The Court

Updated 22 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

The Court is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. The Court is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager (who is also the nominated individual), deputy manager, cook and 3 care staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with 1 person who used the service and 4 relatives, about their experience of the care provided.

We reviewed a range of records. This included 5 people's care records and medication records. We looked at 4 staff files in relation to safe recruitment. A variety of records relating to the management of the service, including audits were also reviewed.

Updated 22 August 2023

About the service

The Court is a residential care home providing personal care to people, some of whom were living with dementia. At the time of inspection, there were 13 people living in the home.

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

The findings of this inspection raised serious concerns with the management of the service and the safe delivery of care. Systems in place to monitor the quality and safety of the service were not fully effective in identifying areas that required improvement and when risks were identified by other professionals, they were not always actioned. There was a lack of systems in place to monitor and oversee records within the service, to ensure they were maintained accurately.

Risks were not always assessed and mitigated safely, leaving people at of risk harm. For instance, fire safety measures were not adhered to, as the fire risk assessment was not adequate, fire doors were wedged open and the external fire escape was not well maintained. There were also risks within the environment, as radiator covers were loose or broken, and there were broken pots and laundry detergent in the garden. Individual risks to people were not always assessed and records did not always show people received the support they required. Although accidents and incidents were managed, there was no evidence that they were reviewed regularly to look for potential trends and ways to minimise any further potential incidents.

Medicines were not always stored and managed safely. For instance, the room medicines were stored in was not maintained at the recommended temperature and prescribed thickening agent for drinks, were not stored securely. There was a lack of information for some medicines prescribed as and when required, or with a variable dose and people’s creams.

People’s nutritional needs were not always assessed and met adequately, as nutritional risk assessments were not in place for all people and when they were, the identified risks were not always acted upon. Care plans did not all reflect people’s current needs, or the nutritional advice provided by other health professionals. When there was a concern regarding how much people ate and drank, monitoring forms were put in place, but they were not completed comprehensively. People told us there was enough food and drinks available.

Infection prevention and control (IPC) practices were not always effective in minimising the risk of infections spreading. Some areas of the home required additional cleaning and although cleaning schedules were in place, there was no evidence of what cleaning was completed each day. There were adequate supplies of personal protective equipment (PPE) available.

People’s care was not always planned in a person-centred way; care plans were not all reflective of people’s current needs, and preferences regarding their care needs could not always be met.

People were not always supported to have maximum choice and control of their lives, and records did not show that staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Although some systems were in place to seek and record people’s consent, they were not always consistently applied to ensure consent was recorded in line with the principles of the Mental Capacity Act. The environment had not been adapted to meet the needs of people living with dementia.

People told us The Court was a safe place to live. Safeguarding referrals were made when required and although not all staff had undertaken safeguarding training, there was a policy in place to guide staff in their practice. Feedback regarding staffing levels was mixed and there was no staffing analysis tool used to help establish required numbers of staff. Records showed safe recruitment procedures had been followed for most staff.

Records showed that not all staff had received relevant training and support to ensure they could carry out their job role effectively. Staff completed an induction when they started in post and received support through group supervisions and team meetings. Staff felt well supported in their roles and able to raise any issues they may have.

People and their relatives provided mainly positive feedback about the support provided and the management of the home. They told us they were kept informed and could raise any complaints or concerns they had. People were supported to maintain relationships with friends and family, and relatives told us they could visit the home at any time.

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 requires improvement (published 21 September 2020). At this inspection the rating has changed to inadequate.

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.

Enforcement and Recommendations

We have identified breaches in relation to risk management, fire safety, medicines, safety of the environment, infection prevention and control, governance systems and meeting people’s nutritional and hydration needs at this inspection. We also made recommendations in relation to consent and person-centred care.

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

Follow up

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 time frame 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.