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Courtfield Lodge Requires improvement

We are carrying out a review of quality at Courtfield Lodge. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 26 August 2020

During an inspection looking at part of the service

About the service

Courtfield Lodge is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 70 people on the ground and first floor. One of the floors specialises in providing care to people living with dementia.

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

We spoke with 11 relatives and one friend of someone living at the home. The feedback was mostly positive on the changes that had occurred since our last inspection. One relative was unhappy with the care their family member received. One relative had concerns related to the leadership of the service but praised the care their family member received. This is reflected in the report.

Staff were recruited safely. People told us enough staff were available to meet people's needs. Medicines were managed and administered safely. Infection control systems and audits continued to ensure a clean environment to keep people safe. Safeguarding procedures were in place to protect people from the risk of abuse, and to educate staff on how to recognise and respond to concerns.

People told us how staff were kind, caring and treated them well. Our observations showed people were happy in the company of staff. We observed people were treated with respect and they were involved with family members in their care planning. One relative commented, "They [staff] are very attentive to [family member], nothing is too much trouble."

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 management team were clear about their roles and provided care which resulted in good

outcomes for people. They worked in partnership with a variety of agencies to ensure people's health and social needs were met. They had worked to address areas of concern previously identified and foster and promote a positive environment through improved communication and effective teamwork. The manager used a variety of methods to assess and monitor the quality of the service. This ensured the service continued to be improve.

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

Rating at last inspection and update: The last rating for this service was inadequate (published 18 May 2020) and there were multiple 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 focused inspection we found improvements had been made and the provider was no longer in breach of the regulations we reviewed.

This service has been in Special Measures since 06 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 29 January 2020 and 05 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve; Person centred care, Dignity and respect, Safe care and treatment, Safeguarding service users from abuse and improper treatment, Fit and proper persons employed and Good governance.

We carried out this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires im

Inspection carried out on 29 January 2020

During a routine inspection

About the service

Courtfield Lodge is a residential care home providing personal and nursing care to 37 people aged 65 and over at the time of the inspection. The service can support up to 70 people across two units. One of the units specialises in providing care to people living with dementia.

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

People continued to be at risk of avoidable harm because oversight at the service was not consistent. When people’s needs changed their care records were not always updated to ensure all staff were aware of the person’s needs before supporting them. This placed people at risk of avoidable harm.

The management of people’s medicines continued to need improvement. For example, staff did not always follow correct procedures for the administration of thickening agents in drinks and food, this placed them at risk of choking and aspiration. Not all staff deployed to administer medicines were trained or deemed competent to do so.

Infection prevention and control systems continued to need improvement. There was a malodour on the first day of the inspection and cleanliness in some areas of the environment was poor. We saw improvements throughout the environment on the second day of inspection.

Since the last inspection recruitment processes had deteriorated. The manager did not always ensure staff were recruited in a safe way.

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People’s rights and freedoms continued to be at risk of infringement because the senior management team were not aware of important conditions outlined in people’s Deprivation of Liberty Safeguards (DoLS).

Person-centred care was not consistently provided. We found examples when staff had recorded people had been supported to receive oral hygiene however, they did not have a tooth brush. We observed mixed standards of person-centred care and not all staff were responsive to people’s needs.

The service was not well-led because there continued to be risk of avoidable harm and people did not always achieve good outcomes. Staff told us they did not feel supported or listened to. The management team were responsive to our feedback and implemented improved ways to monitor the areas identified to be poor by the inspection team.

There had been an improvement in the way accidents and incidents were managed. Staff understood how to safeguard people from abuse and safeguarding procedures had been followed. People had access to a wide range of external health care professionals.

Staff told us the standard of training had improved. Training records showed a wide range of courses available for staff however, some staff deployed to administer medicines had not been suitably trained. The manager arranged this training during the inspection.

Most people and relatives provided positive feedback about the support they received. Staff had built positive relationships with people they supported. People were provided nutritious meals and told us they enjoyed the food. However, on the first day of the inspection we observed staff did not always offer people choice and control at meal times because four people had left their lunch and were not offered an alternative. On the second day of the inspection we saw people were well supported during lunch time meal service. We have made a recommendation about improving people’s experience at meal times.

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

Rating at last inspection and update

The last rating for this service was inadequate (06 August 2019) and there were multiple 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 inspectio

Inspection carried out on 20 May 2019

During a routine inspection

About the service:

Courtfield Lodge Residential Care Home is a residential home registered to provide accommodation and personal care for 70 people aged 65 and over. At the time of the inspection, 53 people lived at the home. Some people were living with dementia.

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

People told us they felt safe and staff were kind and caring. However, practices in the home did not always demonstrate that staff understood how to safeguard people from neglect and abuse. Information we received before the inspection demonstrated people’s safety had been compromised due to lack of consistency in seeking medical attention and poor risk assessment and monitoring practices.

Systems for supporting people after incidents had not been adequately implemented to monitor people’s well-being. People were not always monitored following a fall or incident. The provider had not adequately analysed accident and incident to identify themes and trends and prevent re-occurrences. There were no lessons learnt processes to show how staff had learnt from events. This led to a repeat of incidents that exposed people to risk.

There had been a rapid decline in the quality of the care at the home. There had been instances when people had suffered significant injuries and deterioration of their conditions however staff had not always recognised a deterioration in people's conditions and sought medical attention in a timely manner. The provider needed to improve systems for monitoring people’s healthcare needs to ensure people had access to healthcare services, as necessary without delay. The changes that the provider had planned to introduce to improve people’s safety were not robustly implemented or monitored for effectiveness.

The registered manager and staff had not always followed safeguarding protocols to ensure all reportable concerns were reported to the local authority.

Staff had not carried out effective risk assessments to enable people to retain their independence and receive care with minimum risk to themselves or others. Risk assessments completed were not always accurate and environmental risks had not been adequately managed to prevent harm or injuries.

The provider had an effective recruitment procedure, which ensured only suitable staff were employed in the home. However, the disciplinary procedures were not always robust to give confidence to people that staff who acted unprofessionally would be held accountable. The provider informed us they had reviewed this and brought a new independent process in place.

People did not always receive their medicines as prescribed because medicines management practices were not always safe. This included the management of medicines such as topical creams, thickening powders and 'as required medicines'. Some of the staff who administered medicines were not competent to do so.

The standard of cleanliness and infection control practices needed to be improved. We have made a recommendation about the management of infection prevention measures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the systems and documentation in the service did not always support this practice. Authorisations to restrict people were not always renewed when they expired. During the inspection, the registered provider showed us an action plan which assured us action would be taken to address these issues.

The provider had not ensured their staff completed relevant training and supervision in line with their policy.

The governance systems at the home were weak. The system did not proactively monitor areas where the care delivered was not safe or meeting standards. Furthermore, arrangements in place did not ensure accountability and transparency. The registered provider was not always aware of shortfalls and serious concerns in the home due to a lack of robust oversight on the ca

Inspection carried out on 25 July 2018

During a routine inspection

Courtfield Lodge is a purpose-built care home in a quiet residential area close to the town centre of Ormskirk. There are 61 en-suite bedrooms, 52 of which are single and nine which can be used for single or double occupancy. Accommodation is on two floors and two lifts are provided. Communal areas are available on both floors. There are outdoor garden and patio areas.

At the time of the inspection 59 people lived at the home.

The inspection visit took place on 25 July 2018 and was unannounced.

At our last inspection we rated the service overall Good. The effective domain required improvement in relation to staff supervision and appraisal. On this inspection, we found the service had improved to good in the effective domain and remained good in the other four domains. We saw supervision and appraisal were in place. The registered manager and staff we spoke with said they received regular supervision and appraisal. We also saw evidence of these in staff files.

We found the evidence continued to support the rating of overall good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.

As well as the registered manager there was an additional manager who had recently begun managing the home. People who lived at Courtfield Lodge, their relatives and staff were positive about the management support in the home.

People told us they felt safe and cared for by staff. One person told us, “On a scale of one to ten, I’d give it a ten.” There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments were completed and kept under review. These provided guidance for staff in how to safely support people and reduced potential risks to people. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Medicines were managed safely in most areas. They were ordered appropriately, checked on receipt into the home, given as prescribed and disposed of correctly. The temperature of medicines room was too high for safe storage but this was being rectified when we inspected. People told us they received their medicines when needed.

Staff had been recruited safely, and received training sufficient to develop the skills and knowledge required to support people with their care and social needs. There were sufficient staffing levels in place to provide the support people required. We saw staff were attentive to people’s needs and wellbeing and responded promptly to requests for assistance.

We saw staff provided care in a personalised way, taking people’s preferences into account. They were aware the importance of upholding people’s rights and diverse needs and treated people with respect and care. People told us they were supported in the way they wanted. They said staff provided care in a way that respected their dignity, privacy and independence.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Relatives told us staff were welcoming to people’s families and friends. People told us they enjoyed a variety of social and leisure activities that assisted their well-being.

People told us staff met their care needs promptly and referred them to healthcare professionals where required. We saw from care records

Inspection carried out on 21 October 2015

During a routine inspection

This inspection took place on the 21 October 2015 and was unannounced.

The last inspection of the service took place on 5 September 2014 which was a follow up inspection to a planned inspection in March 2014. The home was judged to be compliant in all the areas we looked at in September 2014 and had addressed the issues found during the inspection in March 2014.

Courtfield Lodge is a purpose built care home situated in a quiet residential area close to the town centre of Ormskirk. There are 61 en-suite bedrooms, 52 of which are single and nine which can be used for single or double occupancy. Accommodation is on two floors and two lifts are provided.

Communal areas are available on both floors. There are outdoor garden and patio areas.

The home had a registered manager in post although they were not present during our inspection due to them being asked to temporarily cover another home within the organisation. 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 told us they felt safe at the home and with the staff who supported them.

We looked at the personnel records of five members of staff. We found references highlighted some issues, such as long periods of sickness absence, and two references referred to performance issues within previous jobs. There was no indication within interview records or any other documentation of these issues being discussed. Another file had no record of a Criminal Records Bureau (CRB) or Disclosure and Barring (DBS) check recorded. We have made a recommendation about this.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns.

All the people we spoke with felt their medicines were managed safely and told us they always received them on time and when they needed them. We asked people if they felt care workers were competent when handling their medicines and everyone we spoke with told us that they felt staff were competent.

It was evident however from looking at staff files and from speaking with staff that formal support via supervisions and appraisals where not taking place and not all the staff we spoke with felt that they had the necessary support from the management team at the home.

The home catered for any specialist diets, whether that be for health or religious needs and that fresh produce was ordered on a weekly basis. The responses we gained regarding the quality of the food on offer were mixed with some people telling us that they were not consulted about they food they were offered.

People’s rights were protected, in accordance with the Mental Capacity Act 2005. People were not unnecessarily deprived of their liberty because legal requirements and best practice guidelines were followed.

People were treated in a kind, caring and respectful way. They were supported to remain as independent as possible and to maintain a good quality of life. Staff communicated clearly with those they supported and were mindful of their needs.

People we spoke with and their relatives told us they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be listened to and addressed.

We saw little in the way of planned activities during our inspection and we received a few negative comments, mainly from relatives, in relation to activities. People living at the home however told us they were happy and had things to do to occupy their time.

We found most plans of care to be person centred, which outlined clear aims, objectives and actions to be taken. These provided staff with detailed guidance about people’s assessed needs and how these needs were to be best met.

People and relatives we spoke with told us they were encouraged to maintain their independence where possible.

The plans of care we saw incorporated the importance of dignity and independence, particularly when providing personal care. We observed staff on the day of our inspection treating people in a kind and caring way.

We saw within peoples care plans that referrals were made to other professionals appropriately in order to promote people’s health and wellbeing.

We saw minutes of a range of staff meetings, which had been held at regular intervals. The meeting notes were very detailed and displayed which members of staff had been in attendance.

A wide range of updated policies and procedures were in place at the home, which provided the staff team with current legislation and good practice guidelines.

A good range of audits were in place that feedback into service provision.

We found one breach of the Health and Social care Act 2008 (regulated Activities) Regulations 2014 in relation to the short falls in staff supervision.

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

Inspection carried out on 5 September 2014

During an inspection looking at part of the service

We considered our inspection findings to answer questions we always ask;

� 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 spoke with nine people who lived at the home and five visiting relatives. All of the people we spoke with were able to tell us or indicate that they felt safe living at Courtfield Lodge. No one cited any issues regarding unsafe practices or unreasonable behaviour or attitudes of staff. During our observations throughout the day of the inspection there were no issues with how staff spoke to people living at the home or any issues with how staff assisted people.

Is the service effective?

A key-worker system was now in place within the home, each person living at the home had two key-workers who were their main point of contact. Families had been made aware of this as appropriate and care plans indicated who each person's key worker was.

Is the service caring?

Each person who lived at the home had a detailed life history in place via a document entitled 'My Life Story'. They included pictures and details of peoples past life, interests, hobbies and family ties and relationships. Each story built up a very good picture of the life that each person had led and meant that it was easier for staff to relate to people and reminisce with them, particularly for those people who were unable to fully converse.

We spoke with nine people who lived at the home and five visiting relatives. The vast majority of comments were very positive, some of the comments received were as follows;

"We have no issues at all. My mum is very happy so we are happy. We can see that a lot of improvements have been made over the last few months."

"I'm more than happy with the care my wife gets. Nothing is perfect in life and if there are any issues they are sorted out on the day."

"I can't fault the staff, they work very hard and are absolutely wonderful."

"Oh yes, I'm happy here. The staff are very kind."

Is the service responsive?

We found evidence of the involvement of, and referral to, other professionals such as the speech and language therapy service, incontinence service, GP's and opticians.

Is the service well-led?

We saw that weekly internal checks were carried out by Flightcare's Care Quality Manager. These reviews looked at different areas each cycle and included checks to the physical premises as well as equipment, policies, documentation and talking to people who lived at the service, relatives and staff. Some of the examples we saw included reviews of care plans, minutes of meetings, staff training, bedrooms and the information placed on notice boards. Any actions needed were noted progress from actions previously set were detailed.

Inspection carried out on 6, 7 March 2014

During an inspection looking at part of the service

On the 18th and 19th of September 2013 we inspected Courtfield Lodge and found them non-compliant with seven of the essential standards of quality and safety.

During this inspection, It was clear family and people who lived in the home had been involved with developing personal information with the activity coordinator.

The home had recently introduced new care plan information and tools. On the day of the inspection we found some of the same concerns within the new file information as we found on our previous inspection.

Staff continued to not have a clear understanding of restrictive practice and did not understand the steps to take before this practice was undertaken.

At this visit we found that appropriate arrangements were in place in relation to medicines administration and recording

Some new recruitment policies needed to be embedded with the management team to enable them to be completely implemented.

Staff had the time to speak to people and assess their needs as opposed to taking each person in turn to try and meet their needs.

We looked at the falls logs kept in people�s files. We saw in some cases falls that had been recorded in the log had not been added to the daily record or accident log for that specific month. We also found the opposite where falls had been recorded in daily records or the accident log they had not been recorded on the falls log.

Inspection carried out on 18, 19 September 2013

During a routine inspection

People we spoke with who lived in the home had not been involved with reviewing the support they received. One said, �I�ve been here a while now and not had anyone sit down with me to ask me if anything has changed.�

The ground floor was described as an Elderly Mentally Infirm (EMI) unit. The lack of a capacity assessment did not allow us the assurances that the needs of the people living on this unit had been effectively assessed.

The dietician was visiting the home on the day of the inspection. We were told that the home makes referrals through the GP in a timely manner.

Staff did not have a clear understanding of restrictive practice and did not understand the steps to take before this practice was undertaken.

We observed part of the morning medicines round and saw that contrary to the homes policy medicines had been prepared for three people at the same time, increasing the risk of mistakes.

We did not see any records of interviews undertaken with potential staff members and when asked the manager said they do not follow a strict set of questions for interviewees.

The home could not evidence an effective assessment to determine if there was enough available and suitably trained staff.

Crucial records were kept of significant conversations, GP visits and multi-agency meetings. This information was not routinely being used to update people�s needs or risk assessments.

Inspection carried out on 28 January 2013

During a routine inspection

People told us that the staff were friendly and helpful and they were happy with the home.

Relatives of people using the home said that it was welcoming and that staff knew each person and were always willing to talk and listen to them.

We observed policies and procedures being put into practice in ways which were appropriate and respected the rights and dignity of people.

We saw that care plans were appropriate and identified people's strengths and preferences as well as needs. We saw that people were encouraged to use their strengths and to exercise choice but that when people needed extra help or support it was available for them.

Inspection carried out on 12 March 2012

During a routine inspection

People we spoke with confirmed they were actively involved in all aspects of their care. They commented positively about the staff and said they were kind, caring and respectful. They said they felt safe in the home and were actively encouraged to express their views and opinions about the service. People said their care was provided to a high standard and confirmed that all their care needs were met.

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