Havering Court Care Home

Havering Court Care Home is a care home registered to provide nursing and personal care to people, aged 18 years and over, who may have mental health needs, acquired brain injuries, learning disabilities, physical disabilities and sensory impairments. It can support up to 52 people. At the time of the inspection, 49 people were living at the home. The home has two floors with adapted facilities and en-suite rooms.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

The service was not always safe because medicines were not managed safely and people were at risk of not receiving their medicines as prescribed. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Systems and processes to protect people from the risk of abuse were in place. Risks to people’s safety were assessed. People and relatives told us staff were respectful and caring. Staff followed infection control procedures and people were protected from the risk of infections.

Right Care

Staff had received up to date training and development to maintain their skills and knowledge. People's dignity, privacy and human rights were respected. People were encouraged to maintain a healthy balanced diet and were provided food and drink that met their preferences and needs. Staff knew people who used the service well and they provided care and support to them in a kind and compassionate way. Care plans were informative and provided guidance on how to meet people's needs. People and their relatives were positive about the management team and could approach them with any concerns.

Right Culture

Leaders and the culture they created did not always support the delivery of high-quality care. The provider had systems in place to assess, monitor and improve the quality and safety of the services provided but they were not used effectively to identify some of the shortfalls in the home. The registered manager took action to make improvements to the service following our inspection.

People were offered a range of activities that were engaging and meaningful. People and relatives were contacted for their feedback about the service. Staff told us they were supported by the management team and received supervision to discuss their performance. People and relatives were positive about the home. There was a positive culture and equality, diversity, inclusion and human rights were promoted in 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 the service was Good (report published 16 March 2021).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risks around eating and drinking. This inspection examined those risks.

We undertook a focused inspection to review the key questions of safe, effective, caring and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and Recommendations

We have identified breaches in relation to the safe care and treatment of people, need for consent to care and good governance 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.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Havering Court Care Home is a residential care home providing nursing and personal care to people aged 18 and over, some of whom have physical disabilities and/or brain injuries.

The home can support up to 51 people and at the time of the inspection, 43 people were living in the home. The home is an adapted two floor building with facilities, including en-suite bathrooms.

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

We found improvements had been made to the home since our last inspection on 17 and 21 October 2019. At our last inspection we found shortfalls in medicine management, assessing risks to people, staffing numbers and supporting staff to carry out their roles. We found care plans were not personalised and audit processes were not robust in identifying areas for improvement. Prompt action was not being taken to ensure people were safe at all times. We also noted there was not a positive culture in the home. During this inspection, we found improvements had been made in all these areas.

At this inspection we saw medicines were now being managed safely and there were robust procedures in place for the administration, recording and storing of all medicines. Risks to people’s health were assessed appropriately and managed. There was sufficient information for staff to follow. There were appropriate numbers of staff and the provider had ensured staffing levels were increased and maintained to prevent the home being understaffed. Recruitment procedures were in place for suitable staff to be employed. Care plans were person-centred and detailed how to provide personalised support to people. There was a wide range of activities for people and staff engaged and interacted with them to prevent social isolation.

The provider ensured infection control procedures were in place and there was guidance for people, staff and visitors during the Covid-19 pandemic to keep them safe. We have signposted the management team to resources around assessing people’s individual risks around Covid-19.

Premises and equipment safety was maintained to ensure the home environment was safe. Quality assurance and governance processes were more robust. The safety and standard of the home was assessed by the provider to identify shortfalls and take action to ensure people received care that was safe, effective and responsive. The management team carried out audits and reviews to check correct procedures were being followed by staff. The provider was meeting regulatory requirements and notifications of incidents were submitted to us.

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.

Staff were respectful and kind towards people in the home. There was an open-door culture for staff to raise issues. Meetings with staff were held with the management team to discuss important topics and go through concerns. Staff worked well with health professionals and other agencies to ensure people’s health and wellbeing were maintained. Complaints had been managed in a timely manner. Systems were in place to obtain feedback from people and relatives.

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

Rating at last inspection

The previous rating for this service was Requires Improvement (report published 20 January 2020) 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.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 17 and 21 October 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment for people, staffing levels, person-centred care planning and good governance of the service.

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, Effective, Responsive and Well-Led which contain those requirements.

Before our inspection, we received concerns in relation to the provision of personal protective equipment (PPE) for staff for protection against infections. 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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

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.

Havering Court Care Home is a residential care home providing personal and nursing care to people aged 18 and over with physical disabilities and/or brain injuries. The service can support up to 51 people and at the time of the inspection, 51 people were living in the home.

Havering Court Care Home is a purpose built, two floor building. Each floor or unit has separate adapted facilities.

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

The provider was failing to ensure the service provided safe, effective and responsive care. We found repeated concerns about the home from our last inspection in July 2018. Medicines were not always managed safely. Times some medicines were given were not always recorded to ensure they were given at the recommended intervals. Some ‘as required’ medicines were not listed on people’s records.

Accidents and incidents that had taken place in the home were not analysed to learn lessons and prevent them re-occurring. Risks associated with people's needs were assessed and staff understood how to reduce these risks, although some assessments lacked detail.

Staffing levels in the home were assessed but the home did not always have the required numbers of staff working due to staff shortages. This had an affect on the care given to people as it placed additional pressure on staff.

The home had made some improvements in recording the repositioning of people at risk of pressure ulcers and recording people’s fluid intake. However, staff were unable to keep people’s care plans up to date, which meant people did not always receive person centred care.

Staff were provided with suitable training to ensure their skills and knowledge were up to date. However, they did not feel fully supported by managers. They did not receive individual support and regular supervisions to encourage them to air concerns they had and review their work.

Activities took place in the home and people were encouraged to participate in them if they wished. However, there was little staff interaction with people when activities were not taking place and most people spent the day alone in their rooms. We have made a recommendation about providing activities that suited people’s preferences.

People or their relatives were supported to make complaints about the home but they did not always have opportunities to discuss concerns they had.

These were ongoing issues in the home that had not been sufficiently addressed. There were inadequate systems in place to ensure the quality of the home was being maintained through robust checks, audits and reviews.

There were procedures to protect people from abuse and staff understood how to report abuse. Staff were recruited safely and their backgrounds checked before they started working for the service. Staff followed infection control procedures to maintain the hygiene and cleanliness of the home.

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

People were supported with maintaining their health and nutrition. The service worked in collaboration with health care professionals, such as GPs, nurses and speech and language therapists to ensure their health needs were met. People were encouraged to maintain their independence as much as they could.

Staff were respectful and caring towards people. Staff knew how to communicate with people who had difficulty speaking. Staff understood the importance of promoting equality and diversity.

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 18 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 not enough improvements had been made and the provider was still in breach of regulations. 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. We have found evidence that the provider needs to make improvement. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified four breaches in relation to medicines management, staffing levels, personalised care planning and the management and governance of the service.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Havering Court Care Home is a ‘care home’ that provides nursing and personal care. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The provider was registered to provide a service to both older and younger people who had a physical disability.

Havering Court Care Home accommodates up to fifty-two people in a purpose built, two floor building. Each floor has separate adapted facilities. There are dining and common areas on each floor and adapted bathrooms. Other facilities included a cinema room and a therapy room with physiotherapist facilities and a large garden. At the time of our inspection forty-six people were living in the 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.

At the last inspection of the service in March 2015 the service was rated good overall but was rated requires improvement in the key question 'is the service safe?' This was because we identified shortfalls in the administration of medicines that could put people at risk of not receiving their medicines in a safe manner.

At this inspection we found that the previous concerns had not been addressed as we found medicines were not being managed in a safe way. Shortfalls identified included, people’s medicines not tallying with the recorded amounts and some prescribed ointments were being administered not always as prescribed. On occasion, some morning medicines rounds were not completed until lunch time and there was a risk medicines doses were being administered too close together. We saw the storage of some medicines was not appropriate and equipment associated with medicines administration not being cleaned.

Some people and relatives felt that quality of care at the service was not as good as previously. They told us there were not enough nurses and care staff and that they sometimes had to wait to have their personal care provided. We found that the registered manager had not been assessing staffing levels on an ongoing basis and in response to changing circumstances. Therefore, they could not be assured that there was sufficient staffing to meet people’s support needs.

Some people felt safe in the home but others did not. They told us that they thought that staffing levels were not high enough, that their possessions were not always safe, that external fire doors were sometimes left open during the day and they were worried intruders might come into the home and garden. They told us that the registered manager listened to their concerns and complaints but they did feel that their concerns and complaints were appropriately addressed and resolved. We have made a recommendation to the provider about this.

People’s records were not kept accurately and in a contemporaneous manner and gaps in recordings were identified.

The management team undertook audits and checks to monitor and help improve the quality of the service provided. However, these had not been effective in identifying all the concerns we found in this inspection. Where the management team were aware of concerns such as the staffing levels they had not put in place timely measures to address these concerns.

People told us they had enough food to eat. Some people felt the food served was very good and some people thought it could be better at times. Many people at the home required staff support to eat and drink. Nurses and some staff were trained to support some people who had medical procedures to support them to have enough nutrition and remain hydrated.

People and relatives told us some staff were kind and patient and took time to understand them. However, the delays in providing a service to people demonstrated that the provider was not enabling staff to provide support in a caring manner. Staff told us how they supported people to make choices in their daily activities and how they encouraged people to be as independent as possible.

Care staff received induction training when they started working at the home and specialist and refresher training to support them to manage all aspects of their work.

The registered manager assessed people prior to them moving into the home to ensure they could meet their support needs.

People had person centred care plans that stated how they wanted their care provided. Care and support plans had been reviewed however not all people we spoke with said they had seen their care plan.

The registered manager worked in line with the Mental Capacity Act 2005 and applied for Deprivation of Liberty Safeguards authorisations appropriately for people who did not have capacity about their care and treatment.

The registered manager held regular meetings with heads of department, nurses and care staff to ensure there was information sharing within the home.

The provider had a clear ethos and values that they displayed in the home and shared progress in meeting those values with staff, people and their relatives.

We found four breaches of regulations in relation to staffing, safe care and treatment, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with told us they were very happy with their care. One person said, "there is nothing wrong with this place at all". A relative told us,' the care is brilliant, I have a laugh with all the carers'. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

The provider has taken steps to provide care in an environment that is suitably designed and adequately maintained. People told us they were happy with their rooms. One person said, "I like this place it is clean and bright". We found that all the bedrooms and communal areas were well maintained and clean.

Appropriate checks were undertaken before staff began work.

There was an effective complaints system available and comments and complaints people made were responded to appropriately.