Archived: Guys Court Residential and Nursing Home

Guys Court Nursing Home provides residential and nursing care for up to 37 people. Situated in Fleetwood, the home has a car park and disabled access to the building. It is a three-storey purpose built home, with a passenger lift to all floors. At the time of the inspection visit there were 27 people who lived at the home.

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

There were issues around safe staffing levels. Comments from people and observations found shortfalls in the level of staff to support people. Although medication administration was satisfactory we found an issue with one person not receiving their medication in a timely manner. People we spoke with told us they felt safe from the risk of abuse. The registered manager recorded and audited any incidents and accidents and learnt from them. Staff continued to be recruited safely Infection control systems and audits continued to ensure a clean environment and reduce any risks.

We have made recommendations about medication and staffing levels, which can be found in the ‘safe’ section of this report.

The service did not have clear support from the provider and changes had affected the running of the home staff were not supported consistently. The registered manager worked in partnership with a variety of agencies to ensure people’s health and social needs were met. The registered manager had improved methods to assess and monitor the quality of the service on a regular basis.

We have made a recommendation about the service and workforce management, which can be found in the ‘well led’ section of this report.

The registered manager ensured staff received an effective induction and training programme that was continually updated. People spoke positively about the quality of meals and praised the cooks for the choices available. People received support with their healthcare needs. 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.

People we spoke with and our observations confirmed staff were kind, caring, and treated people with respect. Information about local advocacy services was available, to ensure people could access support to express their views if required.

Activities were varied, and people told us there were trips and entertainment regularly provided. Activity co-ordinators were employed to support people and their interests. People’s communication needs had been assessed and where support was required this had been given. People knew how they could raise concerns about the service and a complaints procedure was in place.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 11 October 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

This report only covers our findings in relation to the leadership of Guys Court and the safety of those who lived there. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Guys Court on our website at www.cqc.org.uk.

The inspection visit at Guys Court was undertaken on 20 August 2018 and was unannounced.

Guys Court is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both of which we looked at during this inspection.

Guys Court Residential and Nursing Home provides nursing and personal care for 37 older people and people with dementia. It is a three-storey purpose built home, with a passenger lift to all floors. There is a separate dementia unit. Guy's Court is located in a residential area of Fleetwood, close to transport and local amenities. At the time of the inspection visit there were 25 people living at the home.

A registered manager was not in place. A registered manager is a person who has registered with the Care Quality Commission (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 were in the process of registering a new manager with CQC.

At the last inspection we rated the service as good.

During this inspection, we found the provider did not ensure they met legal requirements and improvements were required. Furthermore, we made recommendations to ensure the safety of people was maintained.

We found the provider did not have sufficient information within their risk assessments to be able to keep people safe. In addition, risk was not managed well for people who required nursing care wound care management. This put people at risk of unsafe care and treatment.

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

At this inspection we found the provider did not have safe medication procedures in place to ensure people received their medication safely. This was because documentation was not accurate and up to date which put people at risk. This was contrary to current guidance 'National Institute for Clinical Excellence' (NICE) guidelines.

We have made a recommendation about safe medicine procedures.

Furthermore, we found audits had not identified issues that had we had highlighted during this inspection visit. For example, care plan audits did not always identify any mistakes and ensure people who lived at the home were kept safe and received the correct up to date support required.

We have made a recommendation about efficient monitoring and quality assurance systems.

We found the service did not have clear lines of responsibility and accountability. Changes in management had affected the running of the home and staff were not supported consistently.

We have made a recommendation about structured management systems to support staff in their roles.

Staff spoken with had received safeguarding training and understood their responsibility to report unsafe care or abusive practices.

We looked at staffing levels and skill mixes to check these were sufficient to meet people’s needs with a timely approach. On the day of the inspection visit there were sufficient staff deployed to care for people who lived at the home. However, comments we received from staff were mixed in terms of staffing levels generally. The management team had responded recently to staff shortages and assured us they were now sufficient to meet the needs of people who lived at the home. They told us they were currently recruiting personnel.

Recruitment procedures were in place and had checks in place to ensure suitable staff were employed.

We looked around the building and found it was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required. Recent improvements in infection control and the addition of domestic staff had improved at Guys Court. One member of staff said, “There has been improvement in staffing levels for domestic staff. We have more now so we are able to maintain the building better.”

The inspection visit was prompted by information we received from the local safeguarding team. They were investigating concerns following the death of two people who lived at the home.

The incidents are subject to a separate investigation and as a result this inspection did not examine the circumstances of the deaths. However the information shared with CQC about the incidents indicated potential concerns about the management of health issues and to ensure people were safe at Guys Court. This inspection examined those risks.

This report only details our findings in relation to the potential concerns in safe and well led.

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 care records of people who needed assistance with personal care, potential skin breakdown and pressure sores were receiving support they required. This was in terms of up to date information of the person’s condition, repositioning charts to reduce the risk of pressure areas developing and appropriate body mapping documentation. Care plans, risk assessments and daily reports indicated checks had taken place. Repositioning charts to record the person's positional changes were used where needed. Pressure aids were in place where people were at risk of developing pressure sores for example special mattresses.

We looked at how staff received information and guidance. We looked at training records and found the registered manager had provided more training for staff in ‘pressure ulcer care’. This was to ensure staff had up to date knowledge of current care and guidance. Any care issues or changes were highlighted to staff in both individual supervision and staff meetings.

The service had introduced a number of systems to ensure correct recording and communication sharing was in place to reduce the risk of people who were vulnerable to pressure sores. For example a new all in one document, ‘handover sheet’ provided information about people’s diet, fluid intake and falls risk. This meant better communication and ensured information was documented.

Audits were frequent, documented and any issues found on audits acted upon promptly. They had introduced further auditing of care plans and pressure area support to ensure people were not at risk and kept safe. Support from the organisation regularly visited Guys Court who checked actions were taken where needed.

At the last inspection the service was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The registered manager had procedures in place to minimise the potential risk of abuse or unsafe care. Staff spoken with were able to identify the different types of abuse and had received training in safeguarding adults. We confirmed this by talking with staff and looking at training records.

Staff had been recruited safely, appropriately trained and supported. This was confirmed by records looked at and discussions with staff the management team and people who lived at the home. They had the skills, knowledge and experience required to support people with their care and social needs. Staffing levels were observed to be sufficient to meet the needs of people who lived at the home. The management team monitored and regularly assessed staffing levels to ensure sufficient care and nursing staff were available to provide support people needed.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes were recorded.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required

Medicines had been checked on receipt into the home, given as prescribed and stored and disposed of correctly. We looked at medication administration records of people who lived at Guys Court and found them to be correct and up to date.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We observed lunch served which was a relaxed social occasion for people. There were aids to help people be as independent as they could. During the morning period the chef spoke to everyone before lunch to ask what they wanted for lunch to ensure people got what they wanted. Comments were positive about the quality of food and included, “All home made food fabulous” Also, “The food is great plenty of choice.”

Relatives and people who lived at the home told us staff and the management team had a caring manner and kind attitude to support people. Comments from people who lived at the home included, “The staff make me feel I'm at home here. They are very friendly and we like to have a laugh together.”

Following the recommendation from the previous inspection in March 2015 action had been taken to address the issues. Care records had now been reviewed and updated since the previous inspection when we recommended any treatment or support identified must be recorded and carried through as planned. A staff member said, “We ensure any concerns or action taken in relation to a persons health is followed through.”

People who lived at Guys Court and relatives /friends knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

The registered manager used a variety of methods to assess and monitor the quality of care at Guys Court and told us they were supported by the organisation. These included regular audits of medication, care plans. Also and staff and ‘resident’ meetings to seek the views of people about the quality of care being provided took place on a regular basis. Any suggestions to improve the service were acted upon.

During this inspection we found our concerns had been addressed. A structured activities programme had been devised and implemented on the dementia unit. We saw a number of people participating in armchair exercises during the morning. They appeared to be having fun and getting on well with the staff. During the two hour period we spent on the unit we saw constant interaction between the people being supported and staff on duty. We saw staff encouraging people to drink their mid morning drinks. Assistance was provided if required.

We saw staff assisting people with mobility problems. The staff were patient and took care to ensure the people being supported were assisted safely. The staff members we spoke with confirmed they had received mandatory moving and handling training.

People we spoke with said they were happy with their care. One person said, 'The staff are lovely caring people'.

Some people had limited verbal communication and understanding and were unable to hold a conversation with us. To help us understand their experiences of living in the home we observed the care they received and the interaction by staff.

People living in the home and relatives said they felt staff were caring and supportive. One person said, 'I am happy here. The staff are kind.' A relative told us, 'Without the care given here my relative would not be alive.'

We saw staff engage with people in the nursing areas. Staff checked if people needed anything and supported them. There were also some activities available. There was little staff interaction with people or leisure activities available in the dementia unit. Neither did staff encourage people to drink their mid morning drinks. Some moving and handling practices were unsafe. Staff supervision was limited and meant that staff were unaware what people were doing for some of the time.

The medication policy was not always adhered to, increasing the risk of errors. The home had identified this in a recent audit and was starting to take action to deal with this.

Systems were in place for monitoring the quality of the service people received. People living in the home and relatives told us that they were well supported by the manager and staff team. A relative said, 'You can always speak to the manager, she always makes time for you.'