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Reports


Inspection carried out on 30 September 2019

During a routine inspection

About the service

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 sho

Inspection carried out on 3 October 2017

During a routine inspection

This inspection took place on 3 October 2017 and was unannounced.

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.