St Leonards Court

St Leonards Court provides accommodation and personal care for up to 25 older people some of whom may be living with dementia. At the time of our visit there were 22 people using the service. The home is situated in the village of Mundford in Norfolk.

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

People were not always receiving safe care and treatment. Allegations of abuse or harm had not always been reported to the local safeguarding team or the Care Quality Commission (CQC). We could not be sure that these allegations had been dealt with appropriately or that action had been taken to prevent a reoccurrence. During the inspection we made safeguarding referrals to the local authority safeguarding team. There was not always effective oversight or management of incidents which had occurred. As a result, staff were placing themselves and others at risk. Incidents recurred and people were harmed. The manager took immediate action to ensure safeguarding procedures were followed to keep people safe.

Infection, prevention and control measures were not always being followed to prevent the spread of infections. Staff had received training and regular information updates throughout the pandemic. Infection control and cleaning audits were being undertaken to identify any issues quickly so that action could be taken to make any improvements.

Risk assessments had been completed to reduce risks to people’s health and safety when possible.

Staffing levels were sufficient to meet people’s needs in a timely manner. Vacant roles had recently been recruited to. Recruitment procedures were followed to ensure that staff suitable to work with vulnerable people were recruited.

Safe management of medicines procedures were being followed to ensure people received their medicines as prescribed. When errors in the administration of medication occurred, these had been identified and action taken to prevent a reoccurrence.

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

Rating at last inspection

The last rating for this service was Good (report published August 2018).

Why we inspected

We received concerns in relation to staffing levels, the cleanliness of the home, and people not receiving adequate personal care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Since the inspection the provider has taken steps to mitigate the risks. Processes have been put in place to ensure that all safeguarding concerns are reported to the local authority and the Care Quality Commission. The allocation of staff now ensure that there is a member of staff present in the communal areas during the daytime to support and monitor people.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from harm. Please see the action we have told the provider to take at the end of this report.

We also identified that not all notifications had been sent to the Care Quality Commission as required. We are continuing to investigate this.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

St Leonard’s 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. This comprehensive inspection took place on 7 August 2018 and was unannounced.

At our last comprehensive inspection on 13 April 2017 we rated the service ‘Requires Improvement’ overall. At that inspection we found improvements were needed in relation to the safety of bed rails in use for some people. We found covers (bumpers) in use at that time were ill-fitting and posed a potential risk to people of injury and entrapment. These concerns were a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulation 2014. We found at this inspection that improvements had been made. We checked the beds of people living at the home who were using bedrails and bumpers and found these were safely fitted. The provider is no longer in breach of the regulations.

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.

There was mixed feedback about staffing levels. Staff were busy however we observed that there were sufficient staff to meet people’s needs in a timely manner. We have recommended the provider continue to closely monitor staffing levels. Staff were recruited safely.

Risks to people were assessed, monitored and updated as and when necessary. Action was taken to reduce the risk of incidents and information about risks to people were documented in their care records so that staff were aware.

Staff were supported through training and supervision to perform their roles effectively.

People's individual nutritional needs were met. People were supported to access a range of health professionals to maintain their health and well-being. People were treated with kindness, respect and compassion, and their privacy and dignity was upheld.

Clear information about how to make a complaint was available for people. The service worked in partnership with health and social care professionals and other organisations, to ensure people's care needs were met and that staff kept up with good practice.

The provider had quality assurance processes in place, which helped to maintain standards and drive improvement. People who lived at the home, relatives and staff told us the service was well led. Staff were aware of their roles and responsibilities and were well supported.

Since the last inspection there has been a change in registered manager. The new manager registered with us in the last year. 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 is registered to provide accommodation and care to up to 25 older people with or without dementia. It does not provide nursing care. At the time of our inspection there were 24 people using the service but one had been transferred for a period of assessment so there were twenty three people.

We found that the current manager had made many improvements to the service since their appointment. There was a strong emphasis on personalised care based on people’s wishes. The atmosphere was calm and staff regularly interacted with people to ensure their well- being. The service had regular staff that were familiar with people’s needs and they had a good insight into their previous life experiences and their care preferences.

We found there were enough staff and systems in place to support and help retain staff including good recruitment and induction processes and improved compliance with training. This was readily available to staff and updated as required. Lots of staff had additional qualifications. The service also had developed strong links with health care professionals and provided a seamless service for people living in the home. The service was actively involved in the wider community. Staff were observed to be kind and caring in their actions and there was a lovely, calm atmosphere in the service and people were supported to manage their anxiety and distress in a positive way.

There were good systems in place to audit and monitor the service and the manager was open, resourceful and an excellent communicator who lead by example. We also found the documentation of a good standard and care plans and risk assessment clearly reflected people’s needs and how these should be addressed.

However we did find some gaps. These included some risks to people in terms of ill-fitting bumpers to protect people from the risk of injury and entrapment. We identified gaps in records so we were unable to see if risks from dehydration were adequately monitored. We found records of a high standard but found information duplicated and not all containing the same information which made records unreliable. It would be helpful if records were cross referenced. Staff might be aware of where documents are but we asked the provider to consider how an agency person would access the current recording system.

We found some conflicting information in terms of the Mental Capacity Act with staff drawing different conclusions about a person’s capacity and not always demonstrating how they communicated with relatives holding power of attorney for care. Medication practices were acceptable and staff were knowledgeable of the underpinning policies concerning safe administration of medicines. However a little more knowledge of the actual medicines would be advantageous and we did identify a small discrepancy in one person’s medication stock.

We found a breach of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 in some regulations. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection on 08 October 2013, we found that the provider had made the required improvements around the documentation of people using the services to consent to be photographed and agree to their plan of care.

Two healthcare professionals and a relative we spoke with raised no concerns over the care people received. The healthcare professional told us that, "(Staff) do everything well."

People who used the service had the right level of information to make a decision about their care and support. However, we found that their consent was not always documented.

Care records and risk assessments were reviewed regularly to ensure that people received safe and appropriate care in a consistent way.

We saw that the provider had taken steps to provide care to people who used the service in an environment that was in good decorative order.

There were service contracts in place for all of the equipment being used. We saw that staff had received the appropriate training before using any equipment to ensure that people were not placed at risk of harm.

We saw that the provider had good staff, care and maintenance records which were kept in a secure location.

The healthcare professional and relatives who we spoke with raised no concerns over the care and support people received within the home. The healthcare professional told us, '(Staff) are lovely with the patients and take their time.' One person told us that, 'Care is very good.' And another relative told us that when they visited the home they, 'Were made to feel welcome.'

Care records and risk assessments were reviewed regularly to ensure that people who used the service received safe and appropriate care in a consistent way.

People were protected from the risk of infection spreading as there were effective systems in place to reduce the risk.

Effective staff recruitment was in place to ensure that people who used the service received safe and appropriate care from suitable staff.

There was an effective system in place for people to make a complaint.