Archived: Courtenay House Care Home

Courtenay House Care Home provides accommodation and personal and nursing care for a maximum of 46 older people, some of whom may be living with dementia. At the time of this inspection, there were 35 people living in the home.

We had previously inspected the service in February 2017 and had identified five regulatory breaches. This inspection identified 14 regulatory breaches, five of which the provider had been in breach of at the February 2017 inspection. These repeat breaches related to safeguarding people from harm, staffing arrangements, person-centred care, the governance of the service and the requirement to report incidents to the Care Quality Commission (CQC). You can see what action we told the provider to take at the back of the full version of the report.

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 the time of our inspection, the registered manager was absent from the service.

Incidents that required reporting to the local authority's safeguarding team were not always reported. Statutory notifications of certain incidents that are required in law to be notified to the CQC were not always completed. Risks to people's health were not always identified. When they were identified, the service did not always take appropriate actions to minimise the risks to people's welfare.

The numbers of staff on duty and their deployment was not effective in ensuring people’s needs were met in a timely way. People often waited for their care. Some care staff had been recruited without providing sufficient evidence to show they were suitable for the role. Medicines and prescribed supplements were not always managed safely so that these were available when people need them.

Staff training and checks of their competency, to ensure that they could meet the needs of people living at the home had not been fully completed. Staff had not had supervision to support them in their role, since our last inspection in February 2017.

There was limited understanding and application of the Mental Capacity Act other than at a basic level. Where significant decisions needed to be made assessments had not been carried out appropriately. Where people who had an application to deprive them of their liberty authorised, the conditions under which this was granted were not always followed.

Staff did not always respect and maintain people’s dignity, people received personal care that could be observed by others because doors were not closed.

People's care plans did not contain accurate, up to date or clear information for staff to help ensure that they provided a high standard of care and support to people. People’s preferences had not been identified so that staff could provide care in the way people wanted.

Complaints to the service had not been managed in line with the provider’s stated procedure. Complaints had not been thoroughly investigated, and responses to the complainant were not comprehensive.

The leadership within the home was poor. Effective communication was not always in place in respect of people’s needs and practices that were taking place in the home. Staff felt the registered manager was not visible, and many did not feel comfortable raising concerns with them. Staff were not confident that any concerns raised with the registered manager would be taken seriously.

The provider's auditing system was not robust and had not identified the concerns we found during this inspection. The provider had not made improvements since the February 2017 inspection.

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.

Courtenay House provides accommodation and personal and nursing care for a maximum of 46 older people, some of whom may be living with dementia. At the time of our inspection there were 37 people living in the home.

At this inspection, there were five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

There was a registered manager in place who has been registered with the Care Quality Commission (CQC) since March 2016. 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.

Assessments of risks to people’s safety had been completed. However, staff did not always provide support or monitoring of people’s safety as identified in these plans. Medicines were not always stored safely. People were at risk of not receiving their medicines as the prescriber intended.

People who were at risk of not eating and drinking enough were not supported to ensure that they did. Records to monitor this were not always completed by staff. Changes in peoples support needs were not always updated in all of the records provided for staff to use.

Staff did not always respect and maintain people’s privacy and dignity. People received personal care which could be observed by other people because doors were not closed. Staff could be overheard discussing peoples support needs and personal information.

People’s expressed preferences were not always met. Although staff knew what people liked, they did not always offer people choices. Staff at times were task orientated and did not focus on people receiving care.

There were issues regarding the governance and quality monitoring of the home. The provider's quality monitoring did not always identify shortfalls in the provision of care to people. The registered manager’s audits and checks were not effective in identifying issues around the home. The registered manager did not have a full understanding of their responsibilities and had not always taken the required actions to notify the CQC of certain events.

There were sufficient numbers of suitably qualified staff employed at the service. The provider’s recruitment process ensured they only employed staff deemed suitable to work with people in a care setting. Safeguarding adults' procedures were in place and staff understood how to protect people from the risk of abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Staff had completed an induction programme when they started work and they were up to date with the provider's mandatory training.

Staff sought consent from people in line with the relevant legislation. The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager was knowledgeable about when a request for a DoLS application would be required. Although applications had been submitted appropriately to the relevant local authority, the CQC had not been notified as is required, when an application had been authorised.

The registered manager ensured that people had access to appropriate healthcare. People were able to see a GP when they needed to and access support from community healthcare professionals.

People and their relatives were involved in making decisions about their care as much as they wished to be. People were supported by staff to maintain their independence.

The service had a complaints procedure available for people and their relatives to use and staff were aware of the procedure. The registered manager took action to address people’s concerns and prevent any potential for recurrence.

At the time of this inspection care was provided to 39 people. This comprehensive inspection took place on 18 August 2016 and was unannounced.

The provider is required to have a registered manager as one of their conditions of registration. A registered manager was in post at the time of the inspection and had been registered with the Care Quality Commission (CQC) since 23 March 2016. A registered manager is a person who has registered with the CQC to manage the home. 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 were kept safe and staff were knowledgeable about reporting any incident of harm. People were looked after by enough staff to support them with their individual needs. Pre-employment checks were completed on staff before they were assessed to be suitable to look after people who used the service. People were helped to take their medicines as prescribed by staff who were trained and had been assessed to be competent.

People were supported to eat and drink sufficient amounts of food and drink. They were also supported to access health care services and their individual health and nutritional needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 [MCA 2005] and the Deprivation of Liberty Safeguards [DoLS] and to report on what we find. The provider was aware of what they were required to do should any person lack mental capacity. People’s mental capacity was assessed and care was provided in their best interests. Staff were trained and knowledgeable about the application of the MCA.

People were looked after by staff who were trained and supported to do their job.

People were treated by kind, respectful staff who enabled them to make choices about how they wanted to live. People and their relatives were given opportunities to be involved on a day-to-day basis about their planned care.

People were supported to be part of the community and they were helped to take part in recreational activities that were important to them. People’s care records were reviewed but the frequency of this was variable. It was unclear how people or people important to them were actively involved in the reviewing of their planned care. In addition, although staff knew about people’s individual needs, they had insufficient detailed recorded guidance to ensure this standard of care would be provided in a consistent way. Following our inspection the provider wrote and told us about the immediate action they intended to take to rectify these deficiencies. There was a process in place so that people’s concerns and complaints were listened to and these were acted upon.

The registered manager was supported by a team of management staff and care staff. Staff were supported and managed to look after people in a safe way. Staff, people and their relatives were able to make suggestions and actions were taken as a result. Quality monitoring procedures were in place and action was taken where improvements were identified.

Below is a summary of what we found. This summary is based on our observations during the inspection, speaking with people who used the service, their relatives, the staff supporting them and from reviewing records.

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

During this inspection we found people were respected and supported with their needs in a dignified manner the majority of the time. People told us they were safe and happy in their home.

The plans of care were robust and information was detailed ensuring the care and support to be provided was carried out safely by staff following the guidance written in these plans.

Professional support from various services was used and that support was cascaded by the staff team to ensure the correct methods to offer safe care was in place.

The environment within the home had improved since the last inspection with areas made safer and maintenance records had regular checks completed to ensure the areas throughout the building were safe.

Regular audits and quality checks were taking place to ensure the whole service provision was carried out safely.

Is the service effective?

People’s heath and care needs were met by a team of staff who had the correct information recorded in the plans of care to effectively support people with their individual needs.

Due to the complex needs of some of the people living in the home professional support obtained ensured that the right care was delivered.

A relative told us, “My relative receives excellent care here from staff members who know what they are doing.”

A concern raised prior to our inspection visit was being managed effectively with evidence written and information shared with us on the methods used.

Audits carried out within the home had actions completed to ensure that any areas of improvement required were carried through.

Is the service caring?

We spent time observing staff interacting with people living in the home. They spoke in a caring manner and on being interviewed by us were caring in their replies to questions.

People’s preferences were listened to and people were offered many choices such as what they preferred to eat and if they were happy to have their wash now. One person said, “I know I can join in the activities if I want to but I have my paper and the television so prefer to sit in my room.”

Plans of care had been written in a way that showed the care required was to be offered in a caring manner, promote choice and for staff to abide by the person’s wishes.

Is the service responsive?

Throughout this inspection we listened to staff reporting any concerns and the person in charge acting on the information given.

A relative told us, “My relative only has to ask and the staff will do anything to help them.”

We read in care records where health professions were referred to as concerns were raised. For example, a person living in the home had swallowing problems and another had weight loss. We noted the dates the concerns were raised and found that timely referrals were made. We spoke to professionals visiting the home at the time of this inspection who told us they were called when a need was necessary and worked well with the home to resolve the concerns. This was also confirmed by the practice nurse from the local GP surgery who told us the relationship with the home had improved.

Is the service well led?

The manager at Courtenay House was supportive throughout our inspection. People told us that they were visited by the manager regularly. On talking with the manager throughout the inspection it was evident that they were knowledgeable about all the people living in the home, and ensured their care needs were monitored.

We were told by one person, “I can talk to the manager or staff at any time and they encourage me to raise my concerns and welcome my feedback.” The manager had received concerns on the care and support offered to a person living in the home. We saw evidence on how this situation was managed and the efforts made to resolve the concerns.

We were told by some visitors spoken with that they had completed a customer survey questionnaire in the past. Relatives who had not been visiting long said they had been made welcome and felt able to talk to the manager or staff at any time.

Staff spoken with told us the home had improved and they felt supported. We saw staff records that showed when meetings were held for both staff, people in the home and their relatives. We saw records of how the manager monitored the quality of the service and then took action on improvements required showing the home is led well.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members.

People were provided with a choice of meals and staff members assisted them with eating and drinking if this was required. One person told us that the food was always good.

We found that the carpets, the outside paintwork and the courtyard were not maintained in a way that provided people with safe and pleasant areas to live in and use.

Information showed us there were enough care staff members available, although there were limited numbers of housekeeping staff. One person using the service said there were enough staff available to meet their needs.

There were ineffective systems in place to ensure that people received care and treatment as planned for them. Advice to staff on how to reduce identified risk to people was not effective. Appropriate records were not maintained to ensure that risk to people was reduced.

We saw that recruitment procedures were not always followed. People were placed at risk of receiving care or treatment from staff members who had not undergone appropriate checks before starting work at the home.

During our inspection of 10 January 2013 we saw people being treated with dignity and respect by staff members.

We examined people's care records and saw that people's care needs were assessed with them. We also saw that people's families could input into the way people's care needs were met. Care records were reviewed regularly to ensure they were up-to-date and met people's changing care requirements.

Staff recruitment procedures were now in place to ensure only appropriately qualified and suitable staff members were employed to work with vulnerable people at Courtenay House Care Home.

People told us they felt well cared for and that they received the treatment they expected. However, we found evidence during our inspection that there were ineffective systems in place to ensure people received the care planned for them, or the care that people requested.

Systems were in place to ensure that people were protected from the unsafe use and management of medicines.

Recruitment and selection procedures were seen to be in place. However, we saw that these procedures were not always followed.

We saw that there was an effective system in place for identifying, receiving, handling and responding appropriately to complaints made by people and their families.