Loose Court

We found the following examples of good practice.

Arrangement was in place for visitors to meet in safe places within and outside the service which minimised the risk of infection spread. Staff had consulted with relatives to agree visiting arrangements in line with government guidance.

Visitors were asked health screening questions, temperatures were taken, visitors were also advised to sanitise their hands-on arrival and wear face masks. Lateral flow tests were carried out and once a negative result was received staff facilitated the visit.

Plans were in place to isolate people with COVID-19 to minimise transmission if required. The service had good supplies of personal protective equipment (PPE) such as masks and hand sanitizers that were readily available at stations throughout the service.

Staff had received training on how to keep people safe during the COVID-19 pandemic and staff and were regularly tested for COVID-19. The building was clean and free from clutter and there were enhanced cleaning practices.

Loose Court is a residential care home without nursing for 42 older people. It can also accommodate people who live with dementia and people who have physical and/or sensory adaptive needs.

At this inspection there were 37 people living in the service. Some people lived with dementia and had special communication needs.

People's experience of using the service and what we found

People and their relatives were positive about the service. A person said, “The staff are friendly and the place is fine for me.” Another person who had special communication needs smiled and waved to a passing member of care staff when we used signed-assisted language to ask them about their home. A relative in a thank-you card said, “The biggest thank-you to each and every one of you. We are grateful that mum’s last years were spent in your loving care. Our heartfelt thanks.”

The local safeguarding of adults authority was investigating three historic occasions when people had fallen and injured themselves. We did not look into these events. After the inspection visit the registered manager told us the authority had concluded their investigation and did not propose to take any further action. At this inspection lessons had been learned when things had gone wrong and people were being helped to avoid preventable accidents.

People received safe care and treatment in line with national guidance. There were enough care staff who had the knowledge and skills they needed and safe recruitment practices were in place. Medicines were safely managed, good standards of hygiene were promoted and people had been helped to quickly receive medical attention when necessary.

People were supported to have maximum choice and control of their lives and care 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 accommodation was designed, adapted and maintained to meet people’s needs and expectations. Repairs were being completed to a small number of defects.

People received compassionate and dignified care. People’s right to privacy was respected and confidential information was managed in the right way. People and their relatives were supported to express their views about things important to them.

People were consulted about their care, were given information in an accessible way and were supported to pursue their hobbies and interests. There was a procedure to resolve complaints and people were treated with compassion at the end of their lives.

People had been consulted about the development of the service, their suggestions had been implemented and quality checks had been completed. Good team work was promoted, regulatory requirements had been met and joint working was in place.

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

Rating at last inspection

The last comprehensive inspection published on 12 May 2017 rated the service as Good. However, there was a breach of regulations because of shortfalls in the management of medicines. A focused inspection was completed on 11 August 2017 at which the breach of regulations had been met (published 28 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Loose Court is a residential home providing accommodation and support for up to 42 people who require personal care. The home is located outside the town centre of Maidstone. At the time of inspection 36 people were living at the service.

There was 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.

At our previous inspection on 28 March 2017, the service was in breach of regulation 12 (Regulated Activities) Regulations 2014. This breach was in relation to medicine management. We found that medicine trolleys were being stored incorrectly, gaps in the recording of storage temperatures for medicines, inaccurate amounts of medicine in stock, no protocols in place for medicines prescribed as when required (PRN) and staff not following prescribed guidance for pain relief patches. At this inspection improvements had been made and the service was no longer in breach of the regulation.

People’s medicines were being administered by competently trained staff. Medicines were being stored safely and there were PRN protocols in place. However, we found two gaps in people’s medicine records that had not been accounted for. We have made a recommendation about this in our report.

People were protected from abuse by trained staff who could identify different forms of abuse and who they could report to. The provider had effective safeguarding systems in place.

The provider had ensured that there were appropriate systems in place to identify and minimise risk for people living at the service. Risks to people's safety had been assessed and actions taken to protect people from the risk of harm.

There were sufficient staff to provide care to people. Staff had safety checks to ensure they were safe to work with adults.

Loose Court is registered to provide accommodation and personal care for up to 42 older people. Some people were living with dementia, some had mobility difficulties, and sensory impairments. Accommodation is provided on two floors with a lift between floors for easy access. The home has a garden area which provides a safe outdoor space. The premises are situated on the outskirts of Maidstone. At the time of our inspection there were 38 people living at the service.

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.

At our previous inspection on 26 April 2016, we found breaches of Regulation 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people had not received their medicines as required or as prescribed. The provider had failed to operate an effective quality assurance system and failed to maintain accurate records. Steps taken in the home did not follow the principles of the Mental Capacity Act (MCA) 2005. Staff had not received appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. We asked the provider to take action to meet the regulations.

We received an action plan on 27 June 2016 which stated that the provider would be meeting the regulations by mid July 2016.

People and their relatives told us that they received safe, effective, caring and responsive care and the service was well led.

Medicines were not well managed. Medicines had not been stored appropriately. Medicines records did not always detail why people had ‘as and when required’ (PRN) medicines.

Staff had a good understanding of what their roles and responsibilities were in preventing abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies.

The provider followed safe recruitment practice. Essential documentation was in place for all staff employed. Gaps in employment history had been explored to check staff suitability for their role. There were suitable numbers of staff deployed on shift to meet people’s assessed needs.

The premises were well maintained, clean and tidy. The home smelled fresh.

Staff had undertaken training relevant to their roles. Staff were supported to gain qualifications and were supported in their roles. They had received regular supervision meetings and those that had worked longer than one year had received an appraisal to discuss their performance, training and support.

Meals and mealtimes promoted people’s wellbeing, meal times were relaxed and people were given choices.

Staff had a good understanding of the Mental Capacity Act 2005 and supported people to make choices. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority by the registered manager.

People received medical assistance from healthcare professionals when they needed it. Staff knew people well and recognised when people were not acting in their usual manner. Feedback from healthcare professionals was positive.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the home was calm and relaxed. Staff treated people with dignity and respect.

People’s care was person centred. Care plans detailed people’s important information such as their life history and personal history and what people can do for themselves.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People’s views and experiences were sought through surveys and meetings. People were listened to. People and their relatives knew how to raise concerns and complaints.

There were quality assurance systems in place. The registered manager and provider carried out regular checks on the home. Action plans were put in place and completed quickly. Staff told us they felt supported by the registered manager.

The registered manager demonstrated that they had a good understanding of their role and responsibilities in relation to notifying CQC about important events such as injuries, safeguarding concerns and deaths.

We found a breach 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 this report.

Loose Court is registered to provide accommodation and personal care for up to 42 older people with dementia. Accommodation is provided on two floors with a lift between floors for easy access. The home has a garden area which provides a safe outdoor space. The premises are situated on the outskirts of Maidstone. People had a variety of complex needs including onset of dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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.

Medicine was being administered crushed to one person, which is called covert medicine administration. The correct process for covert administration of medicine had not been followed.

One to one staff supervision had not been consistent. There were gaps in supervisions which showed that staff had not sometimes had supervision for six months or more.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although the registered manager understood the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards and the home complied with these requirements. However, the process had not been fully adhered to regarding medicines and restrictions in the home.

Effective systems were in place to enable the registered manager to assess, monitor and improve the quality and safety of the service. However, shortfalls had not been identified by the registered manager and actions had not been taken in a timely manner to improve the quality of the service.

The provider had systems in place to manage safeguarding matters and make sure that safeguarding alerts were raised with other agencies. All of the people who were able to converse with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the registered manager. Relatives felt their people were safe in the home.

The home had risk assessments in place to identify risks that may be involved when meeting people’s needs. The risk assessments showed ways that these risks could be reduced. Staff were aware of people’s individual risks and were able to tell us about the arrangements in place to manage these safely.

There were sufficient numbers of qualified, skilled and experienced staff 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 recruitment procedures.

The food menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The chef prepared meals to meet people’s specialist dietary needs.

People were involved in their care planning, and that staff supported people with health care appointments and during visits from health care professionals. Care plans were amended immediately to show any changes, and care plans were routinely reviewed every month to check they were up to date.

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. Staff encouraged people to make their own choices and promoted their independence.

People knew who to talk to if they had a complaint. Complaints were managed in accordance with the provider’s complaints policy.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person and their relatives. People were encouraged to take part in activities and leisure pursuits of their choice, and to go out into the community as they wished.

People spoke positively about the way the home was run. The management team and staff understood their respective roles and responsibilities. Staff told us that the registered manager was very approachable and understanding.

During this inspection, we found breaches of regulations relating to fundamental standards of care. You can see what action we told the provider to take at the back of the full version of this report.

During the day we talked with eight people living in the home, and met most of the others. We also talked with nine staff (as well as the manager) and four relatives. All of the relatives spoke highly of the home and the staff. Comments included: 'We are very happy with everything here. Mum likes it here, and it is very homely"; and "The home has a very friendly atmosphere."

We found that care planning reflected people's individual needs, and was appropriately discussed and agreed with people's next of kin or representatives.

We inspected food and nutritional processes, and found that people were provided with a good range of suitably nutritious foods.

The staff were aware of the importance of safeguarding vulnerable people from different kinds of abuse and were trained in carrying this out.

The home had reliable medication procedures in place, and we found that these were followed accurately.

We found that there were ongoing systems for staff training which ensured that all staff kept up to date with mandatory training.

The home had a complaints procedure which was easily available, and was clearly written. People told us that any concerns were quickly dealt with and addressed appropriately.