Archived: James Nugent Court

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.

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 two floors. At the time of inspection James Nugent Court was providing care for 49 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 manager in post was going through the process of registration with the Commission.

During our inspection, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulated Activities 2014 in respect of Regulations 11 consent; 12 safe care and treatment; 17 good governance and 18 staffing. We also identified a breach of Regulation18 the Care Quality Commission Registration Regulations regarding notifying of significant events. You can see what action we told the provider to take at the back of the full version of the report.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had not been adhered to in the home. We saw that mental capacity had not always been assessed appropriately, consent had not always been sought, covert medication processes had not been followed and DoLS conditions that were to be applied by the home had not been carried out.

The medication procedures were not managed effectively as there were medications not administered correctly as prescribed. Equipment was not monitored to ensure it was working appropriately.

Accidents, incidents and complaints had not been managed appropriately. Audits of the service were ineffective and in some cases not carried out.

People received support with their health care. However care plans and risk assessments had not been updated accurately and in some cases contained contradictory guidance that if followed would pose a risk to people's health and safety. People’s personal emergency evacuation plans did not match their risk assessments.

Monitoring information for peoples care such as fluids and nutrition intakes had not always been completed and in some cases had been duplicated with differing information. Information from other professionals such as dieticians had not been transferred into care plans.

We saw no evidence of a robust induction process into James Nugent Court and we questioned the effectiveness and validity of the training staff had received as we identified serious concerns with the service. Supervisions and appraisals had not regularly taken place.

The manager had reduced the number of agency staff being used however feedback we received from people using the service, relatives and staff all indicated there were still issues regarding staffing levels.

People we spoke with told us they felt safe at the home and they had no worries or concerns. People’s relatives and friends also told us they felt people were safe. We observed staff to be kind and respectful towards people. The home provided a range of activities to occupy and interest people

Infection control standards at the home were good and these standards were commented on by both people living in the home and their relatives.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location from the providers registration.

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?

We found that the service was not safe.

Systems were not being used to assess any risks identified when planning people's care and support. For some of the people who used the service, we found that their identified risks had not always been assessed in full and that the assessments were not always accurate.

Is the service effective?

We found that the service was not effective.

Comments from people living at and visiting the service were varied and included ''Everyone is nice.'' and ''I feel lonely and depressed.''

We saw that staff were not always aware of peoples individual needs or their current circumstances such as how much food they had eaten and how much fluid they required. We also found that after an incident had occurred the circumstances were not always fully recorded or reviewed to establish a cause or prevent a further occurrence.

Is the service caring?

One relative visiting the service told us ''The staff are good, there are just not enough of them.'' Another told us that their relative had a fall but staff were unable to tell them any details and they had not been able to speak with the manager.

Some of the members of staff were observed to be sensitive, respectful and kind when assisting people. One person living at the service told us ''The staff are very good, they are always willing to help you.'' Another person told us ''I feel like I am just being tolerated here.''

Is the service responsive?

We found that the service was not responsive.

We found that there were no systems in place to regularly assess and monitor risks to individuals and the environment. We found that referrals to appropriate health professionals when a person's health needs changed were not always being made.

Is the service well led?

We found that the service was not well led.

There were no quality assurance systems being used to monitor health and safety; infection control, the environment and care plans. The manager of the service was in the process of applying to be registered with the Care Quality Commission and therefore the name appearing in this report is that of the previous manager.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

There were effective recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

People had been cared for in an environment that was safe as the building was newly built and well maintained. There was the opportunity for people living at the home and others to express their views and opinions of the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. During the inspection we saw evidence that the correct procedures had been followed in ensuring that an individual who lived in the home had been detained under a Deprivation of Liberty order.

Each person living at the home had a Personal Evacuation Plan detailing how they could be moved out of the building quickly in an emergency and this was kept in their care file.

A member of the management team was available on call in case of emergencies.

Is the service effective?

People had access to a range of healthcare professionals some of which visited the home. They were referred correctly to the appropriate professionals when their needs changed

Relatives who we spoke with of people who lived at the home and others told us that they were happy with the care provided and felt the needs of the people who lived there had been met. It was clear from what we saw and from speaking with staff that they knew the people living there well.

Is the service caring?

People were supported by staff who were kind and respectful and we saw evidence of this during the inspection. An example was explaining to people what they were going to do and working at the pace of the individual. One relative told us that they were always kept informed when their relation had been seen by the G.P. Others told us that ''The staff are absolutely brilliant and they go the extra mile.'' and '' Staff have been very involved in settling my relative in to the home.''

Is the service responsive?

Before moving in to the home the manager or a senior member of staff visited with the individual to determine if they could meet their needs and respond to their health needs and preferences for their everyday lives such as taking a nap and sleeping with a light on. We saw that people were appropriately referred to relevant health professionals when their needs had changed.

Is the service well-led?

The home had a registered manager in post which indicates that the person is of good character, is physically and mentally fit and has the necessary qualifications, skills and experience.

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People were asked for their feedback on the service and staff told us that they felt well supported to deliver good care.