Canning Court Care Home

Canning Court is a purpose built home which is registered to provide residential and nursing care for up to 64 older people living with dementia. The home has two floors, a ground floor unit called Hamlet, and the first floor unit called Gower. Most people who lived at Canning Court had limited mobility and/or a diagnosis of dementia. At the time of our inspection there were 39 people living at Canning Court.

People's experience of using this service

Canning Court had a new management team who were motivated to provide high standards of care to ensure positive outcomes for people, their relatives and the staff team.

The provider had streamlined their systems and processes to audit and check on the safety and quality of the service. Audits and checks were not filed until any actions identified had been signed off as completed. The provider monitored the service improvement plan to ensure progress was being made.

There were enough staff to provide safe and effective care. New admissions to the home were only accepted if the registered manager was confident there were enough staff with the required skills, knowledge and experience to effectively meet people’s assessed needs. Staff received training and support to meet their role and responsibilities.

People’s individual risks were considered and safely managed. Staff were clear about the importance of keeping people safe and protected and reporting any concerns to senior staff or managers. The home was clean and tidy, and the provider was following up to date guidance to reduce the risks of any infections spreading.

Staff monitored people’s health and wellbeing and referrals were made to other health and care professionals when needed. People were supported to have enough to eat and drink and staff were aware of people’s individual likes and dislikes, allergies and other dietary requirements. Staff followed systems and processes to administer, record and store medicines safely and records showed people received their medicines as prescribed.

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 had developed friendly relationships with staff and made many of their own decisions about their daily routines which supported their independence. Staff promoted people’s privacy and dignity by taking time to listen to them and supporting high standards of personal care. People’s engagement with activities was reviewed to ensure they remained relevant and continued to have a positive impact on people's wellbeing.

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 27 January 2020) and there were 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 undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Canning Court is a purpose built home which is registered to provide residential and nursing care for up to 64 older people living with dementia. The home has two floors, a ground floor unit called Hamlet, and the first floor unit called Gower. Most people who lived at Canning Court had limited mobility and/or a diagnosis of dementia. At the time of our inspection there were 38 people living at Canning Court.

People’s experience of using this service

The provider had systems and processes to audit and check on the safety and quality of the service. However, the provider’s quality assurance systems had not been implemented effectively. Audits had been completed, but actions identified had not been followed up. There had been significant changes in the management of the home in the last 12 months which had impacted on the quality of care provided.

There were not always enough staff with the knowledge of people’s individual needs to provide effective and responsive care. Agency staff did not always have the support of experienced permanent staff who knew people well. Risks to people’s health and wellbeing were identified but risks were not always reviewed following significant events. The provider’s policy for reviewing accidents and incidents to identify trends or patterns had not been followed. People received their medicines in accordance with good practice.

A high turnover of staff meant the provider was constantly training new staff who needed time to gain the skills to provide effective care. The provider had recently introduced a more comprehensive induction to support new staff in their role. People’s nutrition and hydration needs were met and they had access to other healthcare professionals to support their healthcare needs.

Overall, 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 used different methods to support people to make choices.

People told us staff were caring and kind and worked hard to meet their needs. Staff were thoughtful when they knew what was important to people. However, a lack of familiar faces meant people regularly received care from staff who did not know them well. Improvements were planned to ensure people did not become socially isolated and everybody had the opportunity to engage in meaningful activities.

A new manager had very recently been appointed and people, relatives and staff had already identified some improvements. The new manager had a rigorous approach to quality assurance and risk management. In the short time they had been in post they had reviewed the standards of care within the home and developed a detailed improvement plan. Some actions within the plan had already been achieved. People and relatives had opportunities to feedback their views on the service they received and overall people and relatives were satisfied with the service provided.

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 29 November 2018) and there were two 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 improvement had been made to meet the regulations and the provider was still in breach.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was:

Regulation 17 Regulated Activities Regulations 2014 - Good governance

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

Follow up

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care.

Canning Court is a purpose built home which is registered to provide residential and nursing care for up to 64 older people living with dementia. The home has two floors, a ground floor unit called Hamlet, and the first floor unit called Gower. Most people who lived at Canning Court had limited mobility and/or a diagnosis of dementia. At the time of our inspection there were 51 people living at Canning Court.

Canning Court is a 'care home'. 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.

Canning Court is required to have 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 and associated Regulations about how the service is run. At the time of this inspection, this service did not have a registered manager in post. A new manager had been appointed and had been in post for four months. The new manager was in the process of completing their application for registration with the CQC when we visited.

We previously inspected the service in June 2017 and the rating after that inspection was 'good'. This inspection was prompted following concerns from local commissioners which included information related to people falling, a lack of permanent staff and poor record keeping. During our inspection visit we found there were areas where the provider needed to improve the service. We changed the rating of the service to 'Requires Improvement'. We identified a breach of the regulations and you can see what action we have asked the provider to take at the back of the full version of the report.

On the first day of our inspection visit there were enough staff to keep people safe. However, there were often occasions when staffing levels as identified by the manager based on people’s assessed needs were not maintained, which impacted on the ability of staff to provide safe, responsive care. A lack of clarity around staffing levels meant senior staff were not aware of when they needed to follow the provider’s policies to report low staffing levels in the home.

The provider had systems in place for auditing the service to monitor and identify trends and better respond to risks to people using the service, but these had not always been effective and had not consistently identified risks to people living at the home. The provider was working towards a quality improvement plan in response to the concerns that had been identified.

The provider had taken action to improve the management of identified risks to people’s health and wellbeing. However, people in their bedrooms did not always have access to their call bells which put them at risk.

Staff monitored people’s health and referred them to other healthcare professionals if a need was identified. People received their medicines as prescribed and in accordance with good practice. The home was clean and tidy and staff followed good hygiene and infection control practices.

New staff had an induction into the home, however, the high turnover of staff meant the provider was constantly training new staff who needed time to gain the skills to provide effective care. Staff did not always feel supported but said their opportunity to speak to senior staff had improved recently.

People's consent was sought consistently by staff and the provider had made applications to the local authority for any restrictions that may be a deprivation of a person's liberty.

People were supported to eat and drink enough to maintain their health and staff were aware of those people who had been assessed as having risks around eating and drinking.

Permanent staff knew people well. They knew about their backgrounds and preferences and understood what was important to them. People received care from staff who were kind and caring and respectful and who understood how people’s background and life experiences might impact on their emotions. When staff assisted people, they showed patience and understanding. However, staff felt their responsiveness to people’s physical, social and emotional needs was inconsistent because they did not always have time.

The provider had improved the provision of activities in the home and there was more emphasis on providing meaningful engagement for people on a one to one basis.

The manager was still settling into their new role but felt confident because they had support from the provider to manage the changes needed to address issues and improve standards of care within the home.

Canning Court provides residential and nursing care to older people with dementia. It is a purpose built home which is registered to provide care for 64 people. the home has two floors, a ground floor unit called Hamlet, and the first floor unit called Gower. At the time of our inspection there were 61 people living at 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.

This service was last inspected on 19 and 20 December 2016 and we found three breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. Procedures and processes to keep people safe were not always followed or effectively implemented, the deployment and management of staff did not ensure people who used the service were kept safe at all times and systems or processes were not robust, established and operated effectively to ensure people were consistently provided with a good quality service. We gave the home an overall rating of requires improvement. The provider sent us an action plan, setting out the actions they planned to take to improve the quality of the service. At this inspection we looked to see if the provider had responded to make the required improvements in the standard of care to meet the regulations. We found they had made improvements and they were no longer in breach of the regulations.

Since our previous inspection, the registered manager had recruited additional staff. There were enough suitably skilled and experienced staff on duty to meet people’s care and support needs safely and effectively. Staff felt more confident because the management of shifts had improved.

People felt safe living at Canning Court. The process to report potential safeguarding incidents to ourselves and the local authority safeguarding team had improved. Risks to people’s health and welfare had been assessed and care plans developed to minimise the identified risks. Staff understood how to support people identified as being at risk.

Staff had received training and felt this gave them the skills and knowledge they needed to effectively meet people’s needs. Staff particularly felt they had benefited from training that had given them the opportunity to understand the sensory experiences of a person who lived with dementia.

Staff worked within the principles of the Mental Capacity Act 2005 when supporting people with personal care. They sought people's consent and respected the decisions they made. The registered manager had applied to the supervisory body when it had been assessed that people did not have the capacity to understand the risks associated with any restrictions to their liberty.

People were supported to maintain a balanced diet according to their needs and to enjoy their meals. Staff monitored people’s weight and nutritional intake and referred them to other health professionals if they had any concerns. People were supported to take their prescribed medicines by trained staff.

People were supported by kind and caring staff who demonstrated a commitment to want to care and enhance people’s lives. Staff regularly worked with the same people so they knew them well and understood how they wanted to be cared for.

Care plans were detailed and reviewed regularly to ensure they met people's changing needs. Essential information was handed over between staff shifts so people's needs were met consistently and responsively.

People had opportunities to engage in activities that were of interest to them and improvements had been made in the social engagement with people who were cared for in bed.

There was a clear strategy to formalise leadership within the home. Staff felt more competent in their roles because they had confidence in the management team to provide leadership and support. Staff respected and appreciated the registered manager’s leadership.

Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice. Where issues had been identified, improvement plans were implemented to ensure care was being delivered in accordance with the fundamental standards of care.

Canning Court provides residential and nursing care to older people with dementia. It is a purpose built home which is registered to provide care for 64 people. The home has two floors, a ground floor unit called Hamlet, and the first floor unit called Gower. Most people who lived at Canning Court had limited mobility and all but one of the people had a diagnosis of dementia. At the time of our inspection there were 62 people living at Canning Court, which increased to 63 when another person was admitted on the second day of our inspection visit.

Canning Court is required to have 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 and associated Regulations about how the service is run. At the time of this inspection, this service did not have a registered manager in post. A new manager had been appointed and had been in post for seven months. The new manager was in the process of completing their application for registration with the CQC when we visited.

Whilst people generally felt safe living at Canning Court, some people expressed concern because other people would frequently walk into their bedrooms uninvited. We were told staffing levels were set by the provider based on an assessment of the level of care each person required. However, the assessment tool did not take into account the spacious layout of the home. The deployment and management of staff meant there were times when there were not enough ‘eyes and ears’ to monitor people safely as they walked around the home and interacted with each other.

Staff and the manager knew how to report allegations of abuse and previous safeguarding notifications showed the provider had acted as required. However, we identified occasions when people had been pushed over or hit by others which had not been reported to the local authority or ourselves as potential safeguarding incidents.

Medicines were managed safely and people received their prescribed medicines. Staff were responsive to fluctuations in people’s health needs and people had good access to health care professionals when required.

Staff received an induction and on-going training to carry out their role effectively. The manager had planned further dementia care training to provide staff with further skills and knowledge in this area. Staff told us they had opportunities to talk about their roles within the home at one to one meetings with senior members of staff.

Staff understood the principles of the Mental Capacity Act 2005 and assumed people had capacity to make everyday decisions. Staff sought people’s consent before supporting them. Mental capacity assessments had been completed where it was believed that a person did not have the capacity to consent to a specific decision.

The provider had identified people whose care plans contained some restrictions to their liberty and had submitted the appropriate applications to the authorising authority in accordance with the legislation.

People were treated with kindness and thoughtfulness by staff who knew them well. Staff understood people’s behaviours and attitudes and supported people as individuals which helped manage their anxieties, emotions and behaviours.

Staff employed to organise activities were able to provide opportunities for engagement and stimulation for people, but other staff had little time to respond to people’s social needs as they were busy completing other care tasks. People cared for in bed had little to do to keep them occupied or to stimulate them.

Many of the people who lived at Canning Court, whilst having a diagnosis of dementia, also had complex physical and medical care needs. Records demonstrated the nursing care provided to people was responsive to their needs.

There had been a number of managerial changes within the home which had led to inconsistency in leadership and this had impacted on the quality of care people received. The provider’s audit process had identified their management of the home during this period of instability had not been effective in maintaining the quality of care people received. The new manager had been in post for seven months and improvements in service provision had already been identified. The new manager was aware that staff needed a consistent leadership approach and was committed to ensuring people received high quality, personalised care from equally committed staff. Staff described the new manager as ‘supportive’, ‘approachable’, ‘visible’ and told us morale had improved within the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with three relatives and one visiting professional to obtain their views about Canning Court. We also spoke with the regional manager, the nurse in charge, the cook, three care staff and the administrator.

We observed staff interaction and talked with care staff about how they met the needs of people they supported.

Staff demonstrated a clear understanding of people's needs and engaged with people in a positive manner. People appeared relaxed and happy in the company of the staff and were not hesitant when they approached them.

We saw consent to care had been obtained for people who lived at the home.

Most of the relatives we spoke with told us they were happy with the care at Canning Court.

We looked at the care planning documentation and we found that care plans were very detailed and demonstrated that staff treated each person as an individual based upon their needs.

Staff told us they were supported by the manager and had access to regular training.

We saw that systems were in place to monitor the quality of the service.

Discussions with staff and people's relatives confirmed staffing levels had improved. We were told that care worker recruitment had been successful. The home was continuing to advertise for some trained nursing staff. Staff confirmed they were happy and felt supported by the new manager.

During the inspection we toured the home to ascertain whether the areas identified as requiring development had been actioned. These areas related to the availability of hoist slings, garden maintenance, equipment storage and high environmental temperatures in the kitchen and laundry areas.

We found the garden had been well maintained. Hoist slings had been identified for people requiring them and an order placed for additional slings to allow people to have their own and avoid cross infection. The BUPA regional manager confirmed that improved storage for equipment was being put in place. We saw temperature monitoring of both the kitchen and laundry facilities had taken place. We were told a BUPA senior manager meeting was due to take place to identify the way forward in relation to this issue.