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Courthill Care Home Requires improvement

Reports


Inspection carried out on 19 December 2019

During a routine inspection

About the service

Courthill Care Home is a care home without nursing providing personal care to up to six people living with learning difficulties and autism. At the time of the inspection four people lived at the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people who used the service could live as full a life as possible and achieved the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

Risks to people were not always consistently assessed and managed which could put them at risk. The provider’s personal emergency evacuation plans in conjunction with the fire policy and procedures did not provide staff with clear guidance on how to support people in the event of emergency. Staff were not reporting behavioural incidents as per the guidance in people’s support plans. Hence the behaviours were not analysed for any patterns or lessons learned.

The provider’s audits did not identify issues we found during our inspection such as lack of reporting of incidents, inconsistencies in records or actions needed around support with communication. The systems and processes were not robust enough to demonstrate the provider effectively monitored the quality and safety. This meant actions were not always addressed to reach best outcomes for people and continuously improve in line with legal requirements and national best practice guidance.

Following our inspection, the provider took action to review and improve their records and governance systems.

People felt safe at the home and staff knew how to protect them from abuse. The provider had safeguarding and whistleblowing policies in place and adhered to the local authority’s guidance.

Staff supported people to take their medicines as prescribed, and the provider had processes and systems to safely order, store and monitor medicines stock. Staff knew how to protect people from the spread of infections and were trained in infection control.

Staff supported people in person-centred manner. Care plans were personalised and included information on people’s needs, life story, interests and identity. Individual behavioural support plans provided detailed guidance for staff on how to support people when they were distressed. People were encouraged to live active lives and participate in activities matching their interests.

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. Staff asked people for their choices and involved them in their care.

The service applied the principles and values of Registering the Right Support. These ensured that people who used the service could live as full a life as possible and achieved the best possible outcomes that included control, choice and independence.

People were supported to eat healthily. Referrals were made to health care professionals where required and staff followed their guidance to ensure people received appropriate care.

Staff knew people well and addressed them in caring and respectful way. People were offered the opportunity to provide feedback and felt listened to.

Staff confirmed they felt supported by their manager and the provider. Staff were offered regular training and opportunities to develop their professional qualifications to be able to better support people. Multidisciplinary reviews of people’s care confirmed that this reduced people’s levels of anxiety and enabled them to live more active lives.

F

Inspection carried out on 13 November 2018

During a routine inspection

The inspection took place on 13 November 2018 and was unannounced. The last inspection was in January 2018 where we rated the service as Good. This inspection found the legal requirements were not fully met in relation to person-centred care planning. You can see what action we told the provider to take at the end of this report.

Courthill Care Home 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.

Courthill Care Home accommodates up to six people in one adapted building. Care is delivered across two floors and people have access to a garden and sensory room. At the time of our visit, there were four people living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The service was not too large and met the principals outlined in Registering the Right Support. However, we did identify areas for improvement around how people’s care and activities are planned. These are detailed within the Responsive domain.

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.

People’s care was not always planned in a personalised way. At the time of our visit, new care plans were being implemented in response to concerns raised by the safeguarding team. Whilst these records were detailed, there was a lack of evidence of people being involved in these. We also identified missed opportunities to support people to find new activities and express choices about their care. Care planning for end of life care was not taking place, although the registered manager told us they intended to introduce this following our visit.

People’s dietary needs were met and people liked the food they were served. Some improvements to how people were involved in menu planning were underway at the time of our visit and put in place following the inspection. We identified the provider could improve the way they reached out to the local community to create a more holistic approach to people’s care. We made a recommendation about community links.

People were supported by a consistent staff team who knew them well, which minimised the impact of some of the issues identified regarding care plans. Staff provided support that encouraged people to develop skills and independence whilst maintaining a good understanding of any risks. Where risks were identified, plans were in place to guide staff about how to keep people safe. Staff understood their roles in safeguarding people from abuse and the provider had carried out checks on staff to ensure they were suitable for their roles.

People were supported to access healthcare services when required and we saw evidence of healthcare professionals input to care plans. There was a system in place to ensure people received an assessment of their needs before coming to live at the service. People’s medicines were managed and administered in line with best practice, with detailed guidelines to inform staff about how and when to administer medicines to people.

Staff felt supported by management and there were a variety of checks and audits in place to monitor the quality of the care that people received. There was an ongoing plan to improve the service and this inspection found a number of improvements implemented, with some yet to

Inspection carried out on 19 January 2018

During a routine inspection

The inspection took place on 19 January 2018 and was unannounced. Our last inspection was in November 2016 where we found one breach of the legal requirements in relation to record keeping and governance. At this inspection, we found that the provider had taken action to meet the legal requirements of the regulations.

Courthill Care Home is a residential care home providing support to up to six people with learning disabilities and autism. At the time of our inspection there were six people living at the home, some of whom also had physical disabilities and mental health conditions.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Responsive and Well-led to at least good. The provider told us they would introduce additional monitoring of risks, audits to improve oversight and governance at the home and introduce more in-house activities for people. We found that these actions had been implemented by the provider when we visited.

Courthill Care Home 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.

Courthill Care Home accommodates 6 people in one adapted building.

There was a registered manager in post, but they were on leave on the date of our visit. 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.

People’s care was planned in a person-centred way that reflected their interests and needs. Staff routinely assessed risks to people and plans were implemented to keep people safe, whilst encouraging their independence. Staff encouraged people to develop skills and confidence. People’s needs and risks were regularly reviewed to identify and respond to any changes. Where incidents had occurred, staff took appropriate actions to keep people safe. Staff had a good knowledge of safeguarding adults procedures. There was a complaints policy in place and people were regularly informed about how to raise concerns.

There was a variety of activities taking place at the service. People had individual activity plans and the provider had introduced a variety of in-house activities. People were involved in their care and were given opportunity to feedback on areas such as activities and food. Meals were provided in line with people’s preferences and staff involved people in shopping and menu planning. People’s legal rights were protected because staff followed the Mental Capacity Act (2005).

People were supported by kind and caring staff that had appropriate training for their roles. Staff completed training courses and these were regularly refreshed. Staff felt supported by management and had regular meetings to provide suggestions to improve the home. There were sufficient numbers of staff to safely meet people’s needs and the provider carried out checks on new staff to ensure that they were suitable for their roles. Staff knew people well and were respectful of people’s privacy and dignity when providing support to them.

People’s healthcare needs were met. Staff supported people to attend appointments and maintain their health. People received their medicines safely and in line with the guidance of healthcare professionals. Staff followed good practice in relation to infection control and regular checks were undertaken in this area. The provider carried out a variety of audits to identify improvements at the service. There was an ongoing plan to improve the service for people.

Inspection carried out on 1 November 2016

During a routine inspection

Courthill Care Home is a care home that provides support to up to six people who have a learning disability and who may display behaviours that challenge. The home is located in Caterham and is a short walk from shops and other local facilities. On the day of the inspection six people were being supported. The people have a range of needs and are supported with a full range of tasks, including maintaining their health and well-being, personal care, support with nutrition and social activities.

On the day of inspection we met the 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.

The inspection took place on 1st November 2016.

We found a breach of regulation. You can see what action we told the provider to take at the back of the full version of this report.

People and relatives said that Courthill Care Home was a safe place to live. Despite this we found a lack of managerial oversight of people’s overall support. We found examples where concerns with people’s support had not been pick up by the registered manager. This put people at risk of not receiving the care and support they needed.

We found that patterns and trends relating to epileptic seizures had not been picked up. These patterns and trends could have been used to manage risks more safely for this person.

Although relatives praised the activities that were offered to people the registered manager had failed to pick up that a person had not attended a favourite activity for a month. On the day of inspection we observed a lack of stimulating in-house activities for people.

We have recommended that the home review their in-house activities for people.

Staff supported people who were at risk of becoming anxious and distressed and staff responded to their needs and effectively reduced the impact of behaviours that may challenge. Staff understood how to report suspected abuse so that action could be taken if necessary. Incidents and accidents were reported and the registered manager reviewed reports to prevent them from re-occurring. When risks to people had been identified they were appropriately managed. People had risk assessments that staff followed to minimise risk and keep people safety.

Risk assessments had been completed to ensure the home was safe for people to live in and there were arrangements in place should there be an emergency. People were supported by sufficient numbers of staff who were recruited safely and had the skills and knowledge to support people.

People received medicines in a safe way. Staff had a good understanding of the medicines they were supporting people to take and medicines were stored and disposed of appropriately.

Staff had the knowledge and skills to support people with learning disabilities and understood how to support people who may display behaviours that challenge. Training was available to staff, which included training courses related to people’s needs.

Staff had regular supervisions with their line manager and felt supported in their role. The registered manager used supervisions and team meetings to ask supportive questions of their team to assess their knowledge.

The requirements of the Mental Capacity Act (MCA) were being met. Staff had a good understanding of MCA. The registered manager had submitted Deprivation of Liberty Safeguard applications, one of which had been granted and five being processed. Staff worked in line with the details of the applications that were still being processed to ensure an effective and safe service was being provided to all that was in line with best practice principles.

People’s nutritional needs were met and people had a varied diet. Staff ensured tha

Inspection carried out on 12 June 2013

During a routine inspection

We spoke with three people who lived at Courthill Care Home. Due to communication difficulties, we were unable to discuss matters at length; however we were told by people at the home that they liked living at the home.

Some of the people who used the service had more complex needs which meant that they were not able to tell us about their experiences of using the service; we therefore used our observations to help inform our judgements. We observed staff interacting with people who used the service in a respectful manner, calling people by their first names and promoting their dignity and privacy.

People who used the service appeared relaxed, content and at ease in their surroundings. We found the property to be in a good state of repair. Following our inspection the provider took action to address the fact they were not routinely screening their water system for the presence of legionella bacteria.

Records demonstrated that staff had been well trained, knew how to meet the individual needs of people and provided care which was consistent with people's care plans.

The provider also demonstrated robust procedures for effectively monitoring the quality of the service to ensure that people received safe and appropriate care and support.

Inspection carried out on 11 January 2012

During a routine inspection

Three people who use the service were able to tell us their views of the service and they all spoke very positively about living there. Comments included �I like living here� and �there are lots of things that I like to do�.

We also spoke to two representatives of people who use the service who told us that they felt the care received was �very good�.

Reports under our old system of regulation (including those from before CQC was created)