Archived: Curzon House

We found the following examples of good practice.

• The service had procedures and protocols in place which ensured people were admitted into the service, and people could visit the service, safely in accordance with national guidance.

• People and their relatives were supported to understand the isolation processes and restrictive practices. The service helped to alleviate them feeling lonely by providing access to supervised visiting and video calls with friends and loved ones. There was dedicated support time from their assigned staff member.

• Staff were supported in isolation/sickness absence by the provider. Staff support and wellbeing was considered and enhanced during the pandemic.

• Personal protective equipment (PPE) was widely available and used correctly and there was an extensive testing program in place for staff, residents and relatives.

• The home was clean and hygienic throughout. Areas in the home had been redesigned to enable good social distancing.

• Staff were trained in infection prevention and control (IPC) and had frequent refresher training and guidance in COVID-19 guidelines. They had links with the local community trust IPC team for guidance and support.

• There was an IPC policy and procedures in place, supported by local and national guidance specific to the pandemic

• Staff were responsible, and were cautious of their behaviours inside and outside of work, in order to minimise risks to colleagues and people living in the home.

Curzon House 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. Curzon House accommodates 35 people in one adapted building. At the time of our visit, 8 people were living at Curzon House either permanently or for respite care.

The service had a manager who was applying to become registered with us. 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. The manager was present during the days of our visit.

We previously carried out an unannounced comprehensive inspection of this service on 12 and 13 February 2018. At that inspection we rated the service as ‘requires improvement’ as we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

On this visit we found that all breaches in regulations had been addressed.

Our last visit found that the service was not always safe and this had resulted in a breach of Regulation 12 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was because risk assessments relating to falls were not always in place, medication recording systems were not accurate and training in supporting those who used pressure mattresses was not provided.

This visit found that falls risk assessments were in place and were reviewed regularly. Falls that people had experienced had been kept at a minimum, were analysed to determine patterns or trends were unavoidable and did not adversely put people at risk of harm.

This visit found that medication recording had been improved. Where medication errors had occurred, these had been backed up by auditing systems which were effective and appropriate performance management for staff involved in place.

This visit also found that training in assisting people who required pressure mattresses had been provided with staff having the knowledge and skills to best support people in using this equipment.

Our last visit found that the registered provider had not always worked within the principles of the Mental Capacity Act 2005. This had resulted in a breach of Regulation 11 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had found that restrictive practices were carried out by staff with no reference to people’s best interests or capacity being recorded. This visit found that a process for making best interests about aspects of people’s lives was in place and was working effectively.

On our last visit we found that governance of the service was inadequate. This had resulted in a breach of Regulation 17 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because auditing of care plans and medication systems had not picked up the shortcoming in medication recording or the lack of a person-centred approach to care plans. We had also found that oversight from the registered provider had not been effective.

This visit found that audits were in place with an ongoing commentary on how any issues were to be addressed. We found that a representative of the registered provider had conducted a detailed visit covering all aspects of the support provided to people who used the service. In turn actions identified were addressed or ongoing.

The premises were clean, hygienic and well maintained. All equipment used had been serviced regularly to ensure that people could use it safely.

Staff were aware of the types of abuse that could occur and how to report it. They were aware of how to raise concerns with outside agencies.

Medication storage was well managed. Staff who had come to work at the service had their suitability to support vulnerable people checked before they came to work there.

Risk assessments were up to date. These related to the risks faced by people in their daily lives as well as from the general environment.

The nutritional people needs of people were met. People were provided with a choice of food at mealtimes and were provided with drinks during the day. Any risks to peoples nutrition were acknowledged and acted upon.

Staff were provided with the training they required to perform their role. They received supervision so that they could be aware of their strengths or areas for development.

The health needs of people were responded to ensure that they maintained their health.

The premises were designed to meet people’s needs and provided signage and decoration to assist those living with dementia.

Staff adopted a kind and friendly approach with people. People were treated with dignity and respect. Staff promoted people’s privacy and dignity at all times.

Care plans were detailed and person centred and subject to effective audits. Information in care plans meant that staff could meet people’s needs in response to changes in people’s physical or mental health.

An effective complaints procedure was in place.

People were invited to participate in activities which were person centred and varied.

The registered provider displayed the service’s ratings from the our last inspection.

The registered provider always let us know about adverse incidents that affected people who used the service.

We previously inspected Curzon House on the 21st and 24th August 2017. The service was rated Inadequate overall and placed into special measures. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 9, 11, 12, 17 and18. This meant the registered provider had failed to ensure people were fully protected from the risk of unsafe care, their capacity to consent was not assessed, care was not personalised and there was ineffective oversight of the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches.

At this inspection we identified repeated breaches of the regulations in relation to assessing and mitigating risks to people’s health and wellbeing, the safe management of medicines, records and good governance.

We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.

Curzon House 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. Curzon House accommodates 35 people in one adapted building. At the time of our visit, 11 people were living at Curzon House either permanently or for respite care.

There was no registered manager. 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. The service had appointed a new manager and they took up this post in November 2017.

On our previous visit adequate risk assessments were not in place. This visit found that whilst some improvements had been made risk assessments required further developments to be made. They did not always clearly identify all risks to people supported and actions staff needed to take in order to minimise the risk of harm.

Our last visit we found that care and records were not person centred. Although improvements in day to day care and support were evidenced, records were still not personalised. Consideration was paid to the proposed introduction of an electronic care planning system that was to be introduced during the weeks following this visit. We were able to look at the new system and found how this potentially would make care plans more person specific. However, in the meantime and before this system was introduced, care plans remained vague and not person centred. Care plan audits had not been undertaken as it was stated that the present care plans were not appropriate.

While people received medical assistance from other agencies such as GPs and hospitals; the registered provider had not always taken after-care into account through care planning. This had been clear through the lack of care planning in health conditions following hospital stays.

Staff demonstrated some understanding of the principles of the Mental Capacity Act 2005 and had received re-training in this. We found that while this training had been provided; it had not been fully embedded into care practice. There was a lack of a best interest decision making into aspects of a person’s care such as covert medication or other restrictive practices to protect people from the risk of harm. This meant that people were not fully consented about the care and support they received.

People received regular opportunities to access food and drink during our visit. However, records reflecting people’s intake of food and fluids were not robust. We found examples of records being incomplete and not including a daily target for the intake of fluids. The amounts of fluids taken were vague and imprecise. Where the nutrition of people had to be carefully monitored; no reference was made to portion size.

People had their weight monitored yet records noted that wide discrepancies in weight had occurred. Records indicated that people were weighed at different times of the day. The manager told us that the weighing scales had been identified as inaccurate and had been replaced.

The recording of medicines was not always safe. Some medication records were handwritten and transcribed from other records. These were inaccurate and had not been double checked. This meant that people were at risk of being given the incorrect medication or the wrong dosage at the wrong time.

PRN medication (that is medication given when needed) had been prescribed to people but care plans were not in place for the staff team to know when to offer these. This meant that people were at risk of not receiving medication to assist their health. The storage and disposal of medication was safe.

Some people had been provided with pressure mattresses to ensure their skin integrity was maintained. However, staff had not received training in their use. We found that the air pressure within the mattresses was incorrectly set meaning that there was a risk of further skin damage to the person using it.

Audits undertaken at the service had had not picked up on issues such as medication, risk assessments and nutritional concerns identified at this visit. The current care planning system was not person centred but had not been audited as it the manager felt they were not ‘fit for purpose’. The new care planning system had not yet been introduced in line with expected timescales. This meant that oversight of the care planning system was not in place and did not ensure that people received safe, effective and responsive care.

The manager had recognised that the staff team required training in a number of key aspects of practice. The staff team had all been enrolled on a programme of training linked to the Care Certificate which is designed to reinforce good practice and values of care. This had been welcomed by the staff team. Our visit found that although staff had undertaken training, this had not yet becoming fully embedded in care practice. Staff confirmed that they received regular supervision and appraisals to help them reflect on their developmental needs.

This inspection found that improvements had been made in respect of the systems that were used to ensure safe care. Assistive technology and managerial oversight had minimised accidents resulting in serious harm with the result that these had been drastically cut. The new manager had sought to have direct control over the auditing process of analysing reasons for accidents.

Staff understood the types of abuse that could occur and had received appropriate training in this. Staff were clear about how to raise concerns and report them. Safeguarding protocols were in place to ensure that these could be investigated appropriately. Staff were also aware of external agencies they could report care concerns to.

The premises were clean and hygienic. All equipment such as hoists had been serviced to the required frequency and the building was well maintained.

People were able to move through the building independently. The building included signs to orientate people and was decorated in contrasting colours to assist those living with dementia.

Improvements had been made in respect of the service adopting a caring approach to the people they supported. Previously, the registered provider’s response to dealing with people and their families when they had experienced serious injuries had not been timely. This had now been addressed. There was evidence that staff adopted a caring and respectful level of care to the people they supported. People told us that they felt well looked after and had their best interests at heart. One person outlined the personal consideration that staff had made to them moving into long term residential care and this had been greatly appreciated by the person.

Support was provided to people in a respectful and dignified manner. People were supported in an unhurried and caring way. Staff were able to give us practical examples of how they would uphold the privacy and dignity of people. Improvements had been made in the way staff assisted those who required assistance with eating. Previously this had come across as a task orientated process yet this visit found that real attention had been given to the person being supported. Responsiveness to concerns raised by relatives had also improved.

Compliments received by the service were put on display for staff to refer to

Our last visit found that activities were not provided to people. This visit found that this had been reinstated with the activities co-ordinator playing a major role in the care and support of people through the organising of activities within the service and in the wider community. Activities we observed were meaningful and gave people the opportunity to mix with others and recall their memories about specific events in their lives.

Our last inspection found that there was a lack of oversight both at registered provider and registered manager’s level. This had led to several breaches of regulations being identified which meant that people were at risk of receiving poor care. This visit found that the new manager had sought to address the deficiencies by devising and action plan and seeking to bring some systems such as auditing of accidents under their scope. The registered provider gave us evidence of how progress to address issues had been discussed and actioned at provider level.

A new manager had come to work at the service since our last inspection. Staff felt that the manager was approachable and

We carried out an unannounced inspection of Curzon House on the 14th and 21st of August 2017 with a further announced visit on the 24th August 2017.

This visit took place in response to concerns that we had received following a serious incident that had occurred in the service. These concerned had focussed on the safety of people who used the service and the management of falls.

Our last inspection took place in May 2017 and the service was rated as good.

Curzon House is a residential care home which can accommodate up to 35 older adults who need residential care and who may also be living with dementia. Curzon House is predominately a short stay service however some people live there permanently. The home is owned by VIVO Care Choices Limited. All bedrooms have en-suite facilities.

On the days of our inspection twenty people were using the service at Curzon House. This included seven people who received permanent care with others receiving respite care.

The service had a manager who was registered with us in August 2017. 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.

During this visit, we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to person centred care, safe care and treatment, consent, and good governance.

The risks faced by people in respect of nutrition and susceptibility of developing pressure ulcers were not taken into account. No risk assessments had been devised by the registered provider in respect of these risks. This had subsequently been addressed by the registered provider.

Risk assessments in relation to falls were lacking in detail and did not contain the information needed by staff to manage falls and prevent future re-occurrence. The registered provider informed us subsequent to the inspection that a new admission protocol had been introduced making specific reference to the high risk of falls that people faced.

People who did not have the capacity to use call alarms to summon help were reliant on staff physically checking them at night. The capacity to use these alarms had not been determined by the registered provider. Records indicated that gaps had occurred in the frequency of these checks.

Assistive technology designed to assist staff to monitor people at night in order to ensure their safety had not been introduced at the time of our visit but we were informed subsequent to the inspection that this was now in place.

Changes to the body structure of people in respect of minor marks such as scratches had only been partially investigated which meant that people were at risk.

The consent of people who lacked capacity to make decisions was not gained.

The principles of the Mental Capacity Act 2005 had not been fully implemented by the registered provider. An overview of a person’s capacity to make decisions was included at the assessment stage prior to admission but this only translated into whether a deprivation of liberty order was needed. Care plans did not include any details on how the principles of the Act could be used to gain consent from people or to make decisions in their best interest.

The registered provider informed us that improvements in Mental Capacity Act training and the gaining of consent had been subsequently introduced.

People who used the service and their families told us that they considered the staff team and manager to be caring. Staff gave us practical examples of how they promoted the privacy and dignity of people. This was confirmed through our observations. The deficiencies identified in this report meant that the service was not consistently caring.

Care plans were not person centred. There was no evidence that people had been involved in their care plan. There was no evidence that staff had been provided with the information they needed to best assist people in making decisions in their daily lives when their capacity was limited.

The registered provider informed us subsequent to our visit that a review of the care planning approach had been made.

People who used the service were at risk of social isolation. There was no structured activities programme in place and therefore people did not receive appropriate levels of stimulation. The registered manager had identified the need to make arrangement for activities but had not yet implemented this.

The service was not well led. The registered provider had failed to identify significant risks to people’s safety. Audits had not picked up issues in respect of incomplete or missing risk assessments. The complete application of the Mental Capacity Act had not been applied to those who were unable to make decisions of themselves. The lack of person centred care plans had not been identified and no analysis of accidents had been made to prevent future reoccurrence or to establish patterns/trends at the time of our visit. The registered provider subsequently informed us of a new system to identify any patterns. The registered provider also informed us subsequent to the inspection that an improvement plan was being implemented.

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An issue in respect of medication and health support for those receiving respite care had been addressed. Arrangements in medication had meant that one person had not received prescribed medication. This had been identified and was now addressed. Medication systems were safely managed.

The premises were clean and hygienic. All equipment within the service was regularly serviced and checks made on the environment to ensure that it met the needs of people.

Staff received training and supervision appropriate for their role. Supervision included observation of care practice such as medication administration and response to specific individuals’ needs.

Staff adopted a caring and patient approach in their support of people. Interactions were friendly and person centred.

A complaints procedure was in place. This provided people with the information they needed to make a complaint and complaints were investigated appropriately.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

On the day of this inspection there were 22 people staying at Curzon House.

Our last visit on 29 October and 3 November 2014 identified that improvement was needed in relation to staff training and awareness of the Mental Capacity Act 2005 and staff supervision. Because of this, we rated the effective domain as ‘requires improvement’. Despite this the rating for the service had been assessed as good overall. This inspection identified that the required improvements had been made. The service met all the relevant fundamental standards and the rating remains Good.

People and relatives told us that the staff were kind and showed compassion and caring in their approach. They said they were well supported by the staff team.

People and relatives told us that they had no concerns or complaints about the service. They were aware of and had access to the registered provider’s complaints policy and would speak to staff if they had any concerns.

Care plans were well documented and held good information about the individual person. Risk assessments were in place as needed and were individually tailored to each person’s needs. All documentation was up to date. Medication was administered safely.

The interim manager understood the requirements of the Mental Capacity Act 2005 (MCA 2005) and the Deprivation of Liberty Safeguards (DoLS). This meant that they were working within the law to support people who may lack capacity to make their own decisions.

The interim manager had systems in place to protect people from harm and to record safeguarding concerns, accidents and incidents and to take appropriate action when needed.

Recruitment of staff was robust. Appropriate checks had been undertaken and people could be confident that staff were suitable to be employed at the home. Our observations and discussions with people who lived and stayed at the home and the staff team confirmed sufficient staff were on duty.

Staff were supported in their roles. Supervision, training, daily handovers and staff meetings were held on a regular basis. This meant that staff had the knowledge and training to enable them to fulfil their roles.

The environment was well maintained with good décor and was clean.

The registered manager used a range of methods to assess, monitor and improve the service. These included regular audits of the service and staff and service user meetings to seek the views of people about the quality of care being provided. A wide range of compliments had been received regarding the service.

Further information is in the detailed findings below.