Archived: Augustus Court

We were mostly assured that this service met good infection prevention and control guidelines.

The home was clean and there was enough space for residents and staff to socially distance.

We observed donning and doffing stations within corridors however, the provider did not have pedal bins in people’s rooms for staff to dispose of personal protective equipment (PPE). The registered manager confirmed these had been ordered prior to our inspection in November 2020. Following our inspection, the registered manager confirmed the pedal bins had been delivered.

Risks of visiting professionals spreading infection were reduced. At the time of our inspection there had been an outbreak and therefore the home was closed to visitors for 28 days. Any health professionals visiting the home had their temperature taken and were asked about their health before entering the service.

To prevent isolation and support people’s mental wellbeing staff supported people to keep in touch with family and friends through video and phone calls and provided designated times for staff to spend with people to complete activities or have one to one time with staff.

Cleaning schedules had been increased and the home was cleaned regularly using products appropriate to minimise COVID-19.

Staff were trained on how to keep people safe from the risk of infection and used PPE correctly. Through observation and discussions with staff, it was clear staff understood how to don and doff (a sequence for putting on and removing PPE) their equipment. People living in the home said they were being well cared for.

The provider had appropriate arrangements to test staff and residents for COVID-19 and was following government guidance on testing.

Further information is in the detailed findings below.

Augustus Court is registered to provide accommodation for people who require personal care and people living with dementia. At the time of our inspection there were 53 people in receipt of care from the service.

This inspection took place on 27 June and 3 July 2018 and was unannounced.

At the last inspection in September 2017 the service was rated inadequate overall as we found safeguarding concerns had not always been acted upon and incidents that had not been recorded which meant processes were not followed in accordance with the provider’s policies to keep people safe from avoidable harm and alleged abuse. Statutory notifications were not always submitted to the Care Quality Commission (CQC) as required and risk assessments did not always reflect people's needs. Complaints had not always been responded to in a timely manner, or at times not recorded. We also identified shortfalls in recording. Following the last inspection, we asked the provider to complete an action plan to show what steps they would take to improve and by when.

At this inspection we found the provider had taken appropriate steps to make the required improvements and that these had been sustained since our last inspection. The provider was no longer in breach of regulations 12, 16 and 17. We found incidents, accidents and safeguarding concerns were being managed effectively with the relevant notifications being sent to the CQC. Risk assessments had been carried out when there was a need and reviewed on a regular basis. We found record keeping had improved within medicines and repositioning charts however, there were still some ongoing recording issues within care records and we have therefore made a recommendation for these to be improved.

At the time of this inspection 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.

People using the service felt safe and staff had a clear understanding of how to protect people from any harm. Staff were provided with annual safeguarding and whistleblowing training. There was a policy in place for staff to follow and report concerns, we found incidents relating to alleged abuse had been reported and the local safeguarding team involved when required. Accidents and incidents had been recorded and reported. This followed the provider’s policy on effectively managing incidents to prevent re-occurrence.

Medicines were managed effectively and all medicines stored correctly in line with the provider’s policy.

Health and safety checks were carried out to ensure the safety of the premises and the home was kept clean.

Staffing levels were satisfactory to meet people's needs and recruitment checks were robust to ensure staff were of suitable good character to work in a care setting. There was an induction programme for new staff and staff completed training on a regular basis to ensure their knowledge and skills were up to date.

Initial assessments were carried out before a person moved to the home and following this individualised care plans were created to ensure people’s needs were met. Care plans were reviewed regularly or when people’s needs changed.

People told us that staff maintained their privacy and dignity whilst promoting their independence when possible. We observed practices that supported this feedback.

People were encouraged to remain independent and to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were aware of people’s nutritional needs and we found people were offered choice about their food preferences. People also received appropriate support from staff to maintain their health and wellbeing.

The provider followed their legal obligations under the Mental Capacity Act 2005 (MCA) and implemented best practice guidance relating to capacity assessments and Deprivation of Liberty Safeguards (DoLS) applications were made.

Staff told us they felt supported by the registered manager, that they were approachable and open and had made significant improvements from the last inspection. Regular supervisions also took place to ensure staff developed their skills and knowledge. We found not all staff appraisals had been completed and the registered manager had a plan to ensure these would be completed in due course.

Audits were carried out to ensure effective monitoring of the service and to identify where improvements were needed. We saw from the last inspection the provider used an ongoing improvement plan to ensure any actions from audits were being addressed accordingly.

The provider used questionnaires, surveys and meetings to receive feedback about the service and to monitor the quality of the service provided to help drive improvements and develop the service delivered.

Statutory notifications were being reported to the Commission and information relating to serious or concerning information was also being shared with external agencies such as the local authority safeguarding adults team and local authority commissioning services.

Augustus Court is a residential home providing accommodation for persons who require personal care and people living with dementia. At the time of our inspection there were 57 people living in the home. The provider registered with the CQC in February 2016 and this was their first inspection.

During our inspection 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.

We identified breaches of the Health and Social Care Act (Regulated Activities); you can see what action we told the provider to take at the end of the full version of the report. Full information about the CQC’s regulatory response to the more serious concerns found during the inspections is added to reports after any representations and appeals have been concluded. 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.

We found the registered manager had not acted on safeguarding concerns that had been raised and that incidents and accidents were not always recorded which meant processes were not followed in accordance with the provider’s policies and no actions were taken to keep people safe from avoidable harm and alleged abuse.

Statutory notifications were not always submitted to the Care Quality Commission as required. Services that provide health and social care to people are required to inform the CQC of important events that happen in the service in the form of a 'notification'.

Risk assessments did not always reflect people’s needs. We found two assessments had not been implemented when there was documentation to suggest a risk was present.

We found shortfalls in recording, for example, topical Medication Administration Records (MARs), re-positioning charts were not always signed, accidents and incidents were not always documented on the providers ‘Datix’ system and complaints made to the service had not always been recorded formally.

Audits were completed however, we could not be confident that these had reflected all that had happened in the home due to the shortfalls in recording and lack of reporting incidents.

People living in the home told us they felt safe and said the staffing levels were sufficient to meet their needs. Appropriate checks were carried out to ensure staff working in the home were safe to do so.

People and their relatives felt staff had sufficient training to do their job and we found training took place with the staff. Staff were provided with regular supervisions and annual appraisals to develop their learning and any new employees completed an induction programme.

We found the provider was working within the principles of the MCA, with completed assessments in place and relevant care plans in situ. We also saw the provider had made DoLS applications when required.

There were mixed reviews about the food but overall this had improved recently. Fluid and food charts were used for people that required further support although, we found these records were not always robustly maintained.

Most of the people and their relatives told us the staff were caring and spoke positively about their relationships.

People told us staff treated them with dignity and respect at all times. We saw people were being supported to be as independent as possible and explanations about a person’s care was provided.

End of life care plans were individualised to the person’s needs and regularly updated.

Initial assessments and care plans were in place and reviewed regularly. We found that people and their relatives were invited to formal reviews of their care on a six monthly basis.

We saw regular meetings took place with people living in the home to ask for their views and found staff and governance meetings were held.

Surveys had been completed and were overall positive about the home. People living in the home and relatives were provided with annual surveys to complete. Action plans were drawn from this to reflect what the provider and registered manager were doing to support changes, ideas and make wishes and needs a reality at the home.

People and their relatives spoke highly of the activities provided at the home. We saw regular activities, weekly timetables of planned events and monthly newsletters.

The registered manager had positive community links with the local school and put on events to include people in the local community.