Archived: James Nugent Court

Updated 14 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 05 and 06 November 2018 and was unannounced on the first day.

The inspection was carried out by one adult social care inspector, two medicines inspectors, two assistant inspectors and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we asked for information from the local authority and we checked the website of Healthwatch Liverpool for any additional information about the home. We reviewed the information we already held about the service and any feedback we had received.

During our visit we spoke with five people who used the service, seven people’s relatives and six members of staff. We also spoke with the manager and the nominated individual for the home. We looked at the care records for six people who used the service, medication storage and records, five staff records, accident and incident report forms, health and safety records, complaints records and other records for the management of the home.

During our inspection, we used the Short Observational Framework for Inspection (SOFI). This involved observing staff interactions with people in their care. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Updated 14 December 2018

This inspection was carried out on 05 and 06 November 2018 and was unannounced. Our previous comprehensive inspection of the home in April 2018 had placed the home in special measures and had rated the service as ‘inadequate’. We carried out this inspection as we needed to check that improvements had been made to the quality and safety of the service.

James Nugent Court 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. James Nugent Court is a modern-purpose built home. It has 56 bedrooms with en-suite accommodation situated over three floors. Each floor has a lounge, dining and kitchen area. The building had hairdressing facilities, coffee shop and landscaped gardens and car parking is provided at the front of the building. At the time of inspection James Nugent Court was providing care for 46 people.

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 service did not have a registered manager in post. However, a ‘turnaround’ manager was in post and a nominated individual who was the providers representative was heavily involved in the home.

At our last comprehensive inspection of the home in April 2018 we found a number of breaches of the Health and Social Care Act 2008, which were related to consent, safe care and treatment, good governance and staffing. We had also identified a breach of Regulation 18 the Care Quality Commission Registration Regulations regarding notifying of significant events. We found that improvements had been made in the majority of these areas but further improvements were required. However, in response to the improvements that had been made we took the home out of special measures.

During our last inspection we found that the medication procedures were not managed effectively as there were medications not administered correctly as prescribed. At this inspection we found that although there were improvements in some areas of medication management, there was still significant concerns.

This is a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulation 12 safe care and treatment.

During our last inspection we found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. At this inspection we found improvements had been made in regard to mental capacity assessments, DoLS and consent. The manager was also holding best interest meetings for those people who needed them.

During our last inspection we also found concerns regarding risk assessments, personal emergency evacuation plans, care plans and health monitoring information. At this inspection we found improvements had been made in each of these areas and they were now person centred and the information held was up to date and regularly reviewed. However, we identified that staff held knowledge about people’s care that was not recorded in the care plan and in some cases the monitoring information had not been fully completed.

During our last inspection we had identified that staff support such as induction, training and supervision was inadequate. At this inspection we found improvements had been made and staff were receiving support to carry out their work, however we saw that although mediation training had taken place we could not be certain of the effectiveness of this training due to our findings in relation to medication management

We had previously found that accidents, incidents and complaints had not been managed appropriately. However, at this inspection we saw that the processes had improved and these were monitored and significant events had been notified to the CQC in a timely manner.

At our previous inspection we had found the manager had not carried out any audits of the service and that the provider audits had not been effective. During this inspection we saw that audits and other quality assurance processes had been implemented and the majority of these were useful in driving the quality of the service. However, due to our findings throughout this inspection found that the audits for medication were not effective.

The majority of staff were friendly, welcoming and we observed good relationships were maintained with people living in the home with a kind and respectful approach to people’s care. However, we did observe staff not listening to people at times.

There was still a high usage of agency staff being booked by the manager, however the feedback from people using the service and their relatives said that regular agency staff were used so there were familiar faces and so continuity for the people living in the home was upheld.

Policies and procedures were in place and updated, such as safeguarding, complaints, medication and other health and safety topics. Infection control standards were monitored and managed appropriately. There was an infection control policy in place and a procedure for staff to follow to minimise the spread of infection, all staff were provided with appropriate personal protective equipment such as gloves and aprons.

The manager was a visible presence in and about the home and it was obvious that she knew the people who lived in the home well. The manager and the provider representative were open and receptive to our feedback. They told us that they recognised that the home needed to continue to improve and that they were committed to the work required.

There was a safeguarding policy in place and staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager immediately.