Archived: Colbury House Nursing and Residential Home

Colbury House is a residential care home providing personal and nursing care to 39 people aged 65 and over some who may be living with dementia at the time of the inspection. The service can support up to 58 people.

During our previous inspection in December 2018 we identified two breaches of regulations. We issued requirement notices in respect of those breaches. At this inspection we found improvements had been made; however, there was a need to sustain the improvements made and to make further improvements. The service has been rated as requires improvement as it met the characteristics for this rating in most key questions. More information is in the full report.

The previous provider had gone into administration before our planned inspection. A care consultancy company had been brought in by the administrators to assist in the running of the service and to ensure people were kept safe till a new provider had been sought. The care consultancy company had made improvements to keep people safe while they had been managing the service.

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

People told us they felt safe. However, some environmental risks were not managed effectively. Improvements were needed for the safe management of water.

We have made a recommendation about the management of legionella and water hygiene management.

Overall, improvements had been made to the management of risks to people and safety monitoring, but these needed to be further embedded into practice to ensure that people were consistently kept safe from harm.

There were systems in place to monitor the quality and safety of the service provided, however these were not always effective and identifying areas for improvement or where safety had been compromised.

Improvements were still needed to ensure people received person centred care which was responsive to their individual needs.

People felt safe living at Colbury House Nursing Home, and they were very much at the heart of the service. We received positive feedback from people and their relatives about the care provided.

There were plans in place for foreseeable emergencies. Staff were able to tell us how to keep people safe.

Relevant recruitment checks were conducted before staff started working at the service to make sure they were of good character and had the necessary skills.

Staff had received training in safeguarding adults and knew how to identify, prevent and report abuse. There were enough staff to keep people safe.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed.

Staff received support and one to one sessions or supervision to discuss areas of development. They completed training and felt it supported them in their job role.

People were supported with their nutritional needs. People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes

People were treated with kindness and compassion. Staff were able to identify and discuss the importance of maintaining people’s respect and privacy at all times.

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’s quality assurance system helped the management team implement improvements that would benefit people. Action had been taken to become compliant with one of the breaches of regulation identified at the previous inspection.

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 22 January 2019) and there were two 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; however, there was a need to sustain the improvements made and to make further improvements

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

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.

There was 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.

Colbury House Nursing and Residential Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Colbury House is registered to provide accommodation and personal care for up to 58 people. At the time of our inspection 49 people were living at the home. The home provides a service for older people, people living with dementia and with a physical disability. Accommodation is provided over two floors, which can be accessed using stairs or passenger lifts.

At our last inspection in December 2017 we found the provider was in breach of three regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of those breaches.

Following our inspection the provider sent us an action plan on 26 January 2018 to tell us about the actions they were going to take to meet these regulations.

During this inspection, we found that insufficient action had been taken to meet the requirements of two regulations the service had breached at the inspection in December 2017.

The provider did not have effective quality monitoring systems in place to ensure on-going compliance with the Regulation's.

The provider had failed to ensure that staff had received appropriate training as necessary to enable them to carry out the duties they are employed to perform.

The provider had a robust and effective recruitment procedure in place that ensured people they employed were of suitable character and background.

The provider had taken appropriate steps to protect people from the risk of abuse, neglect or harassment.

Medicines were managed in a safe way.

People, their relatives and staff told us the registered manager was supportive and approachable.

People were supported by staff who knew them well.

Staff understood the requirements of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives told us they enjoyed the food served which considered peoples individual dietary needs and preferences.

People’s privacy and dignity was respected and promoted. Staff understood how to support people in a sensitive way, while promoting their independence. People told us they were treated with dignity and respect.

People’s care records reflected the person’s current health and social care needs. Care records contained up to date risk assessments.

There was a complaints policy and procedure in place. People’s comments and complaints were taken seriously, investigated, and responded to.

Safety and maintenance checks for the premises and equipment were in place and up to date.

We found two continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

The service had a registered manager. 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.

We last inspected this service on 31 October, 1 and 2 November 2016 and found the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued requirement notices in respect of these breaches. Following our inspection the provider sent us an action plan on 29 December 2016 to tell us about the actions they were going to take to meet these regulations.

During this inspection, we found that insufficient action had been taken to meet the requirements of three regulations the service had breached at the inspection in October / November 2016. In addition to this, we found a further two breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had failed to ensure that staff had received such appropriate support, training, supervision or appraisal as is necessary to enable them to carry out the duties they are employed to perform.

Where risks to people had been identified, steps to reduce or mitigate these risks had not always been completed placing people at risk of unsafe care.

Whilst there were some systems in place in the home to monitor the quality of the service provided via audits these were not effective at identifying the areas of concern that we found during this inspection.

People received their medicines safely, accurately, and in accordance with the prescriber’s instructions. Medicines were stored safely.

People were protected against abuse because staff understood their responsibility to safeguard people and the action to take if they were concerned about a person's safety. People's rights were protected because staff were aware of their responsibilities under the Mental Capacity Act 2005.

People had access to and were supported with their healthcare needs, including receiving attention from GPs and routine healthcare checks.

People were involved in their day to day care. People’s relatives were invited to participate each time a review of people’s care was planned.

People were comfortable and relaxed in the company of the staff supporting them.

Staff treated people with dignity, respect and kindness. They knew people's needs, likes, interests and preferences. People were supported to maintain relationships with their friends and relatives.

We recommend that the service seek advice and guidance from a reputable

source about supporting people with communication needs or with sensory loss to have access to information in a format they can understand.

We found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and identified a further four breaches. You can see what action we told the provider to take at the back of the full version of the report.

Colbury House provides accommodation for persons who require nursing or personal care for up to 58 people. The home has permanent residents but also provides respite care. At the time of our inspection 44 people were living at the home.

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The CQC had not received an application in respect of a registered manager.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider did not return a PIR and a rating’s limiter was applied to the “well led” section of this report which meant they could not achieve a 'good' rating in this domain.

People’s personal emergency evacuation plans and the testing of fire alarm systems were not up to date and we could not be sure that in the event of a fire people would be safe.

Medicines were not stored and administered safely. Medicine administration records were not always completed. Temperatures of refrigerators used to store some medicines were not always recorded.

Staff did not receive regular supervision or appraisals which would have provided them with appropriate support to carry out their roles.

Not all staff had completed training in areas that reflected their job role.

Where people lacked the mental capacity to make decisions the home did not always follow the principles of the Mental Capacity Act 2005 to ensure any decisions were made in the person’s best interests.

Some risk assessments and care plans were not always person centred and did not ensure that peoples care and treatment was appropriate, met their needs or reflected their preferences.

There were sufficient numbers staff deployed to meet people’s needs. Staff were not hurried or rushed and when people requested care or support, this was delivered quickly. The provider operated safe and effective recruitment procedures.

Individual care records were stored electronically and each member of staff carried a personal data terminal to access and update records accordingly.

The provider had systems in place to respond and manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies.

People who were able to talk with us said that they felt safe in the home and if they had any concerns they were confident these would be quickly addressed by the staff or manager.

People were supported with health care appointments and visits from health care professionals.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed.

People knew who to talk to if they had a complaint. Complaints were passed on to the manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found –

Is the service safe?

The service was not safe. We looked at the care plans and risk assessments for four people, who had complex needs. These were inconsistent and did not always describe in sufficient detail how care workers should deliver their care safely and manage identified risks. The needs of some of the people living at Colbury House were not assessed and care and treatment was not always delivered in line with their individual care plan.

Arrangements were in place to deal with foreseeable emergencies. The service maintained a personal emergency evacuation plan for each person and had developed a contingency plan that would ensure that the needs of people who used the service would be met in the event of an incident affecting the safe running of the home.

Care workers we spoke with demonstrated a good understanding of types of abuse people may experience. All care workers we spoke with confirmed they had received training on safeguarding of vulnerable adults. They would not hesitate to report concerns to the manager and stated they were confident any concerns raised would be taken seriously. Care workers knew about the policy and procedures and who to report any concerns to.

The registered manager ensured agency staff were qualified and appropriately registered because the agency provided profiles of staff which included relevant training and registration documentation.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. At the time of our inspection four applications had been submitted and the provider was working with the local authority to ensure further referrals were made proper policies and procedures were in place. The manager understood when an application should be made and how to submit one; and was aware of recent changes to the legislation.

Is the service effective?

Some aspects of the service were not effective. At the time of our inspection the registered manager could only provide evidence of one supervision being completed [the deputy managers] from a staff of 29 over the last 12 months. This meant staff did not received appropriate professional development in respect of supervision and appraisal.

There were arrangements were in place to undertake pre-admission assessments and these considered all aspects of people’s needs. This enabled the service to reach judgements about whether they could effectively meet people’s needs.

A regular visitor to the home from a local out-reach group who had been visiting the home for the past 15 years told us: “I visit and spend time with six to ten people every fortnight. There is always something going on. The activities co-ordinator is very good. I have no concerns at all in relation to the way people are cared for here.

Is the service caring?

The service was caring. We observed two people being supported to eat and drink their lunch in their respective rooms. One person had an eating and drinking care plan which stated care staff were to make sure that they were sitting up when being supported to eat.

One person using the service said: “If all places are like this, they would be doing well. I am really happy here the staff are brilliant with me, it’s much better than it was a year ago”.

Is the service responsive?

The service was responsive. We found risks associated with people’s care had been recognised, assessed and planned for. Risk assessments had been completed in relation to a range of needs such as eating and drinking, moving and handling and managing skin integrity. For example, one person had a risk assessment in relation to their use of the stairs. Another person had a risk assessment to manage their risk of developing infections.

The registered manager responded to complaints in a timely way and took immediate action and included this in the complaints records. All complaints were fully investigated with outcomes and resolutions being relayed back to all parties.This ensured that accurate records were maintained on people's concerns and complaints and the actions that were taken to address them.

Is the service well led?

The service was not well led. Systems were in place to regularly monitor and check water temperatures, nurse call systems, bed rails, security, door closures, and emergency lighting. However records were unclear and did not demonstrate when systems had failed or where issues had arisen. We did not see an audit trail of issues found, reported, and resolved. This meant the provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

The sample of care plans we looked at showed that people’s needs were being reviewed monthly.

At this inspection we found that the provider had taken action to make improvements. There were more robust systems for assessing and monitoring people's care needs. All care plans were now kept electronically and everyone living at Colbury House had a personalised care record. All care plans we reviewed contained up to date information which reflected the needs of people.

An effective recruitment and selection process was in place to ensure that the people who used the service were safe and their needs were met by care workers who were suitably qualified, skilled and experienced. Appropriate checks were undertaken before care workers began work.

We looked at the training records for 10 care workers and saw that since our previous inspection the provider had introduced an 'e-learning' programme for all care workers and nurses. Training records we reviewed showed that care workers were up to date with mandatory training. The manager said there had been a focus on improving training, and this was monitored regularly.

The manager described how regular nurse team meetings and care team meetings had been set up to improve communication within the service and to share learning. For example, there were daily meetings with the deputy manager and nursing staff, as well as shift handover meetings. This meant that issues were communicated effectively.

The manager outlined the improvements that had been implemented since the last inspection. For example, previously we had identified that the heated food trolley was not in working order but this had since been replaced. The manager told us that the Speech and Language Therapist (SALT) was visiting once a week and completing two assessments during each visit. We looked at the care plan for one person who had been assessed by the Speech and Language Therapist. That person's care plan had been updated to reflect that person's current needs in relation to nutrition and hydration.

At our inspection in April 2013 we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. We judged that this had a major impact on people who used the service. As a result of this we issued a warning notice. At this inspection we checked to see that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

We looked at a sample of four care records for people who used the service. We saw that people's care records were kept securely in lockable filing cabinets in the nurses' station. Care plans provided accurate information in relation to the care and treatment provided to those people.

We saw evidence that recruitment procedures had not always been operated effectively. We had concerns about gaps in the recruitment procedure for the manager, who had been in post since 3 June 2013 and also for the deputy manager who commenced employment on the 8 July 2013.

We looked at the care records of six people who used the service. We saw that there was no consistent system for assessing people's needs or planning how those needs should be met.

We found that not all the people living at the home were supported to eat and drink sufficient amounts for their needs.

Appropriate checks were undertaken before staff began work.We reviewed documentation and we saw that checks were completed with the Criminal Records Bureau (CRB) and the Independent Safeguarding Authority (ISA). But not all these records were located promptky when we asked for them

We saw records to show that not all staff had received training to meet people's needs at the home, for example, first aid, food hygiene and nutrition. One care worker told us: "I can't remember the last time I had a supervision. The previous manager never had time. Hopefully it will be different now".

People's personal records did not contain accurate and up to date information about the care and treatment provided. The home had a system in place to check people every hour and record the care provided and to monitor their food and fluid intake however these were not accurate and were not always completed.