to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were minimised.

Improvements were needed to ensure people throughout the service were consistently supported by sufficient numbers of staff with the knowledge and skills to meet their needs.

People, or their representatives, were involved in making decisions about their care and support. People’s care plans identified how their individual needs were met and contained information about how they communicated and their ability to make decisions. The service was up to date with recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) and at the time of the inspection they were working with the local authority to make sure people’s legal rights were protected.

Staff had good relationships with people who used the service and were attentive to their needs. Staff respected people’s privacy and dignity and interacted with people in a caring, respectful and professional manner.

Improvements were needed to ensure people were encouraged and supported with their hobbies and interests and participated in a range of personalised, meaningful activities to meet their social needs.

People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People’s nutritional needs were being assessed and met. Where concerns were identified about a person’s food intake appropriate referrals had been made for specialist advice and support. However, improvements were needed in people’s mealtime experience and how the records relating to how much people had to drink.

A complaints procedure was in place. People’s concerns and complaints were listened to, addressed in a timely manner and used to improve the service.

Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. The service had a quality assurance system and shortfalls were in the process of being addressed. However further improvements were required to ensure the quality of the service continued to improve.