Covent House

Covent House is a care home providing accommodation and personal and nursing care to up to 63 older people, including people who may live with dementia, or a dementia related condition. At the time of our inspection there were 58 people using the service accommodated in a purpose built building.

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

Improvements were required to records to ensure people received effective and person-centred care from all staff members. People’s medicines were not always well-managed.

A quality assurance system was in place, but it needed to become more robust to assess the standards of care in the service. We identified shortfalls with medicines management, care records, people’s involvement, accident, incident analysis, staff deployment, aspects of clinical care. These shortfalls had not all been identified or actioned in a timely manner by the provider’s governance system.

People and relatives were complimentary about the care provided by staff. They trusted the staff who supported them. They said staff were kind, caring and supportive of people and their families. Comments included, “We are 100% happy with the care [Name] receives” and “[Name] is always clean and tidy, their clothes are always pressed and put in the wardrobe, the way [Name] smiles when the staff talk to them is amazing.”

Staff received safeguarding training and were clear on how and when to raise their concerns. Where appropriate, actions were taken to keep people safe. The service was following safe infection prevention and control procedures to keep people safe.

Staffing capacity was sufficient and staff deployment was mostly effective to ensure people's needs were met in a safe, timely way. A person told us, “The staff are all lovely, I like all of them. They come quickly if I ring the buzzer.”

People received a variety of food and drink to meet their needs and any specialist diets were catered for. Staff knew people well but people were not always consulted or involved in daily decision making.

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.

Staff recruitment was carried out safely and effectively. There was evidence of collaborative working and communication with other professionals to help meet people's needs.

People's diversity as unique individuals with their own needs was respected by staff. The staff team provided support discreetly and with compassion. People’s privacy was respected, and people were supported to maintain contact with relatives.

There was a cheerful atmosphere at the service. Staff spoke positively about working at the home and the people they cared for. Several staff had worked at the home for some years. Staff and relatives said the manager was very approachable and they were supported in their role. A relative told us, “The registered manager and her staff are doing a wonderful job.”

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 13 February 2020).

Why we inspected

The inspection was prompted due to concerns received about people’s care. A decision was made for us to carry out an inspection and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see all domains of this full report.

We have found evidence that the provider needs to make some improvements. Please see the safe, effective, responsive and well-led sections of this full report.

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 Covent House on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to good governance and record keeping at this inspection.

We have made recommendations about medicines management, nutrition and hydration, and promoting the involvement of people who may live with dementia, in decision making about their food and drink.

Please see the action we have told the provider to take at the end of this report.

Follow up

We have requested an action plan from the provider to understand what they will do to improve the standards of quality.

We found the following examples of good practice:

The home had sufficient supplies of appropriate PPE which was stored hygienically and kept safe and staff were provided with separate areas to put on and take off and dispose of PPE safely.

Staff were careful to maintain social distancing and wore appropriate PPE in line with current government guidance.

Staff demonstrated a good knowledge of how to support people that had tested positive or were showing symptoms of COVID-19.

The senior staff explained the quality systems they had in place to check the service was providing safe care.

All staff, including catering and housekeeping staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Further information is in the detailed findings below.

Covent House provides residential and nursing care for up to 63 older people. At the time of the inspection 55 people were using the service. Care is provided in four different units, covering residential care, nursing care and dementia care.

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

People and their relatives told us the care was safe and they were happy at the service. Medicines were managed safely. Staff were recruited safely and there were enough staff to meet people’s needs. The registered manager sought to learn from any accidents and incidents involving people.

Senior staff carried out detailed assessments of need to ensure the service could effectively support any new admissions. People were supported to have enough to eat and drink and staff were trained to support people who had different dietary needs. Staff told us they were well trained and supported and supervised by the management team. The service worked well with community healthcare partners such as the local GP practice to ensure people received healthcare support where needed.

People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Interactions between people and the staff team were positive. People were treated with kindness, dignity and respect. Staff were responsive when people needed additional support. People were supported to maintain relationships with those important to them.

People received personalised care that was responsive to their needs and preferences. People were supported to engage in activities to reduce their risk of social isolation. The quality of care records supported a consistent delivery of care. People and their relatives knew how to make a complaint. Those people we spoke with said they had opportunity, through regular meetings, to raise any issues they had. The home received regular compliments about the good care people received. Complaints and concerns were dealt with robustly and proactively by the management team..

Quality assurance measures supported the service to make continual improvements. The registered manager had a clear vision and commitment to achieving excellence in care. Strong leadership supported the staff team to work well together to ensure people received good care which led to good outcomes for people.

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 good (published 12 October 2018). There was an issue with some of the information that we gathered at the last inspection visit so this inspection report supercedes that rating.

Why we inspected

This is a planned re-inspection because of the issue highlighted above.

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.

Covent House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Covent House accommodates 63 people in one purpose built building. The home has five floors, four of which provide accommodation for people with nursing and personal care needs. Some of the people using the service were living with dementia.

The service did not have a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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 new manager was in post who had applied to be registered with CQC.

Covent House was last inspected by CQC on 1 August 2017 and was rated Requires improvement. At the inspection in August 2017 we identified the following breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment) and Regulation 17 (Good governance).

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-led to at least good. At this inspection we found improvements had been made in all the areas identified at the previous inspection.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks.

The manager and staff understood their responsibilities with regard to safeguarding and had been trained in safeguarding vulnerable adults.

Medicines were stored safely and securely. Procedures were in place to ensure people received medicines as prescribed and regular audits were carried out.

The home was clean, spacious and suitable for the people who used the service. Appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were supported in their role via appropriate training and regular supervisions.

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.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People who used the service and family members were complimentary about the standard of care at Covent House. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

Activities were arranged for people who used the service based on their likes and interests, and to help meet their social needs. The service had good links with the local community.

People who used the service and family members were aware of how to make a complaint. The provider had an effective quality assurance process in place. People who used the service, family members and staff were regularly consulted about the quality of the service via meetings and surveys.

The inspection was prompted in part by a historical notification of an incident following which a service user may have sustained a serious injury. During the inspection the Commission became aware of a further incident were a service user died. As such a third day of inspection took place on 5 September 2017 to ensure the immediate safety of service users. These incidents are subject to criminal investigation and as a result this inspection did not examine the circumstances of the incidents.

However, the information shared with CQC about the incidents indicated potential concerns about the management of safeguarding concerns and medicines. This inspection examined those risks.

We last inspected Covent House on 17 June 2015 and found it was meeting all legal requirements we inspected against. We rated Covent House good in all domains at that time.

Covent House is registered to provide accommodation for up to 63 people who need nursing and personal care. It provides a service primarily for older people, including people living with a dementia related condition.

At the time of the inspection there were 57 people using the service.

The service did not have a registered manager. The current manager had been in post for five weeks prior to the inspection and had submitted an application to the Commission to be registered. The previously registered manager had left their post on 29 July 2013 but had failed to cancel their registration. Managers had been in post during this time but had not registered with the Commission.

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.

During the inspection we found areas of concern which constitute breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely safe care and treatment, safeguarding service users from abuse and improper treatment, the need for consent and good governance.

Medicines were not always managed safely for people and records had not been completed correctly.

A recent safeguarding incident had identified failings in relation to risk management, communication, documentation and training. Improvements were being implemented at the time of the inspection.

People were not consistently supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. This meant there was a failure to follow the principles of the Mental Capacity Act (2005) in relation to mental capacity assessments and best interest decisions.

Accurate, complete and contemporaneous records in respect of each person’s care and support had not always been maintained.

The provider’s quality assurance systems had not identified the concerns in relation mental capacity assessments, best interest decisions and some care documentation.

We have made a recommendation about the planning and assessment of care.

Complaints were investigated and there was a record that complainants were satisfied with the outcomes and action taken. The management of one complaint, with regard to a specific safeguarding incident, was being investigated.

The manager completed weekly audits, in addition to walk around checks and audits of medicines, the dining experience and care records. The head of compliance also completed an audit. An action plan was in place which had resulted in some improvements.

The manager had a strong leadership style with a positive vision for the future of Covent House. Staff were complimentary of their approach and felt improvements had been made.

Recognised risk assessment tools were used to assess risks such as pressure damage and nutritional risks. Other risks such as mobility and falls were assessed. Areas of concern were included within care plans.

Some care plans were detailed and provided staff with specific strategies to follow to ensure people received appropriate and consistent care and support, others were not.

People nutritional and health needs were met and we saw referrals had been made to healthcare professionals.

Staff told us there were enough staff to meet people’s needs. We observed staff were not rushed and were able to spend time engaging with people in a meaningful and respectful manner. If people had been funded for one to one support we observed this was being provided.

People and staff were observed to have warm relationships with each other. Everyone we spoke with was complimentary about the care provided and the approach of the staff.

A range of activities were offered, including a cinema room, a gentleman’s club, outings, community involvement, entertainers, music therapy and pet therapy.

There was a reliance on agency staff. Safe practices were followed to ensure agency staff had the required skills to meet people’s needs. A recruitment campaign was underway and safe systems were being used to ensure only appropriate staff were employed.

Staff said they felt well trained and well supported. The provider had identified some improvements were required with regards to supervision and training and this was being addressed.

You can see what action we told the provider to take at the back of the full version of the report

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

People using the service told us they felt safe with staff who provided their care and support. Relatives we spoke with told us they were confident that their family members were safe at the home. We found safeguarding procedures were in place and staff understood how to safeguard the people they supported. One person told us, 'I love it here. Initially I didn't want to come, but I've never regretted it. Overall, I'm very happy, safe and content here.' One relative commented, 'I can come and visit her at any time of the day or night; I have no concerns about her welfare.'

People were cared for in an environment that was safe, clean and hygienic. The building and grounds were well-maintained, secure and other appropriate measures were in place to ensure the security of the premises.

Equipment at the home had been well maintained and serviced regularly, therefore not putting people at unnecessary risk.

We received mixed opinions from relatives about staffing levels at the home. One relative told us, 'The girls have an awful lot to do, but they do it well and do a great job. I have no issues with the staffing levels whatsoever. Is there enough staff? You could say that about anywhere; doctor's surgeries, supermarkets; everybody would like more staff. There are just the odd occasions when they could do with more staff on; sometime they get busy, but apart from that, there is generally enough staff on.' Other relative's comments included, 'There is always someone (staff) floating around,' and, 'There's usually enough staff on duty, usually plenty staff. Sometimes they are busy; but they have enough staff generally ' overall, nothing to concern me.' However, three relatives told us they considered that there were times when insufficient members of staff were on duty, to adequately deliver the care required by some people who currently used the service. Overall, our findings indicated there were enough qualified, skilled and experienced staff to meet people's needs.

Is the service effective?

We received mixed opinions about the care provided. Six relatives told us they were happy with the care and support provided. People and the majority of their relatives told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. One person told us, 'The staff are really nice here; I can trust the staff here. They seem to know what they are doing and they seem to know everyone that lives here really well.' One relative told us, 'The staff are brilliant with her. Some days she can be difficult, but they cope and manage well.'

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives. However, three relatives told us they felt staff could spend more quality time with people and provide more social stimulation.

We found that staff were supported to deliver care and treatment safely and to an appropriate standard. Staff received appropriate professional development, appraisal and supervision and the provider monitored training requirements appropriately.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, 'I'm safe and secure here; there's always someone here for you day or night.' Another person said, 'I've stayed here long enough to know; I've got no complaints and I'm well looked after here. The girls are there if I need them; I've found the care very good.' One relative commented, "I'm happy she's safe, well-looked after and cared for.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed regularly to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

The provider had a written complaints policy and procedure, which detailed the process that should be followed in the event of a complaint. The registered manager told us, and records confirmed that no complaints had been received by the service within the last 6 months. We also noted that 12 compliments had been received by the service within the same time period.

The service followed policies and procedures for the safeguarding of vulnerable adults. This meant that people were safeguarded as required and the provider was able to respond appropriately to any potential allegations of abuse.

Is the service well-led?

In this report, the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of our inspection. Their name appears because they were still a registered manager on the CQC register at the time.

The service had a manager who had been at the home since March 2014 and was awaiting her CQC manager's registration.

The provider had in place, systems to monitor the quality of the service people received.

Staff had a good understanding of the ethos of the home and told us they were clear about their roles and responsibilities. People's relatives were able to complete a customer satisfaction survey. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

Staff felt supported by the management team. Staff comments include, 'I definitely feel supported by the management; very much so' and I find them supportive and approachable if needed,' and, 'The new management are absolutely lovely, so supportive, I couldn't fault them.'

A member of the management team was available on call for advice and support and in case of emergencies.

"I am looked after very well here", "The staff are very good to my mother' and 'If I need anything I get it'.

We saw people were cared for effectively and care was planned to meet the needs of individuals.

We found there was sufficient qualified and experienced staff on duty to provide care and support for people.

We found records were accurate and up to date. They were secure and stored appropriately.

We found people had received inappropriate or unsafe care as the planning and delivery of care did not ensure people's welfare and safety. We found people's personal care needs had not been met.

There was not enough staff to meet people's needs. We found during staff breaks there was often only one member of staff available on a floor to provide care for people.

We found people's personal care records were inaccurate and up to date. People had not been protected from the risks of unsafe or inappropriate care because accurate and appropriate records had not been maintained.

We found the provider had taken appropriate measures to ensure that the environment was suitably designed and adequately maintained for people to live and work in.

Some people we spoke with told us they were happy with the care provided. One person said, 'I couldn't ask for more, the staff are lovely. I'm well helped.' A relative said, 'The care is very good.' However some people did raise concerns with us. One relative said, 'I'm not convinced she gets bathed as much as she would like. That's where they fall down".

Following this inspection and prior to the issue of this report the provider sent us an action plan which described the action to be taken to address the issues identified at this visit. In this action plan the provider told us they would be compliant by the 31st October 2013.

We observed people being cared for with compassion, dignity and respect. Staff were busy, but well organised. Some people stated the home would benefit from more staff on duty. Staff said they were sufficiently resourced. There was a calm and relaxed atmosphere.

Equipment was available on all floors to help meet people's care needs. We found equipment had been serviced to keep it safe.

People told us they were happy with the staff who worked with them. One person stated, 'The staff are all lovely.' Another comment was, 'The staff are very good.' Visiting relatives we spoke with made similarly positive comments. These included the comment, 'I respect the staff, they work very hard.' We found pre employment references and other checks were in place before staff started work here.

People told us they knew how to complain and were confident any concerns they might have would be looked into and addressed. One comment we heard was, 'If anything's not right I'd speak to the girls or the manager ' things are going alright.' We checked relevant records and found complaints were acknowledged, investigated and responded to.

We observed care; spoke to six people who use the service, two visiting relatives, three visiting professionals and six members of staff. We also reviewed care records for people using the service.

We saw good examples of personal choice and care provided by staff. We saw that people were safe and protected from abuse. We reviewed records which showed the provider effectively monitored the performance of the home. We found that the staff at the home was suitably experienced and qualified and that the staffing levels at the home were sufficient to meet the needs of the people who use the service.

One relative we spoke to said the service was, "Absolutely fantastic, anybody could take anybody into there" and' The staff are extremely caring. I just come in anytime and staff are always the same. Some of them are so caring I would give them a gold medal if I could."