Chester Court

Chester Court is a care home providing personal and nursing care for up to 41 people. At the time of the inspection there were 37 people were living at the home.

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

There was a system in place to manage medicines; however improvements were needed to ensure records supported the safe use of medicines. Audits were carried out to monitor all aspects of the home. However, they had not identified the issues we found regarding medicines records. Following our visits; the registered manager took action to address the issues we identified.

The home was clean and safe infection control procedures were followed. Risks were assessed, managed and monitored. One relative told us; "They were in another care home and had a fall there. They have been fine here. I feel they are really safe there, no falls and no concerns about their care or safety. The staff always seem to be in attendance and keeping an eye on them. There are nursing staff as well as carers which is another level of safety I think.”

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.

There was a cheerful atmosphere at the home. People and relatives spoke positively about the caring nature of staff. One relative told us, “Staff try and make it as happy and carefree as possible. They laugh and joke with mum and they will put her music on for her. She likes the staff which says a lot I think. The staff are all very nice and welcoming.”

There was a registered manager in place. The regional director explained they were advertising for a clinical deputy manager who would support the registered manager and have oversight of people’s nursing needs. In the interim; the home was supported by the provider’s team of clinical specialists.

People and relatives told us they thought the home was well managed. They spoke positively about the home. Comments included, “I would tell people that you could put your family member there and have peace of mind that they will be cared for properly and treated with respect" and "I would recommend the home. It is clean, warm, friendly and a good home. He would be unable to cope at home so he is in the best place."

Staff liaised with health and social care professionals to help ensure people’s needs were met. Several health and social care professionals considered that communication could be more effective at times to ensure people’s needs were met.

There were systems in place to involve people, relatives and staff in the running of the home. Meetings and surveys were carried out. We spoke with one person who devised a weekly quiz for people and staff. He also explained he was in the process of devising a newsletter for the home.

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 requires improvement (published 3 February 2021). We carried out a focused inspection in November 2020 and found breaches of the regulations relating to medicines management, IPC and the governance of the service. The provider completed an action plan to show what they would do and by when to improve.

We carried out two targeted inspections in December 2020 and June 2021 to check that improvements had been taken in relation to IPC. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found that action had been taken to improve in relation to IPC.

Why we inspected

We undertook 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 of safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make further improvements. Please see the safe and well-led sections of this full report.

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 coronavirus and other infection outbreaks effectively.

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

Enforcement

We have identified a breach of the regulations in relation to the maintenance of medicines records. Please see the action we have told the provider to take at the end of this report.

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.

Chester Court is a residential nursing home providing personal and nursing care to 41 people. At the time of the inspection there were 27 people living at the home.

Chester Court is a purpose-built nursing home providing accommodation over two floors. All rooms have en-suite facilities. There are a number of communal dining areas and lounge facilities.

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

The provider had a robust infection prevention control process in place. This included staff wearing appropriate PPE and adhering to government guidance regarding its use and disposal. Staff were confident regarding the level and types of PPE they should wear whilst carrying out various tasks within the home. The provider checked staff consistently followed guidance through daily observations and discussions with staff.

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 requires improvement (published 10 December 2020).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this targeted inspection to check the provider had sustained their level of improvement following our targeted inspection on 29 December 2020. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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 coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Chester Court is a residential nursing home providing personal and nursing care to 41 people. At the time of the inspection there were 30 people living at the home.

Chester Court is a purpose-built nursing home providing accommodation over two floors. All rooms have en-suite facilities. There are a number of communal dining areas and lounge facilities.

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

Infection control processes at the home were not robust and staff didn’t always follow government guidance. Medicines were not always managed safely, and records were often incomplete or poorly maintained. Processes to safeguard people from abuse were followed and risks were effectively reviewed and managed. Staffing levels were regularly monitored by the manager and the provider and there were enough staff on duty to support people’s care needs.

People were supported to have good access to a range of food and drinks. People with specific dietary requirements were monitored and supported.

Systems to monitor quality and safety at the home were not always robust. There was a new manager in post who was working through an action plan to help develop and improve the staff and the service. The manager had appointed a representative for people who lived at the home to help capture the user voice and influence.

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 (21 December 2018)

Why we inspected

The inspection was prompted in part due to concerns received about staffing, support with nutrition and the quality assurance systems in place at the home. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chester 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 have identified breaches in relation to infection control, the safe management of medicines and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. Please see the enforcement section at the end of this report for details of the action we took.

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.

Chester Court is a residential nursing home providing personal and nursing care to 41 people. At the time of the inspection there were 31 people living at the home.

Chester Court is a purpose-built nursing home providing accommodation over two floors. All rooms have en-suite facilities. There are a number of communal dining areas and lounge facilities.

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

We were assured by the infection prevention and control [IPC] measures introduced since we last visited. The provider had taken action to ensure staff were trained and followed safe and effective IPC practices in line with government guidance.

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 requires improvement (published 10 December 2020).

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this targeted inspection to check the provider had acted following our inspection on 16 and 23 November 2020 to make the agreed improvements to people's safety and welfare. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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 coronavirus and other infection outbreaks effectively.

CQC have introduced targeted inspections to follow up on specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection in February 2016 we rated the service as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

A registered manager was 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 felt safe and safeguarding procedures were in place which staff followed. Incidents of a safeguarding nature continued to be reported to the appropriate authorities and investigated. Staff understood their responsibility in safeguarding people and told us of the action they would take if they had concerns.

People and relatives spoke positively about the service. We saw positive relationships between staff and people. Staff treated people with compassion and kindness during their interactions. Staff we spoke with described ways in which they worked which demonstrated a caring attitude.

We found care plans were person-centred and consistent in the level of detail and information they contained. Person-centred care planning is a way of helping someone to plan their care and support, focusing on what is important to them. Staff knew people well and delivered personalised care to people. Risk assessments related to the delivery of care and the environment were up to date. Emergency plans were in place and health and safety checks in the environment were carried out to ensure it remained safe.

The administration and management of medicines continued to be safe.

Consent to care and treatment was sought in line with the Mental Capacity Act 2005 (MCA). The best interest’s decision-making process had been consistently followed for people who lacked capacity to make certain decisions themselves.

The service was homely and had been personalised to meet the needs of people. Staff followed infection control procedures and the home was clean, tidy and had no malodours.

People were offered a choice of meals. We received mixed feedback regarding the food available. People were offered an alternative meal if they did not like the choice on offer. The environment for dining was helpful in making the meal time experience pleasant for people. Records were available to highlight if people required a specific textured meal due to swallowing difficulties.

Safe recruitment procedures were followed during the employment of new staff. Staff told us they felt supported and had received regular supervisions and appraisals. Newly recruited staff received an induction and training the provider had deemed to be mandatory was completed by staff.

There were enough staff employed to safely meet the needs of people living at the home.

A range of checks and audits were carried out to monitor the quality of the service. Care records were complete and up to date, they were maintained to a good standard and stored securely so they remained confidential. Incidents were reflected upon and analysed. Where learning was identified systems were changed to reduce the risk of repeated incidents.

People, relatives, staff and professionals were positive about the leadership of the home and the registered manager. The provider was meeting legal requirements in relation to notifying CQC of events and displaying their current quality rating.

A visiting professional spoke of a positive working relationship and that staff knew the needs of people well. The home had good links with a local GP surgery. Relatives we spoke to said their family member received good care.

A complaints procedure was in place and people told us they knew how to complain. Systems were established to gain the views of people and their relatives.

Staff spoke passionately about providing holistic care for people. The home is currently part of a research study regarding hydration needs for people which is linked to current research.

A recognition scheme was in place to show staff they were valued. Staff told us they were happy working at the home and felt proud of what they had achieved. A number of staff had received awards for demonstrating good practice. This included staff winning national awards including one staff winning an award for innovations in wound care. Staff nominated a person living at the home for a gardening award for ‘Bedlington in Bloom’. This was to recognise all their work in looking after the home’s grounds.

Further information is in our detailed findings below.

We last carried out an inspection on 25 September 2014, where we found the provider was meeting all the regulations we inspected.

Chester Court accommodates up to 41 older people, most of whom have nursing needs. There were 41 people living at the home at the time of the inspection.

There was a manager in post. 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 and associated Regulations about how the service is run.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. We spoke with the local authority safeguarding officer who told us that there were no organisational safeguarding concerns regarding the service.

We spent time looking around the premises and saw that all areas of the building were very clean and well maintained. There were no offensive odours in any of the bedrooms or communal areas we checked.

Safe recruitment procedures were followed. Some people and staff told us that more staff would be appreciated. We observed that staff carried out their duties in a calm, unhurried manner on the day of our inspection. The manager provided us with information which showed that staff had completed training in safe working practices and to meet the specific needs of people who lived there such as specialist feeding techniques.

We checked medicines management. We found that there were safe systems in place to receive, administer and dispose of medicines. One of the medicines fridges was faulty and a new one had been ordered.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ it also ensures unlawful restrictions are not placed on people in care homes and hospitals.” The manager had submitted DoLS applications to the local authority to authorise in line with legal requirements.

We observed that staff supported people with their dietary requirements. Staff who worked at the home were knowledgeable about people’s needs. We observed positive interactions between people and staff. There was an activities coordinator employed to help meet the social needs of people.

There was a complaints procedure in place. Feedback systems were in place to obtain people’s views. Meetings and surveys were carried out.

A number of checks were carried out by the manager. These included checks on health and safety, care plans, infection control and medicines amongst other areas. We checked the maintenance of records and noticed that there were some recording omissions in several of the food and fluid charts we viewed. The manager addressed this immediately and instigated a new system to ensure that these were completed accurately.

Staff informed us that they were happy working at the home and morale was good.

' 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?

People were cared for in an environment that was safe. There were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies. We saw that systems were in place to ensure people's medications were safely managed. Other risks to people's safety were assessed and managed in the way care was delivered and reviewed. Accidents were recorded and monitoring arrangements were in place to identify and address patterns and trends.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager and the deputy manager demonstrated that they were aware of these and had made applications in line with the policies and procedures following a recent court ruling that had affected the way these safeguards were applied. The manager told us they were awaiting decisions regarding these applications.

Is the service effective?

People told us they were happy with the care that had been delivered and their needs had been met. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs.

Is the service caring?

People and visitors made positive comments about the care. One relative said, "It is nice and homely and there is a nice atmosphere' Another relative commented, 'I meet with a nurse and go through the care plan each month to check on any changes needed. I find the staff very accommodating'. We observed patient and good humoured interactions between the staff on duty and the people living at the home. One relative said, "There is a lot of friendly banter between residents and staff going on most days."

Is the service responsive?

People's needs had been assessed before and after they moved into the home. A relative told us they were involved in the care provided. Records confirmed people's preferences and wishes. People had access to activities that were important to them. Night time routines were individualised to people's needs. We saw in records that the home referred to outside specialists for support in caring for people.

Is the service well led?

The home had an experienced registered manager. Quality assurance processes were in place. We saw people had been asked for their views about their care. Staff told us they were clear about their responsibilities.

Records showed and staff confirmed the provider had systems in place which ensured that staff were recruited who were appropriately qualified and able to do the job.

We found the provider supported staff through training, supervision and appraisal so that people were cared for by a skilled team of nurses and care staff. One of the people we spoke with said, "They are all good nurses here, all the staff are good, I can't say enough about it."

We saw the provider had various systems for checking the quality of the service and identifying where improvements could be made for the benefit of people living at the home.

The records showed and people confirmed that the home responded to concerns and complaints. One person said, "The boss is good she listens to both sides and forms an opinion." Another person said, "I feel I could go to the staff with my concerns and they would listen."