Archived: Collyhurst

Collyhurst is a residential care home, providing personal care and accommodation to 34 older people. There are 30 bedrooms in the main house spread over 3 floors. The basement and ground floor both have a dining area and a kitchenette. The communal lounge is located on the ground floor. There are a further four bedrooms in a bungalow annex. At the time of our inspection, the provider was making changes to the building to link the main building and bungalow annex. Twenty six people lived at the home when we inspected.

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

Risk’s to people’s health had been identified, but records did not always show how these risks had been assessed and mitigated.

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 did not support this practice.

The registered manager and provider did not fully understood their responsibilities under the Mental Capacity Act. Where a person’s capacity to make a decision had been questioned, capacity assessments were incomplete and not decision specific.

Staff had not always received training to support people with specific health conditions such as epilepsy and diabetes. Some mandatory training was out of date.

Systems and processes had not been effective in identifying the shortfalls found during our inspection.

The home was generally clean but there was a strong odour in the communal lounge. Staff followed good infection control practices and used personal protective equipment (PPE) appropriately.

People and relatives told us they felt safe at Collyhurst. Staff understood their responsibilities to protect people from avoidable harm.

People's health and emotional needs were assessed before they moved to Collyhurst to identify what support they needed.

There were enough staff to keep people safe. Assessed staffing levels had been maintained and staff were recruited safely.

People had access to the healthcare they required and were supported to access healthcare services, such as their GP, district nurse and optician. People received their medicines as per their individual prescriptions.

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 25 June 2019) and there was a breach of regulation 17 Good Governance. 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.

The service remains rated requires improvement. This service has been now been rated requires improvement for the last three consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about poor personal hygiene, staff not responding quickly enough to assist people and infection control practices. In addition, as a breach of legal requirements was found at the last inspection we undertook this focused inspection to review the key questions of safe, effective and well-led only. We also checked they had followed their action plan and to confirm they now met legal requirements.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. As a result, the overall rating for the service has remained the same. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Collyhurst 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 monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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.

We found the following examples of good practice.

• The provider had converted a bungalow at the property into a visiting and testing space. This was external to the main building with a glass screen and speaker system to enable people and their relatives to see each other safely and in private whilst keeping safe. The visiting room had also been used successfully by health professionals to complete visits to people who have required assessment during the pandemic.

• The provider had supported staff at the service both emotionally and financially during the pandemic and recognised the impact COVID-19 had had on staff and their families.

• The provider had employed further domestic staff to ensure increased cleaning was in place and this did not detract from care staff’s time for people using the service.

• The provider had built strong relationships with a local supplier of PPE to ensure they had sufficient supplies should there be a second wave of COVID-19.

Further information is in the detailed findings below.

Collyhurst is a care home, providing support, personal care and accommodation for up to 34 people, there are 30 bedrooms in the main house and a further four bedrooms in the bungalow annex. Collyhurst provides care to older people, some of whom are frail and living with health care conditions. Care is provided over three floors in the main house and the bungalow, located in the garden. The basement and ground floor, in the main house, each has a dining area and a kitchenette. A large communal lounge is located on the ground floor. At the time of our inspection visit 27 people lived at the home.

What life is like for people using this service:

Individual risks to people’s safety and well-being were assessed, recorded and reviewed. Overall, actions were taken to mitigate risks of harm and injury to people. However, some environmental risks had not been identified or actions taken to mitigate risks. When we pointed these out to the provider during our inspection, immediate actions were taken to reduce risks of potential harm or injury.

There were sufficient care staff on shift. However, there were insufficient hours allocated to housekeeping staff. This impacted on the overall cleanliness of the home and we found some areas where dirt, grime and spillages had not been cleaned. There were unpleasant odours in parts of the home.

People had their prescribed medicines available to them and were supported with these by trained staff.

Staff received an induction, training and support from within the staff team and providers.

People had their needs assessed before they moved into the home. People’s plans of care were task focused and the provider told us about their plans to update care plans.

Staff were suitably skilled to meet people’s day to day needs and protect people from the risks of abuse.

People had opportunities to engage in group activities, which reduced risks of social isolation.

People had access to healthcare when required.

People were offered enough food and drink to meet their dietary requirements. However, the lack of staff’s organisation at lunchtime meant the mealtime was not a relaxed experience and people did not always receive support from staff in a person-centred way.

People made decisions about their care and were supported by staff who worked within the principles of the Mental Capacity Act 2005.

People and relatives described staff as kind and caring and 'Collyhurst' being a family home where they were happy.

The provider’s quality assurance system did not consistently identify where improvements were needed, and did not always ensure people received a quality and safe service.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 17 Regulated Activities Regulations 2014 – Good Governance

Rating at last inspection: At the last inspection the areas of Safe, Effective and Well Led required improvements. Caring and Responsive were rated good. This gave the service an overall rating of Requires Improvement. (The last report was published on 9 May 2018).

Why we inspected: This was a planned inspection based on the rating of the last inspection. The service continues to be rated as ‘Requires Improvement’ overall.

Enforcement: Action provider needs to take (refer to end of report).

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

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

Collyhurst is a care home registered to provide personal care and accommodation for a maximum of 34 older people. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is located in a residential part of Bedworth and the accommodation is set out over three floors. There were 31 people living at the home at the time of our visit, some of who were living with dementia.

We last inspected Collyhurst in April 2016 when we rated the service as 'Good' overall. However, at that inspection we found some improvements were required in the leadership of the service so the key question of 'well-led' was rated 'Requires Improvement'. At this inspection we found improvements had not been made and systems required better organisation and monitoring to ensure issues impacting on the safety, effectiveness and quality of care were quickly identified and action taken.

The service had a registered manager. This is a requirement of the provider'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.

The registered manager knew the service well because they supported people and worked alongside staff on a daily basis. People and staff spoke very positively about the registered manager who they described as approachable and responsive. They felt able to share any concerns with the registered manager, who they were confident would take appropriate action. However, this 'hands on' approach meant the registered manager did not always have time for the managerial and administrative aspects of their role. Quality audits and checks were not consistently effective.

There were enough staff to meet people's individual needs and keep them safe. The registered manager assessed risks to people's health and welfare and wrote care plans that minimised those risks. However, some risks to people’s health had not been identified.

People felt safe at Collyhurst and staff understood their responsibility to report any concerns they had about people’s health or wellbeing. Staff received support from their managers, but some training needed to be updated.

The home was adapted, decorated and furnished to meet people's needs. The cleanliness of the home was satisfactory, although one area had not been maintained to the same standards.

People were cared for by kind and compassionate staff, who knew people's individual preferences and how they wanted their care provided. Staff understood people's individual needs and abilities and they received updated information at shift handovers to ensure the care they provided was responsive to people's needs. Staff provided people with opportunities for social engagement and there were plans to improve the provision of activities in the home.

Staff worked within the principles of the Mental Capacity Act 20015. They offered people choice and sought their consent before providing care and support. However, there were no written records of people's capacity to make specific decisions or what assistance they might need to make their own decisions.

People were supported to eat and drink according to their needs, which minimised risks of them not eating or drinking enough. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health, and when their health needs changed. People received their medicines as prescribed, but improvements needed to be made to ensure medicines were stored appropriately to maintain their effectiveness.

Collyhurst Care Home provides accommodation for up to 34 people who require personal care. The home has three floors with 29 bedrooms and a bungalow in the grounds with five further bedrooms. There is access to a well maintained garden area. At the time of our inspection there were 28 people living at the home, one person had been admitted to an acute hospital and five rooms were vacant.

Collyhurst Care Home 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.

Everyone we spoke with told us they felt safe living at Collyhurst. Staff we spoke with were able to confidently describe a good understanding of the types of abuse that may occur and knew how to report this should they need to. We looked at the care records of five people who lived at the home. There were personalised assessments for identified risks for each person. However, the care records were difficult to navigate as they were bulky and contained a lot of information which could have been archived, as no longer up to date or relevant.

There were processes to manage risk in connection with the operation of the home, but the records were not consistently completed, to demonstrate action was taken. For example, the cleaning schedules for the home were not completed consistently.

There were enough qualified, skilled and experienced staff to meet peoples’ needs. Recruitment and selection processes ensured staff were suitable to work with people who lived at the home.

Medicine records showed that people received their medicines as prescribed, however there was no policy to guide staff on the administration of medicines which were given ‘as required’.

Staff did not centrally report incidents or accidents so this meant records could not be audited to analyse the data to identify any trends or patterns. Incidents and accidents were recorded in the individual care records only. There was clutter and items which did not belong in corridors which presented a tripping hazard and the chairs in the lounge were worn, stained and had malodour.

Not all of the staff had received training on the Mental Capacity Act 2005 (MCA), however they were aware of the Deprivation of Liberty Safeguards (DoLS) and demonstrated an understanding of the requirements of the MCA.

There was plenty of choice of food and people could have drinks and snacks whenever they wanted them. People were offered drinks and snacks throughout the day. However, feedback was not recorded from people about the quality and quantity of food offered.

The staff were very caring and ensured people’s privacy and dignity was protected. They knew the people they were caring for well. This included knowledge of people’s likes and dislikes, how they could communicate, their backgrounds and the relationships that were important to them.

Activities for people were limited to the availability of the activity co-ordinator, however peoples’ needs were assessed and care and support was planned and delivered in line with their individual care plans. People told us they were supported to access healthcare services.

All of the staff we spoke with said that staff morale was very good and that the registered manager was approachable and responsive to suggestions made to improve the quality of service. Some systems and processes were not established or operated effectively to ensure that audits assessed, monitored and improved the quality and safety of the services.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were provided with a choice of suitable and nutritious food and drink. We saw menu plans that gave people a choice of nutritious food. Checks were made on people’s weight to ensure they were not at risk from malnutrition.

People were being cared for in an environment that was safe, clean and hygienic. We found the environment neat and tidy with no unpleasant odours. The people we spoke with told us that they felt safe in the home. One of the people we spoke with said, “It’s my home, I feel safe.”

There were enough staff on duty to meet the needs of the people living at the home and keep them safe. The staff records we read showed that the staff had received appropriate training to keep people safe. Training included health and safety and manual handing training. Staff were able to explain how this training kept the people who used the service safe. We observed staff interaction with people who used the service. We saw they followed the infection control procedures and wore gloves and aprons when appropriate.

There were arrangements in place to deal with foreseeable emergencies. This included 24 hours staffing and first aid training.

The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The staff we spoke with understood their responsibilities in relation to this legislation.

Is the service effective?

People told us that they were happy with the care they received and felt their identified needs were being met. People told us that staff were, “always” checking if they needed anything. We observed staff’s interaction with people and saw that they were attentive to their needs.

Is the service caring?

People were supported by kind and attentive staff. The staff we saw were caring when supporting people. The people we spoke with said, “I have no complaints, the staff are nice.” We saw staff treated people in a pleasant manner and took time to re-assure people and understand what they wanted.

Is the service responsive?

People’s needs had been assessed before they moved into the home. We saw people had access to activities that were important to them. We saw the care plans were regularly updated and people were given the opportunity to change their mind about what they wanted to do.

Is the service well-led?

The registered manager was clear about the aims and objectives of the service and checked what people thought about the service. We saw that the service had responded to feedback from people and staff.

We spoke with five people who all told us they were happy with their care and spoke highly of the staff. People told us that they did not have to wait when they needed assistance from staff. One person said, “You only have to ask once for help and it is there.”

We spent time watching how care and support was provided and how staff communicated with people. We observed natural and relaxed conversations and interactions between staff and people. One person told us, “Staff are lovely. They look after us very well.”

Every person had a plan of care, based on their physical health and other care needs. People's plans described what people needed help with, what they could do for themselves and how they should be supported.

Our review of the staff rotas at different times over the previous month showed that minimum staffing levels identified and planned for had been met.

Care staff were positive about working in the home. We spoke with three care workers who told us there were regular training sessions to enable staff to develop their skills and knowledge.

During a tour of the home, we noted that all areas of the home were clean and tidy and the environment was pleasant for both staff and people using the service.

We found that important records about the care and support provided to people were complete and up to date.

Our observations showed that staff interacted well with the people in the home. They spoke to people in a respectful manner using their preferred names and responded promptly to people's requests.

People told us they were happy with the care provided and enjoyed living at Collyhurst. Comments included; “It’s a lovely home, you’re well looked after,” "You couldn't wish for a better home," and “All the staff are lovely, we are all treated equally.”

Staff and people living at the home told us that they felt there were enough staff on duty. One person living at the home told us that they never had to wait long for staff to arrive if they had rung their call bell for assistance. They said, “If you need them in the night, they’re there.”

When we spoke with staff about the people they were caring for, they were able to provide information about people's support that matched what was in assessments and care plans. This helped to show that they had access to information about supporting people appropriately and safely.