Dudley Court Care Limited

Dudley Court Care home is a residential care home providing personal care for up to 22 people in one building. The service provided support to people over 65, some living with early on-set dementia, people under 65 and people living with a mental health condition. At the time of our inspection there were 19 people using the service.

People’s experience of using this service and what we found

People felt safe and were protected from risk of abuse because staff knew what action to take to safeguard people. Information for specific medical conditions was available for staff to read, providing them with guidance on how best to support people safely. There were enough staff on duty to meet people’s needs. Medication was stored and administered safely. People told us they received their medication when they needed it. The home environment was clean. Processes were in place to record and learn from any incidents and accidents.

People and their family members told us they had been involved in the planning and review of their care needs. People’s needs were assessed before joining the service. Staff had received appropriate training to support people safely. People told us they enjoyed the food. People’s hydration and nutritional needs were being met. Health and social care professionals provided support to people to make sure their health and well-being was maintained.

Staff sought people’s consent before providing care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us staff were kind, caring and considerate. People were consulted and involved in daily decisions made about their care and support. The provider ensured people had the support of an advocate if required. An advocate is an independent professional that will help people understand their legal rights, be their voice to express their views and wishes to make sure they are heard.

People received responsive, person centred care. People, and where appropriate, their family members, were actively involved in planning their care needs. People and their family members told us there was a range of different hobbies, activities and interests to reduce risk of social isolation and encourage people to access community facilities. People and family members told us they had not raised any complaints but knew who they would need to speak with should they be unhappy with the service. Processes were in place to investigate any issues or concerns and use the opportunity for learning.

People and their families were regularly involved with the provider’s service in a meaningful way through their feedback. Staff had confidence in the provider and registered manager and told us they were happy and enjoyed working at the home. Processes were in place to monitor the quality of the service being provided and any identified actions were promptly actioned, and measures put in place to mitigate reoccurrence.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 19 June 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about medication, staffing numbers, staff training and poor pre-assessment processes of people’s needs. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe key question section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dudley Court Care Limited on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Dudley Court Care Limited is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 22 people in one adapted building over three floors.

People’s experience of using this service and what we found

We found improvement was required in the effectiveness of the provider’s audit systems to ensure consistent detailed records were kept. The provider had made improvements since our last inspection to develop more robust oversight of the service and improve information available to staff and people.

The provider’s systems did not always clearly show people were administered ‘As and When’ medicines only when they were needed. Systems and processes for safeguarding and whistleblowing to keep people safe were effective. We found people’s needs and preferences were met by a sufficient number of staff who were recruited safely. Infection control measures were in line with current government guidance

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 10 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about the safety of people receiving the service. These concerns referred to the use of medicines, staff shortages and continence care. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this report.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection. Please see the Safe and Well Led key questions.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Dudley Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to safe care and treatment and governance of the service being provided. However, the provider was no longer in breach of Safeguarding service users from abuse and improper treatment.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

We found the following examples of good practice.

Due to an outbreak of COVID-19 in the home they were not accepting visitors at this time. Prior to the outbreak pre-booked window visits with family promoted people’s wellbeing.

Social distancing was promoted throughout the home and limitations were placed on the number of people allowed in communal areas at the same time. When social distancing could not be maintained staff used additional Personal Protective Equipment to reduce the risk of infection.

Admissions procedures were followed to ensure people were admitted to the service safely.

A communal area with windows was used to ensure staff could monitor a person who was at risk of falls during their isolation. This allowed the person to be safely monitored during the day as this was not possible if they were isolating in their bedroom.

Staff ensured people had everything they needed while isolating to make them as comfortable as possible. This included phone calls with family, photos of family, listening to the radio and watching their favourite television programmes.

Further information is in the detailed findings below.

Dudley Court Care Limited is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people in one adapted building over three floors.

People’s experience of using this service and what we found

Systems and processes did not always keep people safe as not all safeguarding matters were escalated and shared. Some aspects of risk management had improved since our last inspection however risk assessments did not consistently provide enough information to staff. People told us they received their medicines when they needed them however medicines where not always stored safely. The provider recruited staff safely. Infection control procedures were in place.

The service did not work within the principles of the Mental Capacity Act. People told us they were supported to access healthcare.

People’s preferences and choices were generally promoted by staff. Staff completed an induction and training program although this was not always effective. People were not always supported to eat and drink enough to maintain a balanced diet. A maintenance and a decoration improvement plan was underway.

Systems had not identified a lack of clarity and accuracy in plans pertaining to choking risks. Systems had failed to identify proper upkeep of the premises and the provider’s systems and processes had not identified medication storage concerns. Audit systems were not sufficiently robust to identify areas of concern and develop action plans. The provider and registered manager understood their legal responsibility under the duty of candour

People told us they did not know about their care plans. People told us they are able to communicate effectively with staff in most instances. The variety of activities had improved, and people were supported to engage in them. People told us they knew how to complain. End of life plans were in place which detailed peoples wishes.

People told us staff took time to spend with people and there were positive interactions between staff and people living in the service. Staff had received equality and diversity training however equality and diversity needs of people were not consistently met. People’s voice was heard and acted upon. People told us staff promote their independence and their privacy was respected and they were treated with dignity.

Sufficient improvements had not been made and the provider is still in breach of regulations.

Our last inspection identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment. The provider remained in breach of this regulation. This was because people's risks including choking, weight management, evacuation plans and medicines were not effectively managed at all times.

Our last inspection identified a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safeguarding service users from abuse and improper treatment. The provider remained in breach of this regulation. This was because the provider had not identified incidents of concern and reported these to the Local Safeguarding Authority.

Our last inspection identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to governance. The provider remained in breach of this regulation. This was because governance systems failed to effectively assess, monitor and improve the quality and safety of the service.

During this inspection we also identified a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to consent. This was because people had been restricted without the completion of capacity assessments and best interests’ meetings.

We prompted the provider to address concerns including a referral to the Local Safeguarding Authority and the completion of capacity assessments where required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 03 October 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made however enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 03 October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the ‘safe’, ‘effective’, ‘responsive’ and ‘well led’ sections of this full report.

Enforcement

At this inspection, we have identified repeated breaches in relation to good governance and safe care and treatment. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Dudley Court Care Limited is a residential care home providing personal and nursing care to 19 people aged 65 and over at the time of the inspection. The service can support up to 22 people in one adapted building.

People’s experience of using this service and what we found

This inspection found the provider had failed to adequately monitor and improve the quality and safety of the service and to ensure compliance with the regulations. We found the provider had failed to address numerous areas of improvement identified at the last inspection in May 2018, and to proactively address other concerns which also put people at risk of unsafe care and inappropriate care, and failed to meet people’s needs and preferences at all times.

Systems failed to protect people from harm and unsafe care at all times. We found the provider was in breach of the regulations because their systems failed to ensure incidents and safeguarding matters would always be appropriately dealt with to protect people. We identified another breach of the regulations because people’s risks, including those presented by the provider’s poor upkeep of the premises, were not always safely managed.

We identified a further breach of the regulations because care planning processes failed to ensure all people’s needs, wishes and preferences could be gathered and met as far as possible including in relation to dementia care, end of life care and to promote good access to activities.

People felt their rooms were clean however systems did not ensure good infection control practices at all times. Systems did not always ensure there were always enough staff to meet all people’s needs. A recent staff recruitment check had been carried out safely however improvements were still required to how recruitment records were maintained. People were supported appropriately with medicines and systems promoted safe practice however some improvements were still required.

People’s needs were not all effectively assessed and reviewed to ensure effective support was always provided and in line with current good practice. Staff did not all feel supported. Training gaps identified at the last inspection were still being addressed. People gave positive feedback about their rooms however improvements about the design and décor of the home from the last inspection had not been fully addressed. People generally spoke positively about their support including meals, and confirmed they were supported to access healthcare services as needed. People were not supported to have maximum choice and control of their lives as far as possible and staff did not always support people in the least restrictive way possible and in their best interests; the policies and systems in the service did not support good practice.

Although people’s feedback reflected some improvements had been made, staff were still not consistently caring, and practices did not always promote people’s independence, dignity and positive experiences as far as possible. People were still not involved in discussions and decisions about their care where possible to ensure their individual needs were known and met and to improve the quality of their care. People felt they could ask for the support they needed, and people and relatives felt able to complain, however, such feedback was not always used effectively to improve the service.

We identified a repeated breach of the regulations from the last inspection because the provider’s systems and processes failed to effectively assess, monitor and improve the quality and safety of the service and the quality of people’s experiences. Our inspection identified a further two breaches of the regulations due to the provider’s failure to meet regulatory requirements to display their inspection ratings and to inform the Commission as required about events including possible safeguarding matters.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

For more details, please see the full report which is on the CQC website at

Rating at last inspection

The last rating for this service was Requires Improved (published 01 August 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had been made and the provider was still in breach of regulations. The overall rating of the service has deteriorated to Inadequate.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

At this inspection, we have identified repeated breaches in relation to good governance, the provider’s failure to display ratings as required and to always notify the Commission as required. The inspection also identified breaches in relation to safeguarding service users from abuse and improper treatment, person-centred care and safe care and treatment. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up; Special Measures

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. We will work alongside the provider and local authority to monitor progress. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

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. The registered manager was on annual leave at the time of our inspection. The assistant manager assisted our inspection process. We met the nominated individual at the beginning of our visit on 17 May 2018 and spoke with them over the phone after the inspection.

People told us they felt safe. Staff showed understanding of how to recognise and report abuse although they had not all received safeguarding training. Staff were suitably recruited, and people’s identified risks were not consistently safely managed by staff who knew them well. Systems and records were not robust to ensure consistently safe practice.

The inspection was prompted in part by notification of an incident following which a person using the service absconded. This incident was not reviewed and learned from to improve the safety of the service. We have made a recommendation about how incidents are reviewed and learned from.

People told us they received their medicines as needed however, records were not always accurately maintained to ensure people were always supported safely. We received mixed feedback around whether there were enough staff to meet people’s needs, and systems were not in place to check staffing levels remained safe. Improvements were required to checks of the health, safety and cleanliness of the premises and to people’s equipment.

Some people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, however this was not a consistent experience for all people. Policies and systems in the service did not support this practice. The provider had not met our previous recommendation to ensure people living with dementia would be supported as far as possible to make decisions.

People and relatives told us people were generally well supported. We saw examples of this and that some staff knew people well. Staff told us they felt supported. However, staff had not received training required for their roles to ensure people were always supported safely and in line with current good practice. Improvements were required around how some people were supported with their communication needs and in response to behaviours that may have challenged. The provider had not accessed current guidance around the design and décor of the home.

People were supported to eat and drink enough to maintain a balanced diet. People were supported to access healthcare support if they were unwell.

Feedback from people and relatives reflected positive experiences and we saw some caring interactions. However, some people’s feedback suggested staff did not always respond appropriately, and engage well with people. We saw staff did not often communicate with people outside of care tasks. Systems did not ensure people were always supported to be involved in decisions and discussions about their care as far as possible.

People did not have consistently good access to activities although we received positive feedback about the group activities that took place. We saw good examples of how people’s individual needs were met however this was not consistent for all. People and relatives told us they felt comfortable raising concerns with staff or management if they needed to. Systems were in place and under review so people could be supported as they wished at the end of their lives.

People and relatives were supported to engage with the service and told us they would recommend the service. Staff told us they felt supported. People’s feedback was sought, however improvements had not been made to ensure this was gathered and analysed to effectively monitor and improve the quality of the service.

The service did not continuously learn and improve through reference to current good practice and requirements. The provider had not always met their regulatory requirements and areas of improvement brought to the provider’s attention at our last inspection had not been fully addressed. Systems did not always ensure the safety of the service

You can see what action we told the provider to take at the back of the full version of the report.

The service has a registered manager who was present throughout the inspection. 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 our last inspection in August 2015 we found that the provider had breached regulation in relation to not having robust systems in place to manage risks to people and in monitoring the quality of the service. We also found that the service needed to improve in staff deployment, involving people in their care and consideration of people’s cultural needs. Following this inspection the provider sent us a plan detailing what they would do to address the breach. At this inspection we found that improvements had been made in many aspects of the service and the provider was no longer breaching regulation. People and their relatives were happy with how the service was managed. The registered manager had made improvements to the systems in place to monitor the quality and safety of the service although we found that further improvements were needed to ensure these systems were fully effective and robust.

People felt safe living at the home. People had support from staff who understood appropriate action to take should they have concerns about a person’s safety and had received training to aid their knowledge.

People were supported to stay safe as the provider had systems in place to reduce and monitor the risks associated with people’s care. People were happy with the support they received with their medicines and we saw that this was carried out safely.

There were sufficient staff available to support people when they needed help. Staff were deployed effectively in communal areas of the home and spent time speaking with people or providing reassurance or assistance where needed. Staff felt supported in their role and received support from the registered manager and from other members of staff in the team.

People were supported by staff who had some knowledge of the Mental Capacity Act (2005) and could explain how they involved people in making choices about their care.

A number of people at the home were living with dementia. Staff were confident in supporting people with this condition but there were limited aids to support people in making decisions. We have made a recommendation about accessing information and resources to support people living with dementia to make decisions.

People had their healthcare needs met and the service was quick to respond and seek advice when healthcare needs changed.

People told us they felt cared for and our observations confirmed that staff were kind and caring in their approach. Care was planned with people and their relatives to ensure the care provided met people’s preferences. Staff knew the people they were supporting well and could explain how each person liked to be supported.

Care was reviewed with people at regular intervals although this wasn’t currently recorded. People had been supported to sustain relationships with people who were important in their lives.

Activities occurred on a regular basis based on people’s known interests.

There were systems in place for people to raise concerns and complaints and people knew how to do this. People had the opportunity to feedback their experience of care at the home and the provider responded appropriately when people raised concerns.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We spoke to several people who lived at Dudley Court Care Home. People told us they felt safe. Comments included, 'I only have to pull the cord (call alarm) and they are there' and 'I feel safe here, the staff are very kind and trustworthy.' Relatives of people who lived at the home also told us that they thought the care home was safe and the care staff were honest and trustworthy.

People were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

We found that the home's safeguarding procedures were robust and staff understood their role in safeguarding the people they supported. We checked staff training records and saw that staff had received recent training in safeguarding vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have been made under this legislation for any person living at Dudley Court, we found that the manager and staff understood their responsibilities in relation to the law.

We checked people's care plans and found them to be detailed, relevant and up to date. This meant that people were receiving safe and appropriate care.

We found that care was provided in an environment that was safe, accessible, clean and adequately maintained.

Is the service effective?

People told us that they were happy with the care they received and the care staff who supported them. We found that care staff knew the people they supported very well.

Staff training records showed that care and catering staff had received appropriate training in a number of relevant topics including: food hygiene, dealing with dementia, moving and handling and infection control. This meant that staff had the appropriate skills and knowledge to ensure that people received safe, appropriate and effective care.

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. We saw that people had regular access to a range of health and social care professionals which included general practitioners, dentists, chiropodists and opticians.

We checked a person's care plan and saw that it had been reviewed on a monthly basis by the manager of the home. The written entries made on the care record (following each review over the past three month period) recorded that there had been no changes to that person's mobility. However when we checked the home's accident records we noted that this person had fallen recently on several occasions. This meant that the review process had failed to acknowledge the change in this person's mobility.

We concluded that the provider did not always have an effective system to regularly assess and monitor the quality of service that people received. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to these concerns.

Is the service caring?

People were supported by kind and attentive staff. It was apparent to us during our observations that care staff were attentive, polite and sought consent before providing care and support. We saw that care staff were patient with the people they were supporting and treated them with respect and dignity. People commented, 'Staff are very helpful and kind, I have no problems with them' and 'The staff are all very nice.'

We spoke to relatives of people who lived at the home. They were also very complimentary about the standards of care being delivered and the competence of staff delivering care and support. Comments included, 'My mom is very well cared for here and I have every confidence in the manager of the home' and 'Staff are very good and we are always kept informed and made to feel very welcome when we visit.'

We concluded that people have a good experience of care and support which is delivered with compassion and respects their dignity and human rights.

Is the service responsive?

Records showed that meetings were held between staff and people using the service to discuss on-going concerns and improvements at the home including; meals, activities, laundry and areas of improvement.

We found that care staff had regular one to one supervision meetings and team meetings with the manager of the home. This meant that care staff had the opportunity to discuss their training and development needs, welfare and any concerns they might have about the people they were caring for.

Dudley Court Care Home has a comprehensive complaints policy. This policy provided clear guidelines as to how complaints would be recorded, investigated and responded to.

There was evidence that learning from incidents / investigations took place and appropriate changes were implemented. We noted that as a consequence of a concern being raised, some procedural changes and new documents had been introduced to improve care and safety. This meant that the manager of the home was responsive to concerns and complaints and took action and made changes when this was considered appropriate.

People living at the care home and their relatives told us that they would have no hesitation in telling the manager and staff if they were unhappy or had any complaints about the service they received. We were told that the manager and staff were approachable and helpful and where they had made requests or raised minor concerns, these matters had been responded to promptly and to their satisfaction.

Is the service well-led?

We found that the registered manager had worked at this care home for several years and was experienced and knowledgeable. We saw that the owners of Dudley Court were involved in the home's supervision and management on a daily basis and were visible and well known to the people who lived there.

People who lived at the home and their relatives were very complimentary about the manager. Comments included, 'The manager is really approachable, we have a good working relationship with her.'

Care staff employed at the home told us that the manager and the owners of the home were approachable and that they enjoyed working there.

We concluded that there was effective leadership at Dudley Court which ensured that safe, effective and responsive care and support was provided.

People were complimentary about the care staff who supported them and their living environment. Comments included, 'I'm very comfortable thanks, my bedroom is fine.' Relatives and friends of people living at the home were also complimentary about the service being provided. Comment's included, 'They give good support to mom, the staff are very diligent.'

We examined care plans and found that people's needs were properly assessed and that care and support was planned and delivered in line with their individual care plans. From our observations it was apparent that care staff were attentive, polite and sought consent before providing care and support.

We looked at staffing levels and concluded that people were safe and their health and welfare needs were being met because there were sufficient numbers of staff on duty who had appropriate skills and experience.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that care was provided in an environment that was safe, accessible and suitably designed and adequately maintained.

We concluded that Dudley Court was a safe, caring, comfortable and well maintained care home.

We subsequently spoke to five people who lived at the care home including one person who was staying there on 'respite' care. People were very complimentary about the care staff who supported them. Comments included, 'The staff are really nice' and 'They really look after us, the food is excellent.'

We examined care plans and found that people's needs were properly assessed and that care and support was planned and delivered in line with their individual care plans.

We saw that since our last inspection of this care home that the manager had introduced a new policy in relation to 'quality assurance'. This document set out how they intended to improve services at Dudley Court and obtain accurate feedback from those who lived there. We also found that risk assessments had been updated (and were now current) and 're-positioning' charts (for those at risk of developing pressure sores) had been completed regularly.

We concluded that the minor concerns identified at our previous visit had been rectified and that Dudley Court Care Home now had effective systems in place to regularly assess and monitor the quality of service that people received.

People told us, 'I feel safe and well looked after" and "I've enjoyed it here, they have been very good to me."

Relatives of people using the service also made complimentary comments about the home. We were told, 'My relative is happy here' and 'This place is very homely.'

Our inspection confirmed much of the feedback we had received. Our observations and conversations with people using the service confirmed that the staff were attentive, polite and that the manager was approachable and responsive to suggestions and feedback. It was also clear that the staff had a good knowledge of all of the people who lived at Dudley Court and were familiar with their preferences and health conditions.

We found that medicines were handled safely and people experienced safe and appropriate treatment which met their needs. We also found that people were cared for and supported by, suitably qualified, skilled and experienced staff and protected from the risks of inadequate nutrition and dehydration.

Our inspection revealed that the provider did not have an effective system to regularly assess and monitor the quality of service that people received.