The Court Retirement Residence

We found the following examples of good practice:

Visitors were only permitted by prior appointment, managed by a Covid Lead staff member. A clear visiting policy was communicated with families to ensure safe and enjoyable visiting.

People and staff have been regularly tested to ensure they have not contracted Covid-19. Strict measures were in place to ensure people and staff would be isolated immediately if they had any symptoms of the virus, or if they had tested positive. Contingency and admission plans were clear. People and staff had received their first Coronavirus vaccination. The home celebrated with certificates and champagne for all.

People had coped well during the pandemic due to a positive staff group and a good range of activities to suit individual interests. Staff hours had been enhanced to enable additional support. For example, staff had been to the shops to buy new clothes and items for people if needed and were available to support visits using technology regularly. There had been many activities to keep people’s spirits up and maintain wellbeing; monthly ‘Round the World’ meal experiences, garden and Halloween parties with themed face masks, pampering, VE Day and hatching their own chicks.

Safe procedures have been followed by staff to minimise the risk of transmitting Covid-19. They had good stocks of all personal protective equipment (PPE). There were supplies of PPE available around the home. Staff were seen using appropriate PPE. Staff had received training on donning and doffing and on the coronavirus pandemic from various sources including local health and social care professionals, e-learning and from in-house training sessions. Links with the wider social care community helped problem solving and sharing information.

The home was clean and hygienic. Detailed cleaning schedules were in place for all areas of the home. All touch points were cleaned frequently including high touch points. Deep cleaning of all areas was carried out regularly. The home was well-ventilated and new cleaning products had been sourced for effectiveness.

The registered manager and providers acknowledged the staff team had been through a very difficult time and supporting staff to have regular time off, support and access to counselling if needed. Staff felt valued and appreciated and had received special treats as a thank you for their hard work.

The Court Retirement Residence is a residential care home providing personal and nursing care to 16 people aged 18 and over at the time of the inspection. The service can support up to 21 people in one adapted building.

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

Significant improvements had been made in all aspects of the management of the service since the last inspection. The management team were working to ensure the improvements were embedded. A comprehensive quality assurance programme had been introduced, and a review of job roles and responsibilities was improving monitoring and accountability. There was an open, transparent and positive culture at the service. Staff told us they felt valued and part of a dedicated team.

People felt safe living at The Court. Staff were recruited safely, and safeguarding processes were in place to help protect people from abuse. Risks associated with people's care had been assessed and guidance was in place for staff to follow. Care plans were detailed, person centred and reviewed regularly with people and their relatives where appropriate. There were systems in place to ensure information about any changes in people’s needs was shared promptly across the staff team.

People received their medicines safely, and in the way prescribed for them. The provider had good systems to manage safeguarding concerns, accidents, infection control and environmental safety.

People were supported by sufficient numbers of suitably trained, competent and skilled staff. This meant their healthcare and nutritional needs were met. External professionals were complimentary about how the service worked in partnership with them.

People enjoyed a wide range of activities which reduced anxiety and depression and supported their cognitive functioning. A relative said, “My [family member] is doing more here than ever before. Reading for the first time in eighteen months. They were joining in making Halloween masks when we came in.”

People lived in a homely environment which promoted their dignity and well being. A renovation programme was in progress with people contributing to the choice of décor and colour schemes.

Staff were caring and kind and had developed positive and meaningful relationships with people. People were respected, included in decisions, and their privacy and independence promoted. The care provided was sensitive to people's diverse needs. All information was available in an accessible format, which meant people could make a meaningful contribution to their community.

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.

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 22 October 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.

We have made a recommendation about the use of orientation aids to promote the independence of people living with dementia.

Why we inspected

This was a planned inspection based on the previous rating.

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.

There was a registered manager at the service. A registered manager is a person who has registered with the CQC 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 had worked at the home for many years and were planning to retire in early 2019.

The last comprehensive inspection was in September 2016; at that inspection the overall rating for the service was good and we found that people were safe. At this inspection in September 2018, people were not always enabled to take part in meaningful activities on a regular basis that reflected their needs, preferences and interests. There were no audits about how people were spending their day. Activities offered by staff and external entertainers, did not ensure each person had their social and leisure needs met.

Some checks and audits were carried out but these had not always identified issues that were found during the inspection. Audits were not completed around maintenance and room checks, care plan reviews or falls. At the last inspection in September 2016, we noted there were some elements of good quality monitoring systems but these were not fully evidenced and the provider was making improvements to ensure systems were effective. This was not shown at this inspection in September 2018. Care records did not always fully reflect people's risks and needs when changes occurred and staff relied on verbal communication and recording in the daily notes. When incidents had happened, plans did not always record how staff were to reduce the risks of reoccurrence, although they knew this information verbally. Although records were not always up to date staff were very knowledgeable about people’s needs through verbal communication and a small, stable staff team.

There was no system such as a dependency tool to enable the provider to know what level of staffing was required to meet people’s needs. Staff felt there was not enough staff and people told us they sometimes had to wait for support. In addition, staff did not have time to spend quality time with people and offer regular meaningful activities. We recommended that the provider use robust systems to ensure there were enough staff at all times.

This inspection was brought forward because of safeguarding concerns. Prior to our inspection, the service became part of an individual safeguarding relating to pressure area care. This meant the local authority safeguarding team had informed us of their concerns. We found this was substantiated and pressure area care management was not robust to ensure people were safe.

On the day of the inspection there was a calm and relaxed atmosphere in the home, with music playing in the entrance hall. Staff interacted with people in a friendly and respectful way and were keen to deliver good support, for example ensuring people received full personal care at their own pace. People were able to choose where they wanted to spend their day and staff respected their privacy. However, the service was not fully caring and improvements were required to ensure there was a homely feel rather than a workplace. Most people required one care worker to support them and preferred to stay in their rooms. This meant that some people spent long periods alone other than when staff completed tasks. However, people and relatives said they liked the staff and were happy with the service.

Staff ensured they had identified those who could not use their call bells easily, and they were checked regularly, other people used pendant call bells and these were answered promptly. People were encouraged and supported to maintain their independence and risk and independence was well balanced in the least restrictive, safe way. Staff engaged with people in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance, for example.

People and relatives said the home was a safe place for them to live. Comments included, “I like it here, they look after me” and “[Person’s name] seems happy and we enjoyed playing ball. I can leave and not worry.” Staff had received training in how to recognise and report abuse. Any safeguarding concerns had been managed well with provider involvement and they had listened to any advice, and the service worked openly with the local authority safeguarding team. Relatives said they would speak with staff if they had any concerns or complaints and issues would be addressed. Staff knew people well, showing patience and understanding. Staff were genuinely happy when people were doing well, noticing improvements and chatting with people as they went about their tasks. People's human rights were protected because the management team and staff understood the Mental Capacity Act 2005 (MCA) and these records were good.

There were not always regular recorded reviews of people's health but there were many examples in daily notes of staff responding promptly to changes in need and accessing appropriate health professionals. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. One person had seen paramedics and gone to hospital and they were now back at the home and doing well.

Medicines were generally well managed, except for recording amounts of medicines received into the home. The registered manager was ensuring this happened by the end of our inspection. Records were completed with no gaps, and there were regular audits of medication records and administration. Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. There was a training programme covering a wide range of topics. The training matrix was being revised so management could easily see which staff required training. A comprehensive induction was completed by new staff and supervisions and appraisals were up to date and showed meaningful discussion. A matrix was being devised for this too, to ensure a consistent approach. The staff team was stable and many care staff had worked at the home for some years as the service was in a rural location.

People's privacy was respected. Staff ensured people kept in touch with family and friends and there was open visiting with people made welcome. Most people living at the service had family and friends able to visit. There was a home newsletter and the administrations manager was looking at ways to encourage easy ways to communicate such as by email, meetings and the staff photo board.

The management team said they were keen to give people good care and valued their staff team. The service was a family run business and the provider and their family lived on site. People living at the service had been included in the administration manager’s wedding in the village church (situated next door to the home) in recent years. Staff said they enjoyed working at the home and felt able to raise issues. The home was seen as important in the local area as it is in a small rural community. Although improvement was required in some records and quality assurance, staff delivered care in individualised ways. The management team immediately began to address our findings and acknowledged that there had been recent management changes which may have contributed to the need for improvement.

Observations of meal times showed these to be a positive experience, although only four people chose to eat in the dining room. People were offered a choice of meals to suit their preferences and dietary needs. They could choose where they wanted to eat their meals, and meals were offered at times of the day to suit their appetite. People were supported discreetly to be as independent as possible, using adapted crockery, having finger food or snacks when they most had an appetite. People’s risks relating to nutrition were addressed, although not always recorded.

The premises were clean and smelt fresh. The building was an older style premises but had been well maintained. The administrations manager was devising a more robust maintenance programme and room check system to address tidiness and storage issues to make the environment more homely. People and relatives appreciated the spacious accommodation and views over the countryside.

There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. The last survey had not been analysed to show actions taken from comments but the registered manager assured us that the current satisfaction survey would include an action plan which would be shared with people. There were no complaints from people or relatives.

We found four breaches of our regulations.

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

The Court Retirement Residence is registered to provide accommodation for 21 people who require personal care. The service does not provide nursing care. At the time of this inspection there were nine people living there, including one person who was in hospital.

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 told us they were happy living there and felt safe. Comments included, “The home runs smoothly. Everything has to be done at the right time and the right day.”

People were protected from abuse or harm by safe recruitment procedures. Staff had received training on safeguarding adults and were confident they knew how to recognise and report on any suspicions of abuse. People were supported by staff who had received a range of training that provided them with the knowledge and skills to meet each person’s health and personal care needs effectively. Staff received regular supervision and support. They were positive and enthusiastic and told us they enjoyed their jobs.

People told us there were sufficient staff to meet their needs. One person told us “I am amazed how many there are.” Two people told us they occasionally had to wait for assistance when they pressed their call bell, but said they understood there were times when staff were assisting other people and could not come immediately. All of the staff we spoke with said there felt the staffing levels were good. Comments included “Yes, there definitely is (enough staff)”.

A new computerised care planning package had recently been purchased. Before new people moved into the home their needs were assessed and the staff consulted with the person to draw up and agree a plan of their care needs. The care plans were easy to use and covered all areas of each person’s health and personal care needs. All anticipated risks were explained and regularly reviewed. Staff were given information on the actions necessary to minimise the risks. The home worked closely with local health professionals to ensure people received the correct care and treatment. Equipment was in place to enable people to move safely and prevent further risk of harm.

Medicines were stored and administered safely. Records of medicines administered showed people had received their medicines at the correct times. Staff followed safe procedures when ordering stocks, receiving stocks in to the home, and ensuring unwanted medicines are disposed safely.

People told us they were happy with the care they received. One person said “I have found it very pleasant. The girls are very caring.” A relative told us “These girls ‘go the extra mile’. They are fantastic. We can’t thank them enough. They do a great job. They are brilliant. From the guy who does the cleaning to the care staff they are all wonderful. Nothing is too much trouble.”

The service was well-led. People told us the service ran smoothly. The provider was in the process of updating and improving many areas of the decoration, furnishings and equipment. There were some elements of a good quality monitoring and improvement system in place but these were not fully evidenced. The provider told us about improvements they were about to make to ensure their monitoring systems are effective.

On the day of our visit we were told there were 13 people living at The Court Retirement Residence. We spoke with four people living at the home, one relative, four members of staff, which included the registered manager and the provider. We also spoke with a visiting healthcare professional. We spent time observing how people's care and welfare needs were met and looked at four people's care files in detail.

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.

Is the service safe?

People's individual risks were identified and the relevant risk assessments were conducted. This meant that when staff were accessing information about a person's needs through their risk assessments, they would be able to determine how best to support them in a safe way. Where risk had been identified the home had taken steps to minimise that risk, for example changing the layout of a room. However, there were not adequate risk assessments of the shared home environment, such as stairs, used by some people. This had the potential to increase risks to people.

Health care professionals said, through feedback surveys to the home and when speaking with us, that they did not have concerns about the care people received. One had written in September 2014 'All recommendations of care are acted upon in a timely manner'.

The provider had not notified the Care Quality Commission at the first opportunity of three accidents at the home. This meant we were unaware of some potential risks at the home. The notifying of incidents had been improved by the time of our inspection visit and will be monitored by CQC.

There was increased risk to people using the service because some records were not fit for purpose. For example, information crossed out without explanation of why or by whom, very minimal pre admission assessment and many records undated or unsigned. However, other records, such as medicine administration records, were detailed and clear. There were also detailed records of steps taken by the home in response to health care professional advice.

Is the service effective?

The service was effective because people were spending their time in the way they chose. We spoke with four people about the home. They told us they were satisfied with the care with comments including "I am quite satisfied"; "I think it's lovely. Everybody's so friendly" and "They (the staff) are friendly and kind". One confirmed they had been visited before admission by a staff member to establish what care they needed. A health care professional had written 'I found the home to be calm and the residents were happy.'

Care plans were up-to-date and in general contained clear instructions. They were broken down into separate sections, making it easier to find relevant information, for example, risk from falling. We saw evidence of health and social care professional visits and appointments, for example GP, district nurse and speech and language therapist. These records demonstrated how other health and social care professionals had been involved in people's care to encourage health promotion and ensure the timely follow up of care and treatment needs.

Is the service caring?

The service was caring because staff were attentive to people's needs and offered them choices and opportunities. For example, some people went out for the morning. Another person enjoyed a sherry before lunch.

We saw the relationships between staff and people in the home were positive. Throughout our visit we saw people were appropriately dressed and cared for to promote their dignity. For example, attention had been given to the use of jewellery and hair care. Staff offered care which was both kind and compassionate in order for people to experience a general sense of wellbeing.

Is the service responsive?

Care files gave information about people's health and social care needs. However, they lacked enough detail, which would be particularly important should a person be unable to state what care they needed and wanted. Care plans included personal information and identified the relevant people involved in people's care. The care files had been regularly reviewed although in one case the plan had not been reviewed following an incident. This might have led to less responsive care following a change in the person's needs.

The people we spoke with were complimentary about the home and told us they were well looked after. One person told us, 'We're very well looked after here, the staff are so kind'. We saw how people's care and welfare was provided with dignity and respect in line with their care needs.

People's nutritional needs were met through a balanced and nutritious diet with choices available at each meal time.

The home was clean and tidy and we saw how the manager and provider had improved the environment and cleanliness and hygiene practices since our last inspection in November 2012.

We found there were sufficient staff to support people's needs; the staff we spoke with told us how they met people's care and social and emotional needs through effective care plans.

We saw improvements in the way quality assurance checks were made for the service and improvements had been made to areas identified in our previous inspection.

Records were accessible and care plans reflected the current needs of people living in the home; staff demonstrated a good knowledge of people's needs and how to meet them.

There were 17 people living in the home at the time of our inspection. The people living in the home told us they liked the home and were happy with the care being provided by the staff. One person who lived in the home said 'it's lovely living here' and 'we're looked after ever so well'. One visitor told us that staff were 'kind and caring here'.

People appeared comfortable and we saw that staff had good knowledge of the needs of people in the home. Staff were observed being patient and kind towards people when they assisted them. We saw that staff offered people choices in accordance with their assessed needs and preferences.

People we spoke with said they generally found the home clean and tidy however we found some aspects of cleanliness and hygiene were not always appropriate. For example we found some rooms had broken tiles or peeling wallpaper. Personal protective equipment wasn't stored appropriately.

We saw that people were safe in the home however the provider didn't always have quality assurance processes in place to monitor the quality of their service; for example safe storage of equipment and routinely maintaining documents relating to people and the running of the home.