Archived: Island Court

Island Court is a residential care home providing personal and nursing care to older people and people with dementia. The accommodation is purpose built over two floors with the ground floor providing nursing care and the first floor providing personal care. The service can support up to 55 people. At the time of this inspection there were 46 people receiving support.

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

People were not effectively safeguarded from abuse. Allegations of abuse were not always investigated or referred to external agencies. Risks to people were not always well managed and the provider did not always put people’s safety first. This left people at risk of ongoing harm. People did not always receive their medicines as prescribed. A shortage of personal protective equipment impacted on the effectiveness of infection control. There were insufficient staff to meet people’s needs. People’s individual needs had not always been met with the right numbers of staff with the required competencies and skills.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The mental capacity legislation was not always followed. There was not an effective system to monitor the status of deprivation of liberty authorisations, (DoLS), Staff were not always gaining people’s consent to their care.

Some people’s nutrition and hydration needs had not been fully assessed and met. People were not always supported and encouraged to eat to maintain a healthy weight.

People were not always supported by staff that were caring. People were not always treated with dignity or afforded privacy. The provider’s staffing levels did not provide time for staff to display their caring values.

Some people spent long periods of time in their bedrooms. Activities were not personalised to individuals, where they were not able to take part in group activities.

The service was not well led. There was not a registered manager. The systems and processes in place identified areas for improvement. An action plan was in place to monitor improvement activity. This process had not always resulted in the required improvements being made and progress was slow. This meant that risks to people’s safety or incidents that left people at risk of harm were not acted upon by the provider. People’s and staff concern about the service had not been acted upon.

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 28 April 2017).

Why we inspected

This inspection was prompted in part by notification of a specific incident. This incident is currently subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

The information the CQC received about the incident, indicated concerns about the management of risk to people’s health and safety and administration of medication. This inspection examined those risks.

We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to keeping people safe, responding to allegations of abuse, numbers of suitable staff to support people to stay safe and meet their needs and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Island Court Nursing Home provides accommodation and personal care for up to 55 people with a range of conditions related to old age which may include dementia. There were 51 people living at the service at the time of 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.

People were supported by staff who had received training on how to recognise the signs of abuse. Staff were confident that if they did raise any concerns they would be listened to and acted upon.

Staff were aware of the risks to people and how to keep them safe from harm. Staffing levels had been reviewed in line with the changes in care needs of the people living at the home and additional staff had been appointed when the need was identified. People were supported to safely take their medicines and regular audits were in place to ensure medicines were administered correctly and safely.

People considered the staff who supported them to be well trained. Staff were supported by management and where additional training was required to meet people’s need’s, this was put in place. People’s human rights were respected by staff because staff applied the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in their work practice.

Staff were aware of people’s dietary needs and for those people who were at risk of losing weight, referrals were made to the dietician and any guidance they provided was followed. People had access to a variety of healthcare services to assist them to maintain good health. Positive working relationships were in place with the local GP and a number of healthcare professionals.

People were supported by staff who were caring and supportive and treated them with dignity and respect. People were supported to make their own decisions on a daily basis by staff who respected their wishes.

Staff were aware of peoples preferences as to how they wished to be supported and how they liked to spend their time. People were provided with the opportunity to take part in a number of activities that were of interest to them and had warm, friendly relationships with the staff who supported them. People were listened to and their views acted upon. Where complaints had been raised, they were investigated and responded to appropriately.

People spoke positively about the registered manager and the staff who supported her. People considered the service to be well led. The registered manager had a good working relationship with the new providers of the service and felt fully supported. Systems were in place to obtain feedback on the service from people and there were a number of audits in place which enabled the registered manager to review the quality of the service provided.