Catherine Court

Catherine Court is a nursing home providing personal and nursing care to 35 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

Catherine Court accommodates people across two floors with each floor having their own communal sitting, dining and small kitchen areas. People’s bedrooms have en-suite facilities and each floor has a communal larger shower.

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

People told us they were happy with their care. They commented “I am happy here; it feels like home to me. The girls are wonderful, friendly, lovely people.” and “I am happy, they treat you natural, it is brilliant, the staff are very kind.”

Relatives found it difficult to comment on the care provided due to the restrictions on visiting imposed over the year, due to the Covid-19 pandemic. However, they felt their family member received safe care and they were generally happy with the care provided. They commented “Staff are fantastic, brilliant and doing a very difficult job. The home has had three outbreaks of the virus and everyone has recovered...that must say something of their skills.”

Relatives believed there had been a high turnover of staff at the service and this impacted on continuity of care. A relative commented “Last year when Covid-19 struck staff left and the home had to replace them...turn over has been very high as it’s a difficult job. Agency staff have been used a great deal, both during the day and night, so very little continuity.’

Whilst relatives had received some communication from the provider and the service during the pandemic, they felt communication with the service had been poor. They confirmed the interim manager had recently held a zoom meeting with relatives to update them on changes within the service, including arrangements for visiting.

We received mixed feedback on the quality of food and activities provided. This was shared with the provider to follow up and address.

We found risks to people were identified but not always managed and some practices around infection control needed to improve to mitigate the risks of cross infection.

Aspects of the service were audited and had picked up some of the issues we identified. Other issues in relation to working to infection control guidance had not been picked up and some records relating to people’s care and the running of the service were not suitably maintained and accurate.

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; however, people’s records did not always support this practice

Systems were in place to safeguard people from abuse. However, processes needed to improve to promote learning from accidents, incidents, safeguarding and complaints to ensure trends were picked up and addressed to safeguard people and prevent reoccurrence.

Safe medicine practices were promoted, and sufficient staff were provided to meet people’s needs. Staff were safely recruited, and systems were in place to ensure staff were suitably inducted and trained for their roles. The interim manager was reviewing staff inductions, training and supervisions to ensure gaps in knowledge were addressed and staff were supported.

The registered manager had recently left, and an interim manager was managing the service. until a new manager was appointed. The interim manager was committed to improving the service, communication, developing staff and supporting the team in their roles to provide positive outcomes for people. Staff were complimentary of the interim manager and told us he was accessible, approachable, encouraging and supportive. They felt listened to and felt issues raised would be addressed.

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 good (published 22 November 2018)

Why we inspected

The inspection was prompted in part due to trends in notifications around poor moving and handling practices, increase in safeguardings and concerns about the service, which included concerns around people’s nutritional needs not being met. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

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 overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Catherine 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.

Catherine Court accommodates 60 people across two floors each of which have separate adapted facilities. One of the floors specialises in providing care to people living with dementia. The other floor supports people with nursing needs. At the time of our inspection there were 50 people using the service.

The service is required to have a registered manager to manage the service. At the time of our inspection 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 our last inspection in 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated concerns.

People and relatives gave positive feedback about the caring nature of staff, comments included “Yes I feel [my relative] is safe and well looked after”, “The staff are very approachable”, I am looked after here”. People told us staff treated them respectfully and in a caring manner.

People told us they felt safe living at Catherine Court and we saw that appropriate referrals were made to the local authority when required.

Staff we spoke with understood the importance of treating people as individuals, irrespective of their preferred lifestyle or physical and mental abilities. During our observations of one person’s support we saw the service respected their chosen lifestyle. The service had policies and procedures in place to guide staff.

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.

Care needs were assessed and reviewed at regular intervals.

Robust recruitment procedures meant that only suitable staff were appointed. People were supported by suitable numbers of staff who had received training to enable them to provide high quality care.

Medicines were mainly managed effectively. Where issues were raised appropriate intervention was carried out.

People told us there was a choice of meals and said they had plenty to eat of good quality food. Staff knew about people’s dietary needs and preferences. Snacks and drinks were available throughout the day.

Activities and social events were available for people to avoid social isolation. Relatives and friends could visit without restriction.

There was a procedure in place for anyone to make comments or raise any issues. Relatives and people told us they knew how to make a complaint if the need arose.

The provider had systems in place to ensure the service offered quality care and support. Where issues were identified the provider took action to enable improvements to be made.

The provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

People were able to attend external healthcare visits to ensure their healthcare needs were met.

This inspection was undertaken on the 1 & 2 March 2016 and was unannounced.

Catherine Court had a registered manager in place. 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.

Catherine Court is a purpose built nursing home divided over two floors. People were supported to maintain their physical and emotional well-being through both care staff and nursing staff. Clear plans were in place on how people wished to be supported and associated risks were assessed and managed.

People were supported by staff who were kind, caring and respectful. People and relatives we spoke with were complimentary about the staff who worked at Catherine Court and how they were looked after. We made good observations of how people were supported in a person centred way.

A range of activities were provided to people living at Catherine Court. People and relatives were involved in the running of the service including areas such as regular reviews of care needs and activities and food committees.

Staff were supported and developed through effective supervisions and training. Management undertook regular auditing to identify where improvements could be made to the service and the way people were cared for. We found the management team were actively striving to improve the service.

People were supported by staff who knew them well to remain safe and well. Recruitment checks were in place to ensure staff suitability to work with people living at Catherine Court. People were supported to maintain their health through good management of medicines.

The provider sent us an action plan which outlined how they intended to become compliant.

We returned to the service on the 8 September 2014 to check if improvements had been made.

Below is a summary of what we found. The summary describes what we observed and the records we looked at .

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were protected from the risk of potential neglect as the provider had addressed our previous concerns around people’s call bells. We found people were individually assessed and risk assessed where it was deemed they could not use their call bell to call for attention. We found where people lacked capacity to use their call bell, the provider worked within the Mental Capacity Act 2005 to ensure alternative arrangements were in people’s best interests.

This meant the service was safe.

Is the service effective?

We found the provider had addressed concerns raised during our visits on the 27 May 2014. The provider now undertook daily ‘floor walks’ to observe staff practice. We found an effective complaints system was now in place to ensure people’s complaints and concerns were responded to appropriately. Daily call bell checks were now undertaken by the maintenance manager to ensure people's call bells were working effectively.

This meant the service was effective.

What people told us and what we found

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? During the time of this visit, the named manager was not in post. We saw evidence a new manager in post had made an application to the Commission.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were protected against the risk of harm in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Where people were assessed as lacking capacity, appropriate procedures were followed to ensure arrangements were in people’s best interests and in line with the correct legal framework.

During our observations we found examples of poor practice relating to people’s care. We found people were unable to access their call bells as they were placed out of reach. We were not provided with a reasonable explanation as to why this was. Care plans and risk assessments did not clearly outline why people’s call bells were out of reach. We found one person’s call bell had not been reported as not working for a period of seven days. We observed poor practice at lunch time where staff had inappropriately handled people using the service. We observed a hazardous substances cupboard left unlocked with the keys in the door for over an hour.

Is the service effective?

We spoke with the manager who was in the process of implementing changes within the service to improve the quality and care. We found although regular audits and checks were undertaken within the service, this did not feed down into practice which was observed during our visit. We found complaints were not always responded to appropriately and in line with the provider’s policy and people were not always sure who they could speak with in regards to concerns or complaints. We found there to be adequate numbers of staff.

Is the service caring?

One person told us “It’s very nice here.” We saw staff actively engaged with people who used the service and provided a range of activities for people to participate in. During the lunch period we found a lack of person centred practice. We regularly saw people were in their rooms with no one to speak to. One person told us “It’s so lovely to have someone to talk to.” We spoke with one person who was very upset about their breakfast. They told us they wanted something warm. We asked a staff member if they could provide them with a warm breakfast and if they were offered a choice. The staff member told us “Tthey always have cornflakes”. This did not demonstrate person centred practice. We observed the manager entering people’s rooms without knocking. This did not preserve people’s dignity or respect.

Is the service responsive?

We saw one person was assisted to attend regular hospital appointments. Arrangements were in place to deal with foreseeable emergencies. During observations we found people’s call bells were placed out of reach. This meant people could not be sure their needs would be met in a responsive and timely manner as they had no alternative to gain staff member’s attention. We were told observations were undertaken. We could find no evidence of observations being undertaken or how often these were being undertaken.

Is the service well-led?

Regular quality monitoring visits where undertaken by the provider which fed into audits completed by management. We were advised annual surveys were sent to service users and relatives to gain feedback on the service. Although audits were undertaken regularly, we could see that checks and audits did not always reflect front line practice which we observed during our visit.

Some relatives told us of concerns they had had, and how they had been addressed. We heard that one person had been offered the wrong medication. The home showed us the steps they had put in place to ensure this could not happen again. We were told that the home had had a recent change of manager and that "Things seem to be more organised now."

We observed many individual episodes of care throughout our two day visit. We saw that the care given on the dementia unit was of a high standard, with the staff taking time to ensure the most effective care was delivered. We also spent time on the nursing floor. The care given there was generally of a good standard, although we observed some variability of practice.

The home was clean with good infection control practices in place. The standard of the food was very high, and we heard many positive comments about it.

The medication policy was now robust, and carried out appropriately.

Staff recruitment and training policies ensured that appropriate staff were in post, and they were well-trained for their posts.

The new manager used regular quality checks to ensure the safe running of the home.