The Court

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.

The Court is a residential ‘care home’ providing accommodation and personal care to 17 people aged 65 and over. At the time of the inspection six people were living at the home.

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

People’s level of risk and areas of support were appropriately assessed; relevant support measures were put in place meaning people received the required level of care.

Risk assessments and care plans contained detailed, consistent and up to date information for staff to familiarise themselves with people’s needs. People received a consistent level of care by staff who were familiar with their support needs.

Medication processes and procedures were safely in place. Staff received medication administration training and complied with medication policies and protocols that were in place.

Safe recruitment procedures were in place. The provider followed ‘safe’ recruitment practices meaning that people received safe, effective and compassionate care by staff who were able to work in health and social care environments.

Staff told us they received an effective level of support from the management team. Staff received regular supervision, were supported to complete the required training courses and received day to day support accordingly.

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

Infection prevention control procedures were in place. The registered manager and staff followed COVID-19 advice and guidance to minimise the risk of the spread of infection. Control measures, policies and procedures were rigorously followed, and the environment was safe, clean and well maintained.

Governance procedures had improved. Effective systems and processes were used to monitor, assess and improve the quality and safety of care people received.

Rating at last inspection and update:

The last rating for this service was inadequate (published 6 November 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection, which identified the improvements they would make and when actions would be completed. At this inspection we found improvements had been made.

During this inspection the provider demonstrated that improvements have been made and the service was no longer rated as ‘inadequate’ overall, however improvements are still required.

This service has been in 'Special Measures' since November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as 'inadequate' overall or in any of the key questions. Therefore, this service is no longer in 'Special Measures'.

Why we inspected

A decision was made for us to inspect and follow up on the actions taken following the last inspection. Due to the COVID-19 pandemic, we undertook a focused inspection to only review the 'Safe', 'Effective' and 'Well-led' domains. Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the ‘Caring’ and ‘Responsive’ key questions were not looked at during this visit.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

The overall rating for the service has changed from ‘inadequate’ to ‘requires improvement’. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to our inspection programme. If we receive any concerning information we may inspect sooner.

We will also request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Court is a care home that provides accommodation for up to 17 people who need help with their personal care. At the time of the inspection 14 people lived in the home. Most of the people living in the home lived with dementia.

People's experience of using this service

At the last inspection, the provider was rated good. At this inspection, we identified serious concerns with the delivery of people’s care and the management of the service. This meant the rating for the service has deteriorated to inadequate.

During the inspection, the registered manager did not demonstrate they had sufficient oversight of the service and the support people received. They did not demonstrate they understood their regulatory and legal requirements with regards to the service.

There were no adequate or effective systems in place to monitor the quality and safety of the service. This resulted in people being exposed to ongoing risks. For example, people’s care plans were not sufficiently detailed to ensure people received safe and effective care and records showed they did not always receive appropriate support. Professional advice obtained from other health and social care professionals was not always followed and the management of medication required improvement.

People did not always receive a suitable diet and some people did not eat enough to mitigate the risk of becoming malnourished. Weight monitoring was inconsistent which meant that the registered manager could not be assured people maintained a healthy weight. People told us the food and drink on offer was satisfactory. There were no menus for people to choose from however and people did not always get a choice.

People were not supported to have maximum choice and control of their lives. 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 or the application of the Mental Capacity Act 2005 (MCA).

Staff recruitment was unsafe and did not ensure that only fit and proper persons were employed to work in the home. Staff had not completed sufficient training to do their job role and the competency of some staff members to do their job safely had not been checked for some time.

Accident and incidents were not properly investigated to ensure that staff learned from these events to prevent them from happening again in the future. For example, some people had sustained unexplained bruising but there was no evidence that the cause of this has been investigated.

The home’s environment although pleasantly decorated was not dementia friendly to promote people’s independence. There were some activities on offer but on the days we visited, a significant amount of people’s time was spent sat in the communal lounge with the radio or TV on. We saw that some people routinely walked around the home asking if they could go home or if they were due a visitor.

The number of staff on duty was sufficient to meet people's needs. People told us they felt safe with staff and said staff were kind and caring. Relatives confirmed this.

People told us the staff were nice and it was clear from our observations that people felt comfortable with the staff team supporting them. Staff spoken with, spoke with genuine warmth about the people they cared for and knew how to safeguard people from the risk of abuse.

The atmosphere at the home was warm and homely and the premises was clean and adequately maintained. The registered manager was open and transparent during our inspection and acknowledged that significant improvements needed to be made. They displayed a positive and committed attitude to making those improvements in a timely manner.

Rating at last inspection and update

The last rating for this service was good (published 02 December 2017). At this inspection it has declined to inadequate. The provider has now completed an action plan to show us what they would do and by when, to improve the service.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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 also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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 will be placed in special measures. ‘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.

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

This inspection was the first for this newly named service with its new provider. The home required and had, 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.

The registered manager (who was also the new provider) of this service had been the manager of the previous service and many of the staff still worked for the home. This meant they had been able to provide continuity of care for the people who lived in the home.

The Court is a large detached period house situated in a quiet suburban area in Hoylake. It is close to local shops and near to local public transport. It provides residential accommodation for up to 17 people with personal care needs and at the time of our inspection, there were 17 people living there. The home had further accommodation which they were hoping to make into an additional bedroom and had applied to CQC to increase the numbers they could accommodate.

The home has 12 large single bedrooms and three double bedrooms, most with en-suite facilities. It is arranged over three floors with passenger lift access. The home has been re-furbished by the new provider and the accommodation is light, clean and has a homely feel to it. Most people had personalised their own rooms and these had been decorated to their choice.

The provider had employed additional staff. The home was clean and tidy with no unpleasant odours. The buildings maintenance was done by a team of tradespeople which the provider had immediate access to if urgent work was needed.

The required safety checks for services such as gas and electrical installations and the lift and fire equipment had all been carried out in a timely manner. However; some improvements suggested had been not been recorded as being completed, although most had been done. The kitchen had a food hygiene rating of five, which is the highest attainable and a variety of food was prepared and served according to people’s needs and preferences.

Staff said they were well supported and trained. We noted that records to show that safe recruitment practices had been followed were incomplete, but we were assured that the previous provider’s administrator had the evidence that they had. They provided this in a later email. Medication was generally correctly stored and administered and staff were trained to administer medication.

Staff were supervised on a regular basis and their yearly appraisal had been scheduled for October 2017.

The provider followed the Mental Capacity Act and its associated deprivation of liberties safeguards (DoLS). There were eight people living at The Court who were the subject of a DoLS.

Care plans were completed and regularly reviewed. They were, in general, person centred and contained risk assessments which had identified any risks to people’s safety and well-being.

People were able to participate in a wide variety of activities and their cultural and religious needs and preferences were respected and enabled.

The management of the home had made changes to the way some aspects of the service had been run under the previous provider. There were still some improvements to make but there was a good rapport and understanding between staff and the managers. People living in the home and their visitors and relatives, told us they appreciated the improvements.