Duke's Court Care Home

Duke's Court Care Home is a residential care home providing accommodation and personal care for up to 60 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 53 people using the service.

The home is set out across 3 floors which can be accessed via lifts. Each floor has a communal lounge and dining room and all rooms have private en-suite facilities.

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

Since our last inspection, improvements had been made to the quality of care people received. Quality assurance systems had improved and these had been embedded into the practice of the service. The registered manager and provider had oversight of the service and worked together to continually improve the quality and safety of the service.

The registered manager was supported by a senior management team as well as senior staff within the home to maintain safety and provide people with a calm, happy home to live in. The registered manager understood and adhered to the regulatory requirements of their role.

People were protected from the risk of abuse and neglect. Risks to people’s health and safety were appropriately assessed, monitored and acted on. There were enough suitably skilled and experienced staff to keep people safe. Medicines were well managed. The home was clean and tidy, and measures had been taken to reduce the risk of the spread of infection. Learning from accidents and incidents took place to prevent recurrence.

People received care from staff in accordance with their assessed needs whilst protecting their rights and freedoms. Staff were well trained and supervised. People were supported to follow a balanced and healthy diet.

Staff supported people to receive external healthcare when needed. When health and social care professionals came to the home to review people’s care; their advice and guidance were followed by staff. The home was well maintained and appropriate for people's needs.

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.

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 15 July 2022). 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 improvements had been made and the provider was no longer in breach of regulations.

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.

The overall rating for the service has changed from requires improvement to 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 Duke's Court Care 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.

Duke’s Court Care Home is a residential care home providing accommodation and personal care to up to 60 people. The service provides support to both older and younger people, people diagnosed with mental health, physical disabilities, dementia and/or sensory impairments. At the time of our inspection there were 55 people using the service.

The home is set out across three floors which can be accessed via lifts. Each floor has a communal lounge and dining room and all rooms have private en-suite facilities.

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

Medicines were not consistently managed safely.

Risks to people from the environment or health conditions were not consistently assessed and mitigated. Injuries were not always monitored for trends patterns and changes. Recording of injuries required improvement to ensure good oversight of the health and safety of people.

Staff were not consistently recruited in line with regulatory requirement to ensure only suitable staff worked in the service.

Systems and processes were not consistently effective in monitoring the safety and quality of the service and driving improvements. The provider had not consistently implemented national guidance and ensured regulatory requirements were followed to keep people safe.

The service was working within the principles of The Mental Capacity Act 2005 (MCA). 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 told us they felt safe and we observed positive interactions between staff and people.

People were protected from the risk of infection and the home was clean and odour free. Personal protective equipment was used appropriately by staff and the provider was following government guidance in relation to COVID-19.

People and their relatives were included in the care planning process and people felt their choices and independence were respected and supported. People were encouraged to share ideas via regular meetings and feedback.

People felt confident in raising concerns with the provider and the provider was open and transparent when things went wrong.

Staff felt well supported and had regular supervision and felt there was a positive culture within the home.

The provider worked in partnership with health and social care professionals.

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 12 January 2018).

Why we inspected

We received concerns in relation to increased falls, unexplained bruising, medicines errors, low staffing numbers and neglect of personal care. As a result, 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 changed from good to requires improvement based on the findings of 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.

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 Duke’s 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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the safety and managerial oversight 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ The service had Personal Protective Equipment (PPE) stock, and staff confirmed the provider always ensured they had an adequate supply.

¿ People and staff were well supported with regular testing as per the government guidance.

¿ People had been supported to access the vaccination and booster program and all staff were vaccinated as per the regulatory requirement.

¿ Staff received training in relation to infection prevention and control. Staff were observed to be wearing the correct Personal Protective Equipment (PPE) and following hand washing guidance during the inspection.

¿ People were admitted safely into the home and were well supported during isolation periods.

We found the following examples of good practice.

¿The service was very clean, tidy and well maintained. Regular and thorough cleaning took place throughout the service including touchpoint areas.

¿Procedures were in place to facilitate contact between people and their families. A purpose-built garden room had been built to facilitate safe visits from relatives when visiting was allowed to take place.

¿Processes in place for any visitors were clear, and included a temperature check, hand sanitizing station, and appropriate PPE offered for use.

¿Suitable arrangements were in place to ensure that anyone moving in to the service, did so safely. This included a negative Covid 19 test before moving in, and isolating for a 14-day period within the service.

¿Staff had access to sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. The registered manager had been proactive in ensuring stock levels remained good for the staff. We observed staff using PPE correctly throughout the service.

¿Staff followed guidelines with the donning and doffing of PPE, and had an area within the service where this could be done safely.

¿Regular testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19.

¿Regular checks and audits around infection control were completed to ensure the registered manager had oversight on the service, and could address any issues promptly if found.

At the last inspection this service was rated good. At this inspection we found the service remained good. The inspection took place on the 13 December 2017 and was unannounced.

The service is required to have a registered manager. 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. A registered manager was not in post at the time of the inspection; however, a manager had been appointed who was in the process of applying to be the registered manager. The deputy manager was managing the home on a day to day basis with the support of the registered provider.

People continued to be treated with respect, kindness and empathy. The staff were friendly, caring and compassionate. Positive relationships had been developed between the people and staff. People had detailed personalised care plans in place which enabled staff to provide consistent care and support in line with people’s personal preferences.

People continued to receive safe care. Staff were appropriately recruited and there were sufficient staff to meet people’s needs. People were protected from the risk of harm and received their prescribed medicines safely.

The care that people received continued to be effective. Staff had access to the support, supervision and training that they required to work effectively in their roles. Development of staff knowledge and skills was encouraged. People were supported to maintain good health and nutrition.

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 home supported this practice. There were a variety of activities available for people to participate in if they wished to and groups from the local community were welcomed to take part in events at the home.

The service had a positive ethos and an open culture. The provider was committed to develop the service and actively looked at ways to continuously improve the service. There were effective quality assurance systems and audits in place; action was taken to address any shortfalls.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints that they may receive.