Livability John Grooms Court

We found the following examples of good practice:

Relatives visiting inside the service had started. A staff member was observed taking time with a relative who was leaving after their first visit, patiently explaining how to take off personal protective equipment (PPE) by showing them.

People who lived in the service missed going out so the service organised theme weekends/evenings including comic relief, karaoke, valentines day. For fire works night they made a Guy Fawkes which they named Jenny and was sat in reception with pretend fire around her chair

People who lived in the service missed out on Christmas celebrations as they had an outbreak of COVID-19. Staff secretly organised a re-arranged Christmas Day at the end of February which was a total surprise and the people really enjoyed.

The friends of the service, who fund raise on the service’s behalf, purchased a chair that lifts people when they have fallen and can’t get up, to be used in event of paramedics not being able to attend, if appropriate.

Livability John Grooms Court is a ‘care home’ providing personal care for people with physical, neurological and/or learning disabilities. The home accommodates up to 29 people in one adapted building. Each person has their own self-contained flat with kitchen and en-suite bathroom. There are also communal living room, dining room and kitchen facilities. At the time of inspection 22 people were being supported in the service.

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

Since the last inspection the service had focussed on improving the management of medicines and the assessment of risks and the environment. Auditing processes were improved and there was a change in management culture.

People told us they felt safe in the service. Individual risks to people had been assessed and staff understood what action to take to manage them. There were enough staff to support people although the service was still reliant on agency. Agency staff had a good induction to the service and were familiar with people’s needs. The management of people’s medicines had improved and there were robust systems in place to make sure people received their medicines as they were prescribed.

People’s needs were holistically assessed. Staff told us they found the one page profile for each person which was in their rooms particularly helpful to get to know people. A new chef had recently been appointed which people were positive about. They told us they liked the food, and peoples people’s dietary requirements were catered for. The service worked with healthcare professionals to ensure they had access to health professionals when required. Key workers were responsible for ensuring people were supported at appointments and that any advice was followed after the visit. The premises were adapted to people’s needs and was fully accessible throughout. The provider had a plan for refurbishment in some areas where walls and floors were marked. 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 practice.

People told us the staff were caring. Staff knew people well and chatted to them while they were providing support. People were involved in their care and preferences; likes and dislikes were recorded in care plans. Staff understood how to maintain privacy and dignity. People were supported to be independent and to go out in the community. The managers told us they were working to promote people’s independent living skills.

The service was responsive to people’s individual needs. Each person was allocated a keyworker who they met monthly to review their care and ensure their needs were being met. An activities worker organised a programme of activities supported by volunteers that included activities within the home as well as in the local community. The service provided end of life care and records were being reviewed as part of the review of all care plans. The service was in the process of completing accreditation in end of life care. We made a recommendation about reviewing people’s end of life care plans.

There had also been changes in management which had caused disruption in the service. The managers were aware of this and working to create a more positive culture in the service. More work was needed on care plans to ensure they were consistent and provided all the information about people’s care needs.

The service had appointed leads to work on areas of improvement including medicine management and management of the environment. This had brought about positive change in these areas. There was an improvement in the systems and processes for monitoring when things went wrong and acting to prevent it happening again in the future. There were also systems for making sure this was reported to the appropriate authorities where necessary.

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 Requires Improvement (published 14 December 2018) 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 inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Livability John Grooms Court on our website at www.cqc.org.uk.

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.

Livability John Grooms Court is a ‘care home’ providing residential care to people physical, neurological and or learning disabilities. 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.

The service is registered to provide care to a maximum of 29 people. There were 22 people living at the service at the time of the inspection.

The service had 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 last inspection completed on 19 and 20 April 2016 we rated the service as good for all five key questions.

During this inspection, we found that risks to people were not always identified or measures put in place to mitigate them. The service was not visibly clean throughout, increasing the risk of spread of infection and cross contamination. Incidents and accidents were not always well managed or action taken in a timely way as an outcome. Some shifts did not consist of the provider’s minimum staffing levels in line with their dependency tool.

Quality audits had not identified area of risk and concern found during the inspection. Care records were not consistently being recorded to reflect completion of care intervention. Not all notifiable incidents and events had been submitted CQC or the local authority safeguarding team.

Staff received the necessary training for their roles and plans were in place for staff to attend refresher and role specific courses where applicable. People's mental capacity was assessed, with best interest’s decision making in consultation with relatives and other professionals, however this needed to be incorporated more into people’s care plans.

Staff supported people to maintain choice, control and involvement in their care and daily routine.

Care plans indicated people’s individual preferences for showers or baths. People's care records identified individual key needs and risks, and contained guidance for staff to follow to ensure provision of consistent standards of care. People engaged with activities, education and employment onsite and in the community.

John Grooms Court provides care for up to 27 people. The home offers self-contained flats for adults who have a physical disability. The building is purpose built, offering accommodation over three floors.

The registered manager had recently left. The deputy manager was acting as the manager until the provider recruited a new registered manager. There was also a further deputy 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.

People benefitted from being supported by staff who were safely recruited, well trained and felt supported in their work. There was consistently enough staff to safely meet people’s individual needs.

Staff understood how to protect people from abuse and knew the procedure for reporting any concerns. Medicines were managed and stored safely and adherence to best practice was consistently applied. People received their medicines on time, safely and in the manner the prescriber intended.

Staff knew and understood the needs of people living at John Grooms Court.

Staff did not receive regular supervision; however staff said they were in regular communication with the management team. The manager was aware of this short fall and was aiming to resolve this shortly.

Staff told us they were happy working at John Grooms Court. They assisted people with kindness, compassion and respect. People’s dignity and privacy was maintained and respected.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service was not depriving people of their liberty unlawfully and worked within the principles of the MCA.

People’s care plans were detailed and individualised. They contained important and relevant information to assist staff in meeting people’s needs in a way that was personalised. People and their relatives had been involved in making decisions around the care they received. People’s needs had been reviewed.

The service had good links with community healthcare teams. People were supported to maintain good health and wellbeing. Some people had complex health needs; these people’s needs were closely monitored. The service reacted positively to changes in people’s health and social care needs.

People enjoyed a range of activities which reflected what they were interested in. People had jobs and performed voluntary activities. People also attended places of further education. People were encouraged to maintain relationships with others and the service actively welcomed family members and visitors to the home.

There was a positive and open culture. There was a friendly and energised atmosphere to the communal areas. People felt listened to and were confident that any concerns they may have would be addressed. People were actively involved in the service. Effective systems were in place to monitor the quality of the service. The management team played an active part in the daily life at John Grooms Court.

Staff were confident that they would know what action to take if they observed any potential abuse. This showed us that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

Maintenance records and schedules were in place and checklists were used to record equipment checks and any remedial action. This meant that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

The registered manager produced a monthly report for the provider and this included information on quality monitoring measures within the service. This and the other evidence inspected meant that the provider had an effective system to regularly assess and monitor the quality of service that people received.

We saw that records were well kept and stored securely and that these could be located promptly when needed. This meant that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

Medicine management systems were in place in the service. This demonstrated to us that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Staff told us that they would assist people in making their concerns or complaints known. They were aware of how to address any complaints that they received or became aware of. This showed us that the comments and complaints people made were responded to appropriately.