Premier Court Care Home

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

At the last inspection of this service the provider had failed to ensure people were protected from the risk of harm. At this inspection we found that improvements had been made. Regular checks were made to help ensure staff worked in accordance with training and health and safety guidance. Systems in place to promote people’s safety and wellbeing included checking pressure mattress settings were correct, reporting and investigating of unexplained injuries, oxygen safety and choking risks.

The provider’s quality monitoring systems were not always being effectively used at Premier Court Care Home to drive forward improvements in areas such as environment, staff feedback and some aspects of care provision. Concerns raised by staff in a 2020 survey had not been addressed, shortfalls in the environment had not been escalated for action.

The service has experienced instability at manager level for the past two years. This has not had a positive effect on the staff team who feel their confidence and trust in the support provided has declined. The staff team report low morale.

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 appeared safe and contented living at Premier Court Care Home. There were enough staff, safely recruited, to ensure people’s needs were met in a timely way. People and relatives praised staff for being kind and caring. Pleasant and appropriate interactions were observed between staff and people.

Staff clearly described how they could report any concerns internally to the management team and externally to local safeguarding authorities. Staff were supported through regular training, supervision and appraisals to provide safe care. Their skills and knowledge were regularly reviewed through competency assessments carried out by the nursing staff

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 09 November 2019) and there was a breach 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 enough improvement had been made and the provider was no longer in breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 October 2019. A breach of legal requirements was 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.

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 Safe and Well-led which contain those 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.

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 remained Requires Improvement. 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 Premier Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified a breach in relation to quality monitoring and management of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Premier Court Care Home is a purpose-built residential care home providing personal and nursing care to 37 people at the time of the inspection. The service can support up to 59 people.

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

People were happy with the care and support they received. Staff were friendly and attentive to people’s needs. People told us there were enough staff to meet people’s needs. Staff were trained and felt supported.

People felt safe and staff were aware of how to promote people’s safety. Regular checks were in place to ensure staff worked in accordance with training and health and safety guidance adhered to. However, some elements and assessments for promoting people’s safety were not in place and this had not been identified through the quality assurance systems. For example, checking pressure mattress settings were correct, reporting and investigating of unexplained injuries, oxygen safety and choking risks. Following the inspection, the manager advised us of action taken to ensure people had the appropriate assessments in place.

There were governance systems in place and these were used effectively in some cases. However, these had not identified or addressed the issues we found at this inspection. Feedback about the previous registered manager, now in the role of regional support manager but still covering the home, and management team was positive. There was an open culture in the home and an expectation that people were supported in a person-centred way. Staff were clear about their roles and the management team engaged with the team and other agencies.

The environment was pleasant with plenty of communal space for people to enjoy, however, this was not used by many people as they were nursed in bed. People enjoyed the activities that were provided, however staff told us that they would like more time to support people in their rooms with activities. Relatives also told us people in their rooms needed more time for stimulation.

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. However, when people did not understand risks, further development was needed in regard to best interest decisions.

People were involved in planning their care, along with their relatives. People had end of life care plans, but these needed further developing to ensure they were in place when needed. Complaints were responded to appropriately and people felt confident to make a complaint if needed. Feedback was sought through meetings, which had recently commenced, and surveys.

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

The last rating for this service was Good (published 27 April 2017). At this inspection the service has deteriorated to Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We have asked the provider to send us an action plan to tell us how they will address the issues. 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.

At the last inspection in November 2015 the service was rated Good. At this inspection we found the service remained Good.

People told us they felt safe living in the home. Risks to people’s health and wellbeing were appropriately planned for and managed. Robust recruitment processes were followed. People told us there were enough competent staff to provide them with support when they needed it.

Staff had received appropriate training, support and development to carry out their role effectively.

People received appropriate support to maintain healthy nutrition and hydration. The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). People were supported to make choices to have maximum control of their lives and staff supported them in the least restrictive way possible.

People and their relatives told us and our observations confirmed that people were treated with warmth and kindness by staff who respected their privacy and upheld their dignity.

People were given the opportunity to feedback on the service and their views were acted on. People received personalised care that met their individual needs and were given appropriate support and encouragement to access meaningful activities. People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

The management team worked hard to create an open, transparent and inclusive ethos within the service. People, staff and external health professionals were invited to take part in discussions around shaping the future of the service. There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

Premier Court Residential and Nursing Home provides accommodation for up to 59 older people who require nursing care and may also live with dementia. At the time of our inspection 45 people lived at the home.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Mental Capacity Act (2005) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. Where they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working in line with the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. Some people who used the service were able to make their own decisions and those who were unable to do so had their capacity assessed. DoLS applications for people who required bed rails to reduce the risk of them falling from bed were pending an outcome. Staff members were not all clear of their role in relation to MCA and DoLS and the registered manager had arranged for further training to improve their understanding.

When we last inspected Premier Court Residential and Nursing Home in June 2015 we found that the manager had addressed shortfalls with medicines and care planning that we had identified in January 2015. The service was meeting the required standards at that time.

People and their relatives told us that they felt people were safe living at Premier Court Nursing and Residential Home. The manager and staff team demonstrated a clear knowledge of safeguarding matters. Risks to people`s health and well-being were identified and plans developed to mitigate the level of risk. The registered manager operated safe recruitment practices and records showed that the necessary checks had been undertaken before staff began to work at the home. There were suitable arrangements for the safe storage, management and disposal of people’s medicines.

People received their care from a staff team who felt supported by the management team. The staff had the basic core skills and knowledge necessary to provide people with safe and effective care and support. People enjoyed the food provided and received support to eat and drink sufficient quantities. People’s health needs were well catered for because appropriate referrals were made to health professionals when needed.

Staff were calm and gentle in their approach towards people and were knowledgeable about individual’s needs and preferences. Relatives and friends of people who used the service were encouraged to visit at any time and people’s privacy was promoted.

People’s care plans were sufficiently detailed to be able to guide staff to provide their basic care needs. People had opportunities for activity and stimulation in the home. Relatives and people who used the service told us that they would be confident to raise any concerns with the management team. The provider had made arrangements to facilitate feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided.

There was an open culture in the home and relatives and staff were comfortable to speak with the manager if they had a concern. The provider and manager had arrangements in place to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

We saw that care plans had been regularly reviewed and updated where necessary. However we also found that there were a number of instances where people had been kept waiting in excess of 10 minutes when seeking assistance from staff.

At our previous visit to the service in October 2012 we found that the dining room was in need of refurbishment. At this visit we found the facility to be bright, fresh and a pleasant place to dine. We also observed that people who needed assistance to eat were supported in a sensitive manner and visitors were encouraged to offer people support.

During our visit in June 2013 we saw that a programme of refurbishment had taken place creating a clean, fresh and comfortable place for people to live in. We also noted that the provider had taken action to reduce the risk of legionella.

We found that people's records were stored securely and confidentially.

People's care records were not always dated, signed or stored securely.

We observed that staff showed respect to people using the service. One person with whom we spoke said, "Staff are respectful and speak nicely to people, there is no animosity."

People using the service said they liked the food. One person told us, "There is a good variety, enough of it and it is well cooked." We saw that people were given the right amount of help to eat their meals.

The environment was tired and in need of refurbishment. Work had started to improve the environment however there were no risk assessments undertaken to ensure the safety of the people living in the home whilst the refurbishment work was undertaken.