Court House Residential Home

Court House Residential Home Care Home is a detached house set it its own grounds situated in the market town of Cullompton. The service is registered to provide care and accommodation for up to 33 people. They provide care and support for frail older people and people living with dementia. There were 30 people living at the service when we visited. One of these people was staying for a period of respite.

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

People were kept safe and protected from the risk of abuse.

People's risks were assessed and monitored. People told us there were enough staff working at the service and recruitment processes were robust.

A new medicines system was being managed in a safe way.

Lessons were learned when things went wrong as incidents were recorded and actions completed to keep people safe.

Infection control practice followed national guidance and sought to keep people safe from infection. The provider had followed all Government guidance throughout the Covid-19 pandemic to support people to stay connected to friends and family.

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's choices were respected, and decisions made in their best interests but not always formally recorded.

The service was well led. The home's culture was person-centred, open, friendly and inclusive. The registered manager and deputy manager led by example to make sure people received care which met their individual needs and wishes.

The registered manager understood duty of candour and fulfilled the service's regulatory requirements.

People, relatives, and staff were able to be engaged and involved with the service through meetings, surveys and providing feedback.

There were quality assurance systems so care could be monitored and improved.

The service worked with other agencies to the benefit of people using the service.

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 18 December 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

We undertook a focused inspection to review the key questions of safe and well led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

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

Follow up

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

Court House is a care home providing personal care to a maximum of 29 older people. They provide care and support for frail older people and those people living with dementia. It does not provide nursing care. Court House is the main building with an attached annexe; there is also a separate building called The Cottage. The Cottage has its own sitting and dining room, and a kitchen that can be used by the people living there. The Cottage, which is based in the grounds of the care home accommodates six people. There were 26 people living at the service during this inspection. The provider had just completed an extension to the home of four further bedrooms and a café. They had applied to register these extra bedrooms with the Care Quality Commission and were awaiting registration.

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

People lived in a service that kept them safe. Staff understood their responsibilities to protect people from abuse and discrimination. They knew to report any concerns and ensure action was taken.

There were sufficient staff to meet people’s needs and they had been recruited safely. Medicines were safely managed. There were appropriate control of infection processes in place which meant people lived in a home which was clean although some areas were a little tired and in need of redecoration. There were checks and audits in place to protect people from the risks of unsafe and unsuitable premises.

The provider was working to ensure staff received the appropriate training. They had recently changed training provider and were working with staff to complete all the mandatory training and refreshers where required.

People at Court House were supported by staff who knew them well. They were attentive, caring and kind. They demonstrated compassion and were sensitive and reassuring in their manner. The atmosphere at the home was calm and welcoming with people living there appearing ‘at home’.

People were provided with personalised care which was centred around them as individuals. People had been assessed prior to going to the home and had a care plan in place with relevant assessments completed, from initial planning through to on-going reviews of care.

People’s social needs were met, they enjoyed a variety of social activities which included in house activities and entertainers, trips out, social events and family visits.

People were very positive about the staff and the management team and said they were treated with dignity and respect. People’s, relatives’, staff and professionals’ views were sought, and opportunities were taken to improve the service. Staff were supervised, supported and were clear about their roles and responsibilities.

People were supported to eat a nutritious diet and were encouraged to drink enough to keep them hydrated. People and relatives said they liked the food and could make choices about what they had to eat.

People were supported to access healthcare services. Staff worked closely with health professionals, including the GP and community nurses and referred people promptly.

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. Staff ensured people living with dementia had given consent or received care in their best interests in line with current legislation.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it.

Staff worked closely with local health professionals and together they ensured appropriate medicines were available for people nearing the end of their life, to manage their pain and promote their dignity. Procedures were in place for people to identify their wishes for their end-of-life care. This included any wishes they had for receiving future treatment or being resuscitated.

The service continued to be well led and benefitted from clear and consistent leadership. Systems were in place to monitor the quality and safety of the service. Regular audits were completed and where improvement had been identified, these had been addressed. The management team engaged with other organisations and provider’s which demonstrated a commitment to ongoing improvements and learning to ensure best practice at the home.

More information is in the full report.

Rating at last inspection and update: The last rating for this service was Good (published 30 May 2017). At this inspection we found the service remained good.

Why we inspected: This was a planned inspection based on the rating of the service at the last inspection.

Follow up: 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.

We last inspected Court House on 11 and 15 July 2016; the overall rating for the service was ‘good’. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 relating to the management of medicines and identified areas for improvement. The registered manager had produced an action plan to ensure improvements were made and sustained. At this inspection, we found that improvements had been made and the breach was met.

People said they felt safe and secure living at the home. They were positive about their relationships with staff and each other, for example, “I find it very nice, I am very happy here.”

People were protected from potential abuse and avoidable harm. Staff had undertaken safeguarding adults training and understood their responsibility to reports concerns immediately. There were sufficient numbers of suitable staff available at all times to meet people's individual needs.

Since the last inspection, the registered manager had resigned. The providers were present on both days of the inspection and advised us they had appointed a new manager. By the second day of inspection, the new manager was in post and had already taken action to address issues that had been identified for improvement on first day of the inspection. The provider and the manager told us after an induction period, the aim was for the manager to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

Court House was run by providers who worked closely with staff and the manager. Through investment they showed an on-going commitment to improve the experience of people living and working at the home, including refurbishment. Further improvements had been made to the garden and the home continued to be refurbished and updated in an on-going commitment to improving the experience of people living and working there. Staff praised the team work and how they were supported to carry out their job. They respected people’s choices and valued people as individuals knowing when to change their approach based on their knowledge of the person.

The manager was spending time to get to know staff and people living at the home and had already begun to instigate changes based on feedback. The manager was getting to people living at the home and they were establishing relationships with them and gaining the confidence of staff. People said concerns or complaints would be listened to and acted upon. People were offered a choice of meals. They were supported with their health needs and had access to health professionals, when necessary.

There were gaps in recruitment information from 2016, which had not been identified by the providers but was addressed during the inspection. The new manager showed they were clear about the steps needed to make recruitment practices more robust. They confirmed requests for key pieces of recruitment information were now their remit and their practice and records demonstrated their experience in this role. Work was also completed during the inspection to ensure risk assessments for individuals using the outdoor space were completed.

Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and demonstrated through their practice an understanding of the legal requirements. Staff were clear about the values and ethos of the home and were supported with their training and personal development. There were systems to monitor the quality of the service, including responding to suggestions for improvements.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

‘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.’

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state ‘You can see what action we told the provider to take at the back of the full version of the report.’ Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work at there.