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Archived: Court House Care Home Good

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Reports


Inspection carried out on To Be Confirmed

During a routine inspection

Court House Nursing Home provides personal and nursing care for a maximum of 60 people. The home was split into three units; two were for older people and one for younger adults. Midsummer Unit provided accommodation for 25 older people, on the day of our inspection there were 23 people living on this unit. Brecon Unit provided accommodation for 16 older people, and there were 16 people living on this unit on the day of our inspection. The third unit, Holly Bush Unit provided accommodation for 19 younger adults and there were 18 people living on this unit on the day of our inspection. On the day of our inspection there were a total of 57 people living at the home.

The inspection took place on the 25 and 26 June 2015 and was unannounced.

There was not a registered manager in post when we inspected, however the provider was taking all reasonable steps possible to remedy this. The provider was advertising the position to be filled as soon as possible. There had not been a registered manager in post since 15 January 2015. The provider had made suitable arrangements by covering the post with an experienced registered manager from another home. 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 who lived at the home and their relatives said they felt safe and staff treated them well. Relatives told us staff were kind and caring and thoughtful towards people. Staff we spoke with understood they had responsibility to take action to reduce the risk of harm for people. They demonstrated awareness and recognition of abuse and systems were in place to guide them in reporting these.

People who lived at the home were supported by staff with up to date knowledge and training. Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. We saw the manager had a system to ensure there were enough trained staff on duty.

People were protected against the risks associated with medicines because the manager had appropriate arrangements in place to manage medicines. People’s preferences were taken into account and respected. We saw staff treated people with dignity and respect whilst supporting their needs.

The manager had followed the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when assessing people’s ability to make specific decisions for most people living at the home. Applications had been submitted to the supervisory body for most of the people living at the home where their liberty was restricted. However we found that this was not universal and other people who were subject to some restrictions also needed to be referred to the local authority. This was to ensure that any decision to restrict somebody’s liberty was only made by people who had suitable authority to do so.

People had food and drink to maintain a healthy diet. We saw at mealtimes there was a relaxed atmosphere and people and their relatives told us they enjoyed the food. People were supported to eat and drink well and had access to health professionals in a timely manner.

All the visitors we spoke with told us they were made welcome by the staff in the home. People were able to see their friends and relatives as they wanted. There were no restrictions on when people could visit the home.

People and relatives knew how to raise complaints and the provider had arrangements in place so that people were listened to and action taken to make any necessary improvements.

The provider promoted a positive approach to including people’s views about their care and service development. People who lived at the home and staff were encouraged to be involved in regular meetings to share their thoughts and concerns about the quality of the service.

The provider had systems were in place to monitor and improve the quality of the service, however these systems did not always identify short falls in assessments to ensure people were not deprived of their liberty unlawfully.

Inspection carried out on 22 January 2014

During a routine inspection

We inspected Court House Nursing Home and spoke with five people who lived at the home. We spoke with a registered nurse, four members of staff on duty and the registered manager. We spent time and observed the care and support people received. Court House Nursing Home provides care and support in three separate units and this inspection focused on Beacon unit.

People were positive about life at the home. One person said: "It�s lovely here, like home from home. I feel safe and I�m happy here". Another person told us: "I think it is (the care) good" and "Very happy with what goes on here".

During our inspection we saw that staff helped people to make simple everyday decisions such as, what they wanted to drink and what they wanted to do. There were arrangements in place where required, to help people with the bigger decisions so that their best interests were maintained.

We saw that staff were aware of each person�s needs and how to give care and support to meet those needs. We found that information had been kept up to date and that plans were in place to support staff to make sure they worked in a consistent way.

People were supported with access to additional medical services as necessary to make sure their health and social welfare was protected at all times.

There was a complaints procedure in place and on display at the home. The registered manager told us this procedure would be followed in the event any comments or complaints were received.

Inspection carried out on 3 December 2012

During a routine inspection

We spoke with six people who used the service and six members of staff. People who used the service were complimentary of the service and told us that they were cared for well. One person we spoke with had recently moved into the service. They told us that they felt quite comfortable.They said they were surprised how easy the move to the service from their home had been for them.

We found that people�s individual needs had been assessed and supporting care plans had been developed. This ensured their needs would be met by staff and they received appropriate care.

Since our last inspection there had been a review of staffing levels and the majority of people we spoke with told us there was enough staff most of the time.

Staff had a good understanding about what constituted abuse and the action they should take if they had any concerns about the people they cared for.

There were arrangements in place for monitoring the quality of the service. People who used the service and staff told us they had no difficulties raising issues if necessary and knew that they would be listened to.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Inspection carried out on 28 March 2012

During an inspection in response to concerns

We carried out this visit because we had received some concerns from members of the public about staffing levels on Beacon unit. This was a unit where we previously had concerns about staffing but which we found had improved when we visited in October 2011.

The home manager told us that typical staffing levels for the unit were one nurse and three care workers from 8am until 8pm and one nurse and one care worker at night.

On the day of our visit fifteen people were living on Beacon unit who were being cared for by one nurse and two care workers. This was due to unforeseen staff absence and during the morning temporary cover was provided by agency staff.

We spoke with four staff who worked on Beacon unit. Staff told us that they felt there were insufficient numbers of care staff on duty to meet people�s needs, there was not always three care workers on duty and that absences were not always covered.

When we looked at the staffing rota for the unit we saw two occasions during the month when there had been only two care workers on duty and no cover had been provided to ensure people had been kept safe and their individual needs met.

Staff told us that because of current staffing levels they had to stick to a fixed daily routine to ensure all of their designated tasks were completed.

They said that they had a weekly bathing rota and that if people asked for a bath or shower outside of their designated day or time they would be unlikely to be able to provide it as there were not enough staff to do so. They also said that they were not always able to fit in scheduled baths or showers in the morning and these sometimes had to take place during the afternoon.

In addition to this staff told us they had to rely on night staff getting some people up before they came on shift as they would not have time to provide personal hygiene for everybody before lunchtime each day. There was no evidence that staff were aware of or able to respond to people�s preferred time to get up each day.

They told us that they were very aware of the importance of meeting people�s social needs but did not have time to sit and chat with people who lived on Beacon unit .

We spoke to one person who lived on Beacon unit. They told us that in their opinion there were not enough staff on duty during the day and they could often wait 15 to 20 minutes for help. They were however very complimentary of the care workers and said they were very kind and that they cared for them well. They told us that they don�t always get a shower when they want one due to staff shortages and they had not been able to have a shower for two weeks.

They told us that there was not enough to keep them occupied but they didn�t wish to trouble staff as they were very busy.

Beacon unit had an activities coordinator to provide social and recreational opportunities for people who lived on the unit for four hours each weekday. They told us there was one schedule of activities for all three units but most of the people on Beacon unit preferred one to one activities.

It was apparent from discussions with activities staff that they had to spend some of their time supporting care workers and providing personal care to people which left less time for social and recreational opportunities.

Prior to our visit we had received concerns that people who lived on Beacon unit were alone in the lounge for long periods with no interaction from staff. During our visit we saw that the lounge was unsupervised on a number of occasions and when we spoke with staff they told us that with the current staffing levels it was not possible to do this. Staff told us that they were concerned about the levels of supervision and their ability to ensure people were being kept safe.

One member of staff we spoke with was very positive about their role and the home. They described it as �home from home�. They said they felt people were well cared for. They highlighted some of the positive feedback about staff and the home that they had heard from people who had attended residents meetings.

During our last visit to the home in October 2011 a full refurbishment programme was being carried out to all of the three care units which included improvements to communal areas and people�s bedrooms. When we visited this time we saw that this work had been completed and that there were significant improvements to the environment. When we spoke to the home manager they told us there were further plans to create a sensory room on one unit and a sensory garden which could be used by everyone living in the home.

All of the three care units we visited appeared clean.

We looked at some people�s bedrooms and saw that they were homely in appearance and appropriately furnished to meet their needs. We saw that the hairdressing room on Beacon unit had been updated and redecorated since our previous visit.

When we visited in June and October 2011 we found that the records for the ongoing monitoring of people�s fluid intake were poor. It was not possible to see if people identified at risk were having sufficient fluids. Our findings from this visit showed this was still a problem.

When we walked around the home we saw that people had access to cold drinks and that hot drinks were available.

There had been a change in the management arrangements for the home since our last visit to the home in October 2011. A new home manager had been appointed and had been in post for two weeks.

Inspection carried out on 11 October 2011

During an inspection looking at part of the service

We spoke to four people living in the home and a visitor during our visit. Everyone we spoke to said they felt safe and that staff cared for them well. People told us that they felt comfortable raising any concerns with staff or management and that their concerns would be listened to. All of the people we spoke to told us that that they were appropriately cared for and were able to make choices about how and where they wished to spend their time.

When we spoke to staff about the people they cared for they were able to tell us about each person, provide some details about their lives, their preferences for their day to day care and the people and relationships that were important to them.

We spoke to staff that provide activities. They told us that they were in the home to support people each weekday and come in at weekends as required. Changes had recently taken place which meant that each unit had its own designated activities coordinator. Staff we spoke to said that this had helped to strengthened relationships with residents, visitors and staff and was proving to be very successful.

One person who lived in the home told us that they enjoyed being able to go on outings. They had a number of photographs of ones they had enjoyed since living in the home. They told us they were looking forward to a forthcoming trip to the theatre. They said that often find it hard at weekends when activities staff are not usually on duty and said that it can get a bit boring for them.

When we visited the home in June 2011 we observed the lunchtime routine on Beacon unit. We found that people waited a long time for their lunch and that people were not being supported appropriately at mealtimes.

When we visited this time we observed the lunchtime routine on Beacon Unit. The atmosphere was very calm and relaxed and people who required support were being cared for by staff in a relaxed and unhurried manner. People seated in the dining room were served their meals at the same time and were served good sized portions. We saw that people were able to make choices about what they wanted to eat and could have something different if they did not like the meal stated on the menu. Cold drinks were available to everyone to have with their meal.

People we spoke to in all three units told us they enjoyed their meals and that they received plenty to eat and drink. One person commented that food portions can sometimes be too large and this can sometimes put them off their meal.

Since our last visit to the home a programme of planned refurbishment had taken place. This had included improvements to communal areas and people�s bedrooms. We were told that work was due to be completed at the end of the month.

Meetings for people living in the home and their relatives were taking place each month to give them updates on progress with this work and provide an opportunity for them to give their views.

People we spoke to were pleased with the changes. One person told us they were happy with the changes to their room and the fact that it had been done fairly quickly. They said they moved out of their room to a different one for one week while work was completed. They had been able to choose the carpets and curtains for the room and the colour scheme.

Staff spoke positively about the refurbishment and the changes that had been made. One staff member said, �The refurbishment has been good. It really makes me happy. Residents are happy. I can see it even in those who are not able to communicate�. They highlighted the fact that people had been able to personalise their rooms and that it was also a much better environment for staff to work in.

One area that was not subject to refurbishment was the hairdressing unit on Beacon unit. When we looked in this room we saw that it appeared worn and tired in appearance and was being used as a storage room for cleaning and other equipment and for the electrical charging of battery packs for moving and handling equipment.

When we visited the home last time we found that not all of the areas we saw were clean, some equipment was not clean, and not all laundry staff had received training on infection control.

When we visited this time although refurbishment work was being carried out most of the areas we saw were clean. We looked at some of the equipment used in the home. Most of the equipment we saw was clean and fit for purpose but three of the six commodes we looked at (Beacon and Midsummer units) were not clean on the underside of the frame with brown staining apparent.

Following our last visit to the home in June 2011 we received concerns about staffing levels on Beacon unit. When we visited this time we spoke with some staff who worked on Beacon unit. They told us that things had improved since our visit and that they felt there were normally sufficient staff on duty. They said that they had a more established staff team and staff were working well together.

On the day of our visit we observed staff on the unit caring for people in a calm and unhurried manner and call bells were responded to promptly.

When we spoke to people living on Beacon unit one of them told us that in their opinion there were not always enough staff especially after lunchtime and at bedtime. They said that sometimes staff can be slow at answering bells. When they call for assistance staff respond and say they will come back and sometimes take a long time to do so.

Another person said they don�t generally have to use the call bell for help but when they do staff respond promptly and that in their opinion staffing levels are sufficient most of the time.

One person spoke about the accessibility of call bells in the lounge area and commented that staff had told them to call out for help when needed. They told us they were reluctant to do this as they felt it was inappropriate to shout out in front of other people who may be in the lounge.

Inspection carried out on 13 May 2011

During an inspection in response to concerns

The people who we spoke to liked staff, felt safe and well cared for but, at times, had difficulty getting help in a timely way. Feedback from relatives of people who used the service was mixed. Many people spoke warmly of the responsiveness of the staff. However, there had been some complaints about declining levels of care and low staff numbers in Beacon unit in 2010.

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