Red Court Care Community

Red Court Care Community provides accommodation, nursing and personal care for up to 49 people, some of whom may be living with dementia, physical disabilities and sensory impairments. People were accommodated on the ground floor across two units. At the time of the inspection there were 45 people living at the service.

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

The risks to people’s safety were not robustly assessed. The risk assessments did not contain enough information about people’s needs. The systems and processes in place to safeguard people from neglect or poor care were not always used effectively by staff. Incidents and accidents were not always reported on.

The quality monitoring processes in place to review and analyse information both in people’s care plans and incidents and accidents records were not effective, putting people at continued risk of harm.

There was not always a positive culture of person-centred care promoted at the service.

Staff undertook safe practices when administering medicines and there was enough staff to meet people’s needs. There had been improvements to the environment and how this was monitored

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.

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 6 April 2022) and there were breaches of regulation. A warning notice was issued to the provider and registered manager. At this inspection we found some improvements had been made and the provider was no longer in breach of one of these regulations. However, they have remained in breach of two regulations.

The last rating for this service was requires improvement (published 6 April 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 full report.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding people for abuse and improper treatment, as well as oversight and management of the service at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Red Court Care Community provides accommodation, nursing and personal care for up to 49 people, some of whom may be living with dementia, physical disabilities and sensory impairments. People are accommodated across three separate wings. At the time of the inspection there were 46 people living at the service.

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

People had risk assessments in place. However, risk assessments such as use of bed rails were not always followed, putting people at risk of entrapment.

Staff told us that they did not feel staffing levels were safe. We found the number of staff supporting people living with dementia to be inadequate. We found that there were delays in people receiving the care they needed.

Since the inspection the registered manager and deputy manager have been looking into making improvements to the staff rota and have said they will increase the staffing levels.

We found improvements were needed to safe medicine practices, such as storage and administration.

Although most staff were wearing PPE appropriately, we did find some staff did not always wear their mask in an effective manner.

Systems and processes to ensure visiting professionals were vaccinated from COVID-19 were neither robust nor effective. There have been several professionals who visited the service without anyone recording if they had seen their vaccination status.

The registered manager had delegated quality audits to heads of departments at the service. The registered manager had poor oversight of these audits. Issues within the service were not identified prior to the inspection. Issues included infection prevention control (IPC) and hygiene and cleanliness of the kitchen.

Not all incidents within the service were recorded effectively. Learning from events was not robust, themes and trends were not always identified. Learning was not always shared with the wider staff team. There was a high number of incidents involving people who were living with dementia. People living with dementia’s care needs had increased, however it had not been assessed prior to the inspection that staffing levels needed to be increased accordingly.

People living at the service told us they felt safe and were cared for by kind and friendly staff.

Safe recruitment processes were in place such as disclosure and barring checks (DBS).

People at the service had access to a wide range of activities. We observed several people at the service engaging in activities during our visits.

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 28 April 2021). The service remains rated as requires improvement. This service has been rated requires improvement for the last three consecutive inspections. Prior to this it was rated inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about infection control. We inspected and found there was a concern with staffing and the providers management and oversight of the service, so we widened the scope of the inspection to cover the key questions of safe and well led.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Red Court Care Community 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 and will take further action if needed.

We have identified breaches in relation to safe care and treatment, deployment and staffing levels at the service, as well as oversight and management of the service.

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

Red Court Care Community provides accommodation, nursing and personal care for up to 49 people, some of whom may be living with dementia, physical disabilities and sensory impairments.

At the time of our inspection there were 46 people using the service.

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

The service had improved since our last inspection, and breaches had been met, but further improvements were needed to risk management, medicines management, and the provider’s system of auditing the service.

There were more staff on duty and most people, relatives and staff were satisfied with staffing levels. However, some relatives and staff were concerned there were not enough staff to always meet people’s needs promptly.

We have made a recommendation about staffing levels.

Staff were safely recruited, kind and caring. A relative said, “[Person] seems to be getting wonderful care. I have no concerns.” Staff worked as a team and met frequently with managers to share information and receive training and updates.

Staff ensured people they had their medicines when they needed them. They were trained in infection prevention and control and wore masks, gloves and aprons. All areas of the premises were clean and tidy.

The service was homely. Staff supported people to personalise their rooms. People sat in socially distanced small groups. Staff ate meals with people on the dementia unit to support them discreetly and encourage a sociable and friendly atmosphere.

The premises had been upgraded with new lighting, decoration, and floor coverings. Corridors were themed to make it easier for people to find their way around. There was a new visiting room in the grounds of the service to make visiting easier and safer.

The registered manager had made positive changes to the service. A staff member said, “It’s very person-centred now. The [registered] manager is keen to make it all about the residents, which is how it should be.”

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

Why we inspected

This was a focused inspection based on concerns we had received about the service. These were in relation to people's care and governance. As a result, we undertook this focused inspection to review the key questions of safe and well-led only.

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 the same. This is based on the findings at this inspection.

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

Red Court Care Community is a residential care home providing personal and nursing care to people both under and over 65, including some living with dementia. The home can support up to 49 people. At the time of our inspection there were 41 people living in the home, including two people who were admitted to the home on the day of the inspection.

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

Although the provider claimed they placed people at the heart of the service, relatives and staff expressed concerns about staffing at weekends and nights, and at times during the day.

At the time of our inspection there was not 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. The new manager, who had only been there three weeks, had proposed shift changes to cover the identified busier times of day.

The service was not well managed. There had been a lack of effective oversight of the service by the provider. The lack of robust, effective quality assurance meant people were at risk of receiving poor quality care.

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 29 August 2019).

At this inspection we found improvements had not been made and the provider was now in breach of regulations.

Why we inspected

We had received concerns about the lack of robust systems and processes to ensure consistent supplies of PPE, staffing, food and laundry supplies, particularly through the Covid-19 pandemic.

A focused inspection was undertaken to specifically check whether sufficient improvements in the safety of the service and people's care had been achieved and to assess whether the manager and provider now had sufficient oversight of the service. At this inspection we continued to have concerns about the safety of the service and its leadership.

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 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 full report.

The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Red Court Community Care 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 breaches in relation to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) Regulation 17 (Good Governance) and a Breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3) Regulation 18 (Staffing) 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.

Red Court Care Centre 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. It provides accommodation for older people including people living with dementia. The home can accommodate up to 49 people. At the time of our inspection there were 23 people living in the home.

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

Arrangements were in place to monitor and manage medicines. However, medicine records were completed inconsistently. Where people received medicines covertly (in drink or food without their knowledge) arrangements were in place according to good practice guidance.

The service placed people at the heart of the service and its values. It had a person-centred ethos. We saw evidence of caring relationships in place, and a commitment to support people at difficult times with compassion.

Staff were aware of people's life history and preferences and they used this information to develop relationships and deliver person centred care. People felt well cared for by staff who treated them with respect and dignity.

There was a process in place to carry out quality checks. These were carried out on a regular basis to ensure the quality of care was maintained. There were arrangements for communicating with people. We have made a recommendation about involving people and their relatives in the running of the home.

There was a range of activities on offer. People were supported to access the local community.

Care records were personalised and had been regularly reviewed to reflect people's needs. Care plans contained information about people and their care needs. People were supported to make choices and have their support provided according to their wishes.

People said they felt safe. There was usually sufficient staff to support people and appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people. People, their relatives and staff expressed concerns about staffing at weekends. We have made a recommendation about the management of staffing at weekends.

People enjoyed the meals and their dietary needs had been catered for. This information was detailed in people’s care plans. Staff followed guidance provided to manage people's nutrition and pressure care.

People were supported by staff who had received training to ensure their needs could be met. Staff had begun to receive regular supervision to support their role.

People had good health care support from professionals. When people were unwell, staff had raised the concern and acted with health professionals to address their health care needs. The provider and staff worked in partnership with health and social care professionals.

The environment was adapted to support people living with dementia. The home was clean, and arrangements were in place to manage infections.

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

The provider had displayed the latest rating at the home and on the website. When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.

Rating at last inspection

The last rating for this service was inadequate (18 March 2019) and there were multiple breaches of regulation. This service has been in Special Measures since March 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.

At this inspection the rating was requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. We found no evidence during this inspection that people were at risk of harm from this concern.

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.

At the time of our inspection there was not 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.

This was the first inspection for this home since registration in September 2017. At this inspection we found breaches of regulation 18, regulation 12 and regulation 17. There were insufficient numbers of suitably skilled staff. The provider had failed to put systems and processes in place to ensure the safe delivery of care and improvement of quality. A system was not in place to carry out suitable quality checks and action plans were not always in place to address issues identified.

Risks to people’s safety had not been consistently assessed, monitored and managed so they were supported to stay safe while their freedom was respected.

Guidance was not in place to ensure people received their medicines when required. Processes were not in place to manage medicines safely. Where people required their medicines in food arrangements had not been put in place to ensure the method of administration did not affect the efficacy of the medicine.

People were not consistently treated with dignity and respect. Arrangements were in not place to ensure staff received training to provide care appropriately and effectively. People were not helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People, their relatives and members of staff had been consulted about making improvements in the service. However, actions were not always taken. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

People told us that they received good care. Sufficient background checks had been completed before new staff had been appointed according to the provider’s policy.

Where people were unable to make decisions, arrangements were in place to ensure decisions were made in people's best interests. Best interest’s decisions were specific to the decisions which were needed to be made.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. The environment was clean.

People were supported to have choice and control of their lives. Staff supported people in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were usually treated with kindness and compassion and they were given emotional support when needed. They had also been supported to be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a range of activities. The registered manager recognised the importance of promoting equality and diversity. Formal complaints were responded to according to the provider’s policy to improve the quality of care.

Arrangements were in place to support people at the end of their life.

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

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is

still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

Further information is in the detailed findings below.