Cypress Court

Cypress Court is a residential care home providing accommodation for persons who require nursing or personal care to up to 60 people. The service provides support to younger adults, older adults and those living with dementia. At the time of our inspection there were 47 people using the service. Cypress Court is a single, adapted building spread over 2 floors.

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

People received their medicines as prescribed. Records relating to medicines were accurately maintained, but topical and liquid treatments were not always marked with a date of opening. We made a recommendation about this. There were enough staff to support people and systems were in place to safeguard people from the risk of abuse. Risks relating to people and the environment were assessed and control measures put in place to keep people safe.

The service was bright, clean, airy and well maintained. However, there were limited orientation aids to assist people living with dementia to navigate around the service effectively. We made a recommendation about this. People were supported to drink and eat enough to maintain a balanced diet. Staff completed a mixture of mandatory and person specific training, which was supported by regular supervisions and appraisals. 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.

Some people had difficulty in communicating with staff members who supported them. We made a recommendation about this. A range of activities were taking place, but people showed limited interest or engagement. The provider was working towards improving this process. There was a robust complaints procedure and where concerns were identified, improvements had been made.

People were supported by staff who respected their privacy, dignity and independence. We observed staff interacting with people in a kind and compassionate way. Relatives spoke positively of the staff approach and people were involved in expressing their views on the care they received.

Quality monitoring and audits had been improved and developed to ensure they were robust. Relatives and staff spoke positively of the management team and felt well supported. People, their relatives and staff were engaged in the running of the service and we saw evidence of good partnership working. The management team and staff had worked to ensure sustained improvements had been made since the last inspection.

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 7 June 2023). 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. At our last inspection we recommended that the provider reviewed their recruitment procedure of overseas employees and their systems for the recording of medicines, including 'as required' medicines in line with good practice guidance. At this inspection we found the provider had acted on these recommendations, and improvements had been made.

This service has been in Special Measures since 7 June 2023. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

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.

Recommendations

We have made recommendations regarding topical and liquid medicines, staff communication and the use of dementia friendly orientation aids.

Follow up

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

Cypress Court is a care home providing personal and nursing care to 58 people at the time of the inspection. The service can support up to 60 people, in one adapted building across two floors. The home is located in a residential area, close to shops and local amenities.

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

People told us they felt safe in the home, however, we raised concerns regarding the staffing levels. The deployment of staff within the home did not allow for care to be delivered in an effective and timely manner. People were left waiting for personal care to be met and their meals.

Equipment in place to keep people safe including call bells were not always within reach or responded to in a timely manner. There was an unpleasant odour within the home and there were concerns regarding the cleanliness and suitability of the equipment. Bedding was not always being changed and some bedrails were damaged.

Good practice regarding the safe administration of medicine was not always being followed. The oversight of medicine was not robust enough to ensure people were safely given their medicines.

People’s care plans and risk assessments were not clearly updated, consistent and did not always reflect a person’s current needs. People were not actively involved in their own care planning and care delivered was task focused. There were gaps in the recording of information, this meant we were not assured people were getting the care they required in line with their assessed need.

People were not always supported and encouraged at mealtimes; people were left waiting for long periods of time before receiving their meal. We observed people sitting in bed with their meal on their knee without cutlery. People were not always given a choice of when they wanted a bath or shower, there was a rota in place and people told us they were told when they could have a bath.

The provider employed 2 part time activity co-ordinators however, people complained about the lack of meaningful activities, one person told us the most they do is eat.

Governance processes were not always effective in the monitoring of the service. Whilst some of the concerns were identified through the service’s own provider audits, they had failed to rectify the concerns raised. The provider sought feedback from people who lived at the service, their relatives and staff members however it is unclear how this is analysed and improvements made.

Safeguarding policies and procedures were in place and staff were clear on their own roles and responsibilities.

Health and safety checks were in place and were being monitored.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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

Rating at last inspection

This service was registered with us on 03 May 2022 and this is the first inspection. The service was last inspected under previous provider 03 April 2020 and was rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and quality of care. 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 have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to care not being delivered in a person-centred way and how people’s needs were risk managed. Governance systems were not effective in managing and monitoring the service and adequate staffing levels.

Recommendations have been made in relation to the recruitment procedure of overseas employees and for the provider review their systems for the recording of medicines including ‘as required’ medicines in line with good practice guidance.

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

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.