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Archived: Prestbury Court Residential Home Inadequate

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Reports


Inspection carried out on 18 August 2017

During a routine inspection

Prestbury Court Residential Home is a care home without nursing, providing care and accommodation for up to 48 people. People living at the service were older people, some of whom were living with significant dementia or long term health conditions. At the time of the inspection there were 31 people living at the service.

There was no registered manager for the service. 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. An acting manager had been appointed in May 2017 and was in day to day control of the service.

This inspection took place on 18, 22 and 23 August 2017. The first two days of the inspection were unannounced. The service was last inspected in October 2016 when it was rated overall as Good, with the key question ‘Well-led’ being rated as Requires Improvement. Prior to the inspection in October 2016 the service had been inspected in December 2015 when we found significant improvements were needed. At the inspection in October 2016 Improvements had been made. However, at this inspection in August 2017 we found the improvements had not been sustained.

We carried out this inspection because we had received information that three safeguarding alerts had been made to the local authority in August 2017. The concerns had been raised about the care people received at the service. The local authority’s safeguarding team and commissioners were investigating the matters and working together to keep people safe.

The overall rating for this service is ‘Inadequate’ and the service was therefore placed in ‘special measures’ and enforcement action was considered. However, since this inspection the provider has applied to de-register Prestbury Court and asked for support from the local authority to help people move to other care services.. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the provider had not taken sufficient action to ensure people received safe and high quality care from well trained and competent staff. The quality monitoring systems were not effective and failed to identify and address th

Inspection carried out on 4 October 2016

During a routine inspection

This inspection took place on the 4 October 2016 and was unannounced. The inspection started at 06:30 am to allow us to meet with the night staff and see how staff were deployed for the day.

Prestbury Court Residential home is a care home without nursing providing care and accommodation for up to 48 people. People living at the home were older people, some of whom were living with significant dementia or long term health conditions. Some people were at the home for short term respite care. At the time of the inspection there were 35 people living at the home.

On the 25 and 27 March 2015 the Care Quality Commission (CQC) had inspected Prestbury Court Residential Home and identified concerns about the safety and well-being of people. On 8 and 9 December 2015 we returned to the home to see what had improved. We identified the concerns from March 2015 had not all been addressed and there were additional concerns over the management of the home. We identified breaches of Regulations12 (Safe care and treatment), 18 (Staffing), 9 (Person centred care), 11 (Need for consent) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014. We served warning notices on the provider and then registered manager for breaches of Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activity) Regulations 2014.

In December 2015 the home was involved in a series of complex safeguarding concerns with the local authority safeguarding team and the local authority was no longer supporting admissions to the home. The local authority quality team were supporting the service with a service improvement plan.

Following our inspection in December 2015 the home was rated as inadequate overall and placed in ‘special measures’. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months of the publication of the last report. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Following the inspection the provider told us what changes they intended to make. We received regular information on progress being made from the home’s management, through the safeguarding processes and from the local authority team.

During this inspection of 4 October 2016 we found that significant improvements had been made. Improvements were seen across all areas inspected, and the warning notices had been complied with. The home had managed to complete the action plans for the local authority, who were satisfied with the improvements made, and there were no open safeguarding concerns. People told us the changes at the home had been a “remarkable turnaround” and that it was like a ‘different home’ to visit. However as some of the changes made have been recent and we do not have a clear track record to show they have been sustained long term we have rated the key question for well led, previously rated as ‘inadequate’ as ‘requires improvement’ at this time. This will be reviewed at the next inspection.

The home is no longer in ‘special measures’.

Since the last inspection on 8 and 9 December 2015 the then registered manager had left the home. There was not a registered manager in post at the time of this inspection, however a new experienced manager had been employed and they had made application to CQC to be registered. 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. They are referred to throughout this report as the manager.

People living at Prestbury Court Residential Home received good quality, sa

Inspection carried out on 8 and 9 December 2015

During a routine inspection

This inspection took place on the 8 and 9 December 2015. The first visit was unannounced and started at 7am, to allow us to meet with the night staff. The visit on the second day was by appointment. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection followed up on an inspection carried out on the home on the 25 and 27 March 2015. On that inspection we identified a number of concerns about the service. On this inspection in December 2015 we looked to see what had improved.

Prestbury Court Residential Home is a care home, registered to provide care for up to 48 people. People living at the home are older people, many, though not all of whom are living with dementia. People may also stay at the home for a short period of time on respite, or for intermediate care prior to a return home. At the time of the inspection there were 31 people living at Prestbury Court Residential Home.

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.

We found that although there had been some improvements, some areas were still of concern. We also identified new concerns in relation to the management of risks.

We found there was a lack of effective leadership and governance at the home. Systems had not been put in place to fully address the concerns identified in the last inspection report, or to ensure care was delivered effectively and safely. It was not always possible to see what improvements had been made as the results of audits, because they did not always contain a robust analysis of the information gathered.

Risks to people were not always being assessed, or actions were not always taken to minimise risks where possible. Learning did not always take place following incidents because information was not always updated or analysed. Risks to people from infections were not assessed or mitigated.

Care plans were personalised to each individual but did not always contain sufficient detailed information to assist staff to provide care in a manner that met people’s wishes. A new care planning system was being provided which the registered manager told us would address these concerns.

Staff had a good basic understanding of how to support people with dementia, and allowed people to be as active as they wished, although this was not always consistently practiced where people demonstrated behaviours that challenged. We saw many examples of positive and supportive dementia care being delivered, but we also saw instances where staff did not recognise that people’s physical care needs were not being met.

The home had a programme of activities for people to follow which were provided one to one or in groups. However some people remained at risk of social isolation.

Medicines were not always being managed properly, or stored securely. People did not always receive their medicines as prescribed and stock levels were not possible to assess as records were not being properly maintained of the medicines held at the home.

People were protected by the home’s systems for the safeguarding of people. Staff understood what they needed to do to keep people safe or report concerns, and staff were recruited following a full recruitment process. However, there were not always enough staff on duty to support people consistently and in the way they needed, and staff had not yet all received the training and support they needed to carry out their role. This included for behaviours that presented challenges or to support long term health conditions such as diabetes. Following the inspection we were told that the home manager had been authorised to use agency staff to cover if needed for staffing shortfalls, and that additional staffing cover had been provided.

The premises were subject to a programme of refurbishment, and adaptation to better meet the needs of people with dementia. We have made a recommendation with regard to seeking further advice on best practice in relation to environmental adaptation for people with dementia.

The principles and implementation of the Mental Capacity Act 2005 (MCA) were not well understood or put into practice. We did not identify that people were being unduly restricted or that staff were not acting in accordance with their best interests. But there was not a clear understanding of the principles and practice of the act and records were not completed appropriately to ensure for example people that should be involved in best interest decisions had always been consulted. This meant people’s wishes might not be being acknowledged.

People enjoyed their meals and people’s dietary needs were respected. Where people needed support with eating this was given with time for people to eat at their own pace.

Systems were in place to manage complaints, however, stakeholders had limited opportunities to influence change and suggest improvements at the home.

Records were not all well maintained, for example records to show how much people who were at risk of dehydration or poor nutrition had eaten or drunk. Records we saw were not kept up to date.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Inspection carried out on 25 and 27 March 2015

During a routine inspection

We carried out an unannounced comprehensive inspection on 25 and 27 March 2015. We had decided to bring forward a planned inspection because of concerns raised with the Care Quality Commission (CQC) about staffing levels and the provision of care at the home.

Prestbury Court residential home is registered to provide accommodation for up to 48 people. The service is intended for older people, who may have needs due to dementia or other mental health needs. The provider had recently had a new extension built which has added five further bedrooms with en-suite facilities at the home. At the time of our inspection there were 30 people living at Prestbury Court with one person staying for a short period of respite support.

There was a 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.

We last inspected the home in June 2014 and found no breaches in the regulations we looked at.

At this inspection where people did not have the capacity to consent or make decisions, the provider had not acted in accordance the Mental Capacity Act (2005) and Deprivation of Liberty safeguards. There were no mental capacity assessments for people who lacked capacity. There was no records of ‘best interest’ decision making to show how people, relatives and other professionals were consulted and involved in decision making about people’s care and treatment.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). Applications had been made to deprive people of their liberty using the least restrictive options and the registered manager was undertaking assessments of other people at the home to consider whether any further applications were required.

People were at risk of being socially isolated. Activities were provided at the home but there were long periods of time when meaningful activities were not happening and people isolated in their rooms were not able to access the activities at the home.

People received most of their prescribed medicines on time and in a safe way. However, some improvements were needed in management of topical creams and ointments.

Staff recruitment processes were not robust. The provider had not always undertaken assessments and checks to ensure staff were of good character before they were working unsupervised at the home.

Staff had not received an effectively managed induction process to ensure they had the skills needed to meet people’s needs. Improvements in staff training were needed to ensure staff were supported to acquire and maintain skills and knowledge to meet people’s needs effectively and safely. Records showed only a third of the staff had received training in manual handling, safeguarding vulnerable adults and Mental Capacity Act (2005) and Deprivation of Liberty safeguards. Staff had received formal supervision and appraisals and had the opportunity to attend monthly staff meetings, so they had the opportunity to express their views and concerns.

Staff were aware of the signs of abuse and knew how to report concerns internally and were confident these would be investigated. Only a third of the staff had been trained in safeguarding vulnerable adults and some were not able to tell us about external agencies they could report concerns of abuse to.

Staffing levels at the home had been reduced due to residential occupancy levels. Staff had found it difficult to adjust to the new staffing levels. The registered manager agreed to look into concerns raised by staff about senior staff not being allocated care duties each morning. This had meant staff had found it difficult to complete care tasks promptly and people were having a late breakfast.

Staff working at the home knew people’s needs and preferences well and people and relatives said staff were caring and kind. On the whole there were friendly and respectful interactions between staff and people. People were supported to have suitable and sufficient food and drink.

Quality assurance and audit processes were in place to help monitor the quality of the service provided. The provider had an audit sent to them each month undertaken by the registered manager which was the means they used to keep them informed of how the service was operating and a registered manager from another one of the provider’s homes to support the registered manger. However The audit had not recognised or dealt with the identified shortfalls found at this inspection because the systems used to populate the audit were not systematic and thorough.

Improvements were required to ensure systems and processes were in place to protect people’s rights, to ensure they were supported by staff who had received appropriate training and to make care more personalised and accurate to people’s individual needs. The provider annually sought the views of people using the service and their relatives and friends by being asked to complete a quality assurance questionnaire for their views on the service.

The premises were well managed to keep people safe. The maintenance at the home was overseen directly by the providers. There were emergency procedures and evacuation plans in place to protect people in the event of a fire or emergency.

We found six breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.

Inspection carried out on 9 June 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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?

People who live at the home told us they were well looked after and were happy. One person we spoke with said "Everything here is fine�. Another person confirmed that living at the home was �Lovely, I love living here�. Another person confirmed that they were "well cared for".

People had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage medicines.

Recruitment practice was safe and thorough.

Policies and procedures were in place to make sure that unsafe practice had been identified and people were protected. Systems were in place to make sure that the manager and care staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one.

Is the service effective?

We found that people's consent had been obtained for care and treatment provided to them by the service. However this had not been consistently recorded when people had received treatment or when care plans had been reviewed.

People's health and care needs had been assessed with them or their representative, and those who wished to, and had been able to, had been involved in writing their plans of care.

Is the service caring?

We spoke with eight people who live at Prestbury Court. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; "They are all lovely and all work so hard".

When speaking with and observing care staff during this inspection it was clear that they genuinely cared for the people they supported. They told us about people's individual health and social care needs and how these needs had been met in an individual way.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

We spoke with eight people who live at Prestbury Court. People we spoke with were satisfied with the care and support they received. We saw from records that planned care and treatment had been provided in line with people's individual care plans. Aspects of people's needs or care had been linked to risk assessments. Specialist health needs had been identified where required and appropriate health care professionals had been consulted and involved in providing care.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People who live at the home had been asked to complete a satisfaction survey in May 2014. The manager, who was registered with the Care Quality Commission on the 11th June 2014, told us where shortfalls or concerns were raised these would be taken on board and responded to appropriately.

Inspection carried out on 18 June 2013

During a routine inspection

At the time of our inspection 37 people were living at Prestbury Court. We spoke with four of those people. We also spoke with the relatives of three other people who used the service. Some people were not able to communicate with us verbally. We used our Short Observational Tool for Inspection (SOFI) to observe care and understand the experience of people who could not talk with us.

We observed that people appeared at ease and comfortable around care workers. People were treated with dignity and respect. They had opportunities to be involved in and shape their own care. Where people did not have the capacity to make decisions for themselves their rights were protected. People told us they felt safe and we found that the provider had systems in place to protect people from the risk of abuse. People told us the service was good. Comments included, "It's warm, great food, and the staff are fine."

We found that staff were well supported and had completed appropriate training. They knew people as individuals and were aware of each person's needs. They were assisted by care plans which contained clear assessments of needs and the strategies to meet those needs. Care records were reviewed and updated regularly. The service had good relations with health care professionals and acted upon their advice.

Systems were in place to monitor the quality of the service. We found that the provider was responsive when issues were raised and lessons were learnt from incidents.

Inspection carried out on 30 April 2012

During an inspection in response to concerns

We spoke to people who lived at the home, where they were able to do communicate their experience to us. In addition we used a short observational framework for inspection (SOFI) to help us undersatnd the experiences of those who could not tell us about their care.

In total we spent 7 hours at the home on the day of our visit. We spent a further two hours on a later date talking on the telephone to relatives of people who live at the home and to more staff members.

We began this unannounced inspection during a night shift, so most people who live at the home were initially asleep. We spoke with all three staff on duty at night. They told us that it had been a busy night with lots of people needing changes of bedding.

We were told, �It is a heavier workload than some other homes, but I think there are usually enough of us on duty�.

Later in the day we spoke to a person who used the service. They told us they felt safe and well looked after. We asked if they could choose what time they go to bed or get up. They replied,

�Yes, I get up early because it�s what I like to do� they do look after me well here.�

A health professional told us that the home was widely regarded as having improved due to recent changes in management:

�They listen and take on advice and are creative and bold now�.

People who had family members living at the home told us that they felt that their relatives were safe and well looked after. They said that the home did listen if they raised any issues and acted upon them. One relative told us:

� They genuinely seem fond of their residents. I have complained about a few things and they do respond, though it can take a while to change.�

Inspection carried out on 3 November 2011

During a routine inspection

We visited the home on two occasions on the 27th October and 3rd November 2011 to complete this inspection. On the first occasion we took with us an expert by experience, who is a person who through their own experience or that of caring for others has used or has knowledge of care services. We spent around six hours in total talking to people at the home, observing their care or talking to relatives and other supporters about the services provided at Prestbury Court.

A relative of a person who had been receiving respite care at the home told us "I wouldn't hesitate for my father to come back in here - it's a really excellent place". Another relative we spoke to told us that they had visited several places before choosing Prestbury Court, but had chosen it as it was close to other family members.

One person we spoke to who was very able told us the location of the home gave them difficulties in that they were not able to go out independently to a local shop or facilities. Another person who was also very able told us they had difficulties with the number of people at the home who had dementia.

The expert by experience told us they had been �able to speak to two visitors while at the home, they were very happy with the care that their uncle was receiving and felt that the staff kept the family involved in all aspects of his care. They were especially pleased to report that their Uncle could have a pint of Guinness in his room and this was a pleasurable thing for him.�

One person living at the home said about the staff �Some were better than others� but that mostly they were �good at working out what people need and when�. Another said �I don�t know how they do all they do and keep so cheerful, they always seem to be so busy and it is a thankless task at times�.

We saw staff working with individuals throughout the two days we were at the home. In some instances we saw care being delivered and supported very well with clear communication from staff in ways that supported the individual. However this was not always consistent.

We were told that sometimes the staff did not always listen to people living at the home when they said how they liked their care delivered. This led to them feeling their views were not always respected.

One person was very complimentary about the activity worker. They said that they receive one to one support from her and because they choose to stay in their room this interaction is vital to their wellbeing.

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