Collingwood Court

We found the following examples of good practice.

The service had an IPC champion in place who was knowledgeable and dedicated.

Staff had been recognised and rewarded for their extra efforts during such difficult times with bonuses and thank you letters from the provider.

The registered manager had communicated well with residents, relatives and staff, to ensure they received the latest guidance on visiting.

Further information is in the detailed findings below.

Collingwood Court is a residential care home providing accommodation and personal care for up to 63 older people. At the time of this inspection 47 people were using the service, some of whom had dementia related conditions.

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

People’s health and social care needs were thoroughly assessed. Staff delivered care which reflected people’s current needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received support from caring staff, who knew them well. Staff protected people’s privacy and dignity and respected their wishes and choices. Independence was encouraged, and people were involved making decisions about their care.

People were safe living at Collingwood Court. There were enough staff on duty to meet people’s needs. Staff were well supported by the registered manager to provide high-quality, person-centred care to people.

People’s health, safety and well-being were protected by staff who followed appropriate risk reduction measures. Positive risk taking was encouraged to enhance people’s quality of life. Medicines were well managed.

The premises were safe, and the home was clean and comfortable. Any accidents or incidents were fully investigated and reported as required. Lessons learned were shared with staff.

Staff recruitment was safe, and training was up to date. Competency checks were carried out with staff to ensure they remained suitable for their role.

A variety of activities were organised, which were interesting and meaningful to people as well as encouraging socialisation amongst people, their relatives and the local community.

The provider had a robust quality assurance process embedded throughout the service to ensure people received high-quality care. Regular checks of the service were carried out to monitor the safety and quality. The registered manager made continuous improvements and developments to the service with support from the wider organisation.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 20 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about Collingwood Court until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected the service in December 2016, at which time we found the provider continued to breach one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, related to safe care and treatment from their previous inspection in March 2016. Subsequently, the provider sent us an action plan setting out the improvements they had made to immediately rectify the issue. This inspection took place on 20 June 2017 and was unannounced.

The service had a registered manager in post. This was the same registered manager who was present at the last inspections. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection in December 2016 we identified that the procedure around the disposal of unwanted medicines which had been removed from its packaging was both unsafe and untraceable. The staff we spoke with confirmed this was their working practice. We spoke to the registered manager about this issue and it was immediately addressed. By the end of that inspection, safe working practices had been implemented. At this inspection, we checked that these had been sustained and found that they were.

At this inspection, people told us they felt safe at Collingwood Court and relatives confirmed this. Staff were able to describe their responsibilities with regards to safeguarding vulnerable people from abuse and they had attended an awareness course.

We found staffing levels to be appropriate and people told us they were responded to promptly. Safe recruitment procedures were followed and pre-employment vetting checks continued to be carried out.

Company policies, procedures and reporting systems were used effectively to enable staff to provide safe and good quality care. Improvements to record keeping, noted at our last inspection, had been sustained. Care plans were thorough, personalised and up to date. Regular reviews and updates took place following changes to people’s needs.

Accidents and incidents were recorded and reviewed without delay to enable the registered manager to monitor people’s well-being and make referrals to external health and social care professionals as required. People had good access to specialists for on-going monitoring of their needs.

Emergency plans were up to date and the safety and maintenance of the premises continued to be monitored. The home was attractively decorated and was clean and tidy. There were elements of a ‘dementia friendly’ environment incorporated into the design of the home.

CQC is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements.

People were supported to maintain a healthy and well-balanced diet. Catering and care staff followed best practice guidance and they were knowledgeable about people’s special dietary needs.

A corporate induction process was in place for all new employees and any staff new to the care industry also completed a robust induction process which measured their competency. All staff were regularly supported by senior staff and the registered manager through staff meetings, supervision and appraisal sessions.

Staff displayed kind and compassionate attitudes and treated people with respect. We saw staff gave people choices and their dignity and privacy was protected.

The registered manager had not yet filled a vacancy for a second activities coordinator which meant people may not always have access to activities which met their individual preferences. The current programme of activities included meaningful and stimulating activities which were mostly offered on a group basis, although some one-to-one support was given by the activities coordinator and care staff. The service continued to welcome families, friends and visitors into the home and supported people to maintain links with the community.

The registered manager held meetings with staff, residents and relatives to gather their feedback of the service. People and relatives told us they knew how to complain and would feel confident to do so. Complaints records showed the registered manager followed company procedures to record, investigate and respond to all complaints or concerns as necessary.

The registered manager maintained records which showed the quality and safety of the service was robustly monitored through daily, weekly and monthly audits.

We last inspected the service in March 2016, at which time we found the provider to be in breach of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Subsequently, the provider sent us an action plan setting out the immediate and on-going improvements they intended to make. This inspection took place on 1 December 2016 and was unannounced.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 kept records which showed the quality and safety of the service was robustly monitored through audits. However one aspect of the management of medicines had not been thoroughly checked. Although improvements had been made to the management of medicines, they were still not completely managed in line with safe working practices. We found that whilst the previous concerns around the storage and disposal of surplus medicines had been addressed, a separate concern was identified.

We found the action plan which was submitted to us following the last inspection had been completed and the safety issues had been addressed. There was continuous action in place to improve the quality of the service.

People told us they felt safe at Collingwood Court and the relatives we spoke with confirmed this. There was a safeguarding policy in place and staff were able to describe their responsibilities with regards to protecting vulnerable people from abuse. More permanent staff had been recruited since the last inspection and additional staff were on shift; agency staff were still being used to ensure staffing levels were appropriate at all times.

Staff now used the company policies, procedures and systems effectively to enable them to provide safe and good quality care. Record keeping had significantly improved. Care plans were thorough, well detailed and personalised. They were regularly reviewed and updated following changes to people’s needs.

Improvements had also been made to the management and monitoring of accidents and incidents. These were now processed without delay into the electronic care records system to enable the registered manager to keep track of people’s well-being and make referrals if necessary to external health and social care professionals.

Emergency plans had been reviewed and updated as necessary and the safety and maintenance of the premises continued to be monitored.

CQC is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements. The registered manager had applied to the local authority for DoLS authorisations for the majority of people who lived at the home. Care records now showed that mental capacity assessments were completed and decisions which were made in people’s best interests had been carried out and recorded in line with the MCA principals.

People continued to be supported by staff to maintain a well-balanced, healthy diet. We observed the kitchen staff followed best practice guidelines and they were knowledgeable about people’s individual dietary requirements.

The provider ensured a corporate induction process was given to all new employees and staff new to the care industry went on to complete a robust induction process which measured their competency. All staff were now regularly supported by senior staff and the registered manager through supervision and appraisal meetings.

We saw staff displayed kind and caring attitudes and treated people as individuals. We heard and observed staff giving people choices. People were respected by staff and their privacy and dignity was upheld.

Most people enjoyed a variety of activities; however some activities were not available to all people. The provider planned to increase the activities provision and a second activities coordinator was being recruited. We’ve made a recommendation that the provider reviews their activities program to ensure it meets the needs of all people who use the service. The staff continued to welcome families, friends and visitors into the home and support people to maintain links with their community.

The registered manager continued to hold meetings with staff, residents and relatives to gather their opinions and feedback about the service. People and their relatives told us they knew how to complain and would feel confident to do so. The provider had a complaints policy in place and the registered manager followed the correct procedures to record, investigate and respond to all complaints or concerns as necessary.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 9, 10 and 11 March 2016 and was unannounced. We last inspected this service in March 2014, at which time we found them to be compliant against all of the regulations that we inspected.

The service had 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 told us they felt safe living at Collingwood Court with support from the staff. There was a safeguarding policy in place and staff understood their responsibilities with regards to protecting people from harm or improper treatment. There were mixed feelings amongst people and staff as to whether there were enough staff employed at the service. We discussed this with the registered manager who told us she was in the process of recruiting more staff; however she felt the care staff had worked hard as a team to ensure the shortages did not affect people’s care.

Policies, procedures and systems were in place to provide support to the staff. We found that staff were not using the systems effectively enough to enable them to provide safe, high quality care. Record keeping required improvement; in particular care plans were basic and brief. In some cases, whole sections of the care plans we examined were blank.

Personal emergency evacuation plans were in place and checks on the safety of the home were routinely carried out by maintenance staff as well as by external professionals where necessary.

Medicines were not always managed in line with safe working practices. We found concern around the storage and disposal of surplus medicines. We observed medicines being administered safely and hygienically and medicine administration records were well maintained and accurate.

Accidents and incidents were recorded manually and passed to the deputy manager to input onto the electronic care records system. We found there was a delay in this process which had led to two people not receiving medical attention and further action to monitor and refer people to other appropriate healthcare professionals had not taken place. We made safeguarding alerts to the local authority regarding several incidents which had taken place recently.

Resident/Relative meetings and annual surveys were used to gather feedback and opinions from people about the home and the service they received.

Evidence showed the registered manager and staff did not have a thorough understanding of the Mental Capacity Act (MCA) and their own responsibilities. Most people living at the home lacked mental capacity and the registered manager had applied to the local authority for deprivation of liberty authorisations. However decisions which were made in people’s best interests had not been carried out in line with the MCA principals.

We saw that people were supported by staff to maintain a well-balanced, healthy diet. We found staff received an induction and were trained; however formal staff supervisions and appraisals were overdue.

People were respected and their privacy and dignity was maintained. Staff displayed kind and caring attitudes and treated people as individuals. Staff gave people choices and encouraged them to make small decisions about their daily life.

We observed people participated in a wide range of activities. The service supported people to maintain links by welcoming family and friends into the home. People and their relatives told us they knew how to complain and would feel confident to do so if necessary.

Staff told us they worked well as a team. They felt supported by the registered manager whom one staff member described as “supportive and approachable”.

The registered manager held records which showed the monitoring of quality and safety of the service through audits. However we found that several high risk issues which had been identified by the registered manager nine months ago were still outstanding at the time of our inspection.

We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

At this visit, we spoke with six people who used the service, the manager and three members of the care staff team. We concluded improvements had been made in respect of the shortfall previously identified.

People using the service were happy with the way they were cared for. One told us, 'It's very good here. Its way above. The staff are brilliant; they bother about people. They ask what you want to do.'

We found before people received any care they were asked for their consent and their wishes and decisions were respected. We concluded that if people did not have the capacity to consent, the provider acted in accordance with legal requirements.

We saw that staff routinely sought people's consent before providing care. However, we concluded that the provider needed to formalise the procedures followed in accordance with legal requirements, where people could not consent to their care. We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found the premises were maintained, secure and suitable for the people who used the service.

People were complimentary about the staff. Comments included, 'They're very good.' We concluded appropriate checks were undertaken before staff began work and effective recruitment and selection procedures were in place.

There was an effective system in place for handling complaints from people. People found the manager approachable and responsive.

We spoke with three people who were using the service. They told us they felt safe at Collingwood Court and said they were treated well. One said, 'It's a good crowd here'.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to train staff and ensure they understood the importance of protecting vulnerable people from harm. Staff knew the importance of reporting concerns and confirmed they had been trained in how to safeguard people from abuse.

People told us they were happy living at Collingwood Court. Comments included, 'it's not bad at all. The girls are very good. They help me whenever possible' and 'It's very nice. I like it here, that's the main thing'.

Relatives we spoke to were also positive about the service. They told us, 'I can go home and know she is safe. I have peace of mind' and 'I have a good relationship with the staff'.

We found that people were treated with dignity and respect and their independence was promoted. People's care and support needs were appropriately assessed and their care was planned and delivered in line with their individual support plans. People were involved in making decisions about their care and their views were sought regularly. A relative said, 'we work together ' it's not them and us'.

We found that staff were appropriately trained and the service had systems in place to monitor the quality of the service it provided. However, we found that there had been a failure to act on a concern expressed by someone living there, which meant people could have been put at risk.