Court House Residential Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question as good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt safe at the service and would speak to staff if they had any concerns. One person told us, “I feel very safe and I am very happy”. A relative told us, “Staff always know how [relative] is, and where [relative] is”. Another relative told us staff were quick to recognise signs of concern in their family member, and escalated their concerns in a timely way, so the person received the appropriate support, for example, medical attention.

Staff understood their responsibilities to safeguard people and knew which process they would follow, supported by training and policies. They were able to explain how they would report any concerns both inside the organisation and externally, for example, to their senior, or to CQC and the local authority safeguarding team.

We observed positive interactions between staff and people who used the service. Staff practice and delivery of care ensured they kept people safe.

The service had systems to support the safeguarding of people in the service. The service had a safeguarding policy and staff knew how to access this. Staff followed this policy to help protect people and referred on to other agencies. Staff were trained to appropriate levels of safeguarding and records confirmed this.

There were safeguarding records to evidence when safeguarding had been reported. Safeguarding reported to the local authority had also been reported to CQC.

The service was largely working with the principles of the Mental Capacity Act 2005 (MCA). Applications had been made where necessary to deprive a person of their liberty.

People were involved in decisions about their care and treatment to help keep them safe. People were involved in their original care planning, but they did not always understand or remember what was documented. However, they told us when staff provided they were involved and asked for consent. The manager had frequent conversations with people about their care and any required changes.

Staff worked with people to understand and manage their risk, and to meet their care needs while keeping them safe. Staff always assumed someone had capacity for a decision unless they had been assessed as not having capacity to make their own decisions. Staff understood people well. Staff had the up to date information they needed to be able to provide safe and effective care for people.

We observed staff using equipment safely to support people. People were supported and encouraged to be independent, for example using walking aids.

People’s care records demonstrated risk assessments and care plans were completed. Care plans were person centred and proportionate.

Staff ensured a safe care environment.

The service had systems and processes to manage risk. Staff completed risk assessments and care plans based on individual needs and staff followed these. Staff assessed people’s needs before they were admitted to the service where possible. Staff reviewed care plans monthly, or when a person’s needs changed. Documents we reviewed confirmed staff assessed people’s needs and care plans were updated when required.

Staff completed regular handovers to ensure information was shared between shifts to keep people safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People largely told us their needs were met, but they would like staff to have more time to talk with them. One person told us, “I couldn’t ask for anything better, they help me with whatever I need.” A relative told us staff had the necessary knowledge and skills, and were, “Very much on the ball, they know what they are doing.” However, some people and relatives told us they didn’t know how long they would have to wait for staff to attend to them after using the call bell. One person told us their call bell was turned off by staff and it took some time for their needs to be met. They also said this had happened before. We raised this with the registered manager who was investigating.

Most staff told us they wished there were more staff employed at the service. They felt people’s needs were met, but they didn’t have very long to sit and chat with people.

The registered manager had recognised the need for more staff as people’s needs had increased since their admission. There had been some delays in recruitment outside of the provider's control.

One member of staff told us, “The care that is done here is good and you do get that time with the residents, so it is good.” However, they also told us people with capacity expressed their frustration with not knowing how long they would have to wait to have the call bell answered.

Several staff told us how good they thought their training was, and some staff completed training before starting in their roles. Training could be provided to staff face to face, for example lifting and manual handling training.

During our onsite assessment there were not always enough staff to meet people’s needs. We carried out a short observational framework for inspection (SOFI) in a communal lounge. Staff were not present in the room at the time, and didn’t check on people’s needs for the 17 minute duration of the observation. We spoke with the registered manager about what we observed. They told us staff were stressed because of our assessment and behaved differently from how they would usually behave.

We also observed lovely interactions between people living at the service and staff. This was confirmed by visiting professionals who also commented how staff had the right manner to help motivate the person to engage with their occupational therapy.

The service was mostly staffed safely with appropriate staffing levels and skill mix, although more staff would help meet the full needs of people and allow staff to spend more time with people. Service leaders used a dependency tool which showed the service was overstaffed. The registered manager kept staffing under review. Although no vacancies were identified in their dependency tool, they recognised more staff were needed. They were actively recruiting for a new role to improve the efficiency of seniors, and to enable staff to spend more time with people.

The service had robust and safe recruitment practices in line with schedule 3 of the Health and Social Care Act. Recruitment records evidenced staff were recruited safely and this was in line with the recruitment policy. Disclosure and Barring Service (DBS) checks had been carried out to ensure staff were safe to work with people.

Staff received training appropriate and relevant for their role. This included training in communication with people with learning difficulties. Staff were supported to complete their care certificate, fostering a learning culture.

Staff received the support they needed to deliver safe care. Staff were supported in their development receiving quarterly supervision, we saw written evidence of these having taken place. Staff received annual appraisals to review performance, identify improvements and set future goals. Service leaders reviewed staff competencies and updated them in line with care delivery needs.

Staff had opportunities to learn and senior leaders managed poor performance.

The registered manager carried out monthly audits of the call bell system to understand the response time of staff and their capacity. They were able to explain occasions where there were delays in responding to the call bells meaning people had to wait longer than expected. For example, when there had been an incident in the home at that time.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were not directly asked about their medicines.

Staff told us they received appropriate medicines training and their competencies were checked. The competency checks ensured their practice was safe and signed off before completing medicine related tasks. Service leaders checked these periodically to ensure their practice continued to be safe.

Staff stored and managed medicines safely. Medicines, including controlled drugs, were stored securely and temperatures for fridges storing medicines were regularly checked.

Staff completed medication rounds. We observed medicines being administered. Staff administered medicines safely and in line with their policies.

We reviewed people’s medicine records. As required medicines (PRN) were received but not always clearly recorded. This was raised with the registered manager and immediate improvements were made to their PRN medicines recording. Care plans for people’s medicines reflected their individual needs.

The management of medicines at the service was safe and people received their medicines safely and as prescribed. Staff clearly recorded prescribed and administered medicines in people’s records.

The service had systems for regular medicine audits and staff conducted stock checks. We reviewed medicine stocks, balances and records which showed people received medicines prescribed to them. We reviewed medicine audits which staff completed.

The service had a medicines policy which supported the safe management of medicines. The service had clear processes for administering and dispensing medicines which staff followed.