We carried out a review of the data available to us about Comfort Call - Monica Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Comfort Call - Monica Court, you can give feedback on this service.
Comfort Call Monica Court is an extra care scheme located in Salford, Greater Manchester. Two other extra care schemes form part of the registration called Mount Carmel and Moores House. Extra care schemes operate in purpose-built properties, which provide accessible and safe housing for older people to live independently. At the time of the inspection, 135 people were using the service.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Staff had received training in safeguarding people. People were protected from the risks of abuse and harm and people said they trusted staff to keep them safe. People's care needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. Accidents and incidents were recorded and monitored. Medicines were managed safely. People told us they felt supported with their medicines.
Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults.
The provider used an electronic system to determine staffing levels. The provider operated an on call system for staff support during evenings, overnight and weekends.
Governance systems were in place to monitor the standard of care people received. Regular audits of people's care plans, daily communication records, staff files and schemes took place. Staff praised the registered manager and wider management team, they felt supported in their roles.
Person-centred care was promoted. The manager and staff demonstrated a commitment to people, and they displayed person-centred values. People’s views and decisions about support were incorporated in their care plans. The service worked in partnership with other health and social care organisations and the community to achieve better outcomes for people using the service.
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 requires improvement (published 9 September 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
We received concerns in relation to staffing and the management of accidents and incidents. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from requires improvement to good based on the findings of this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
People’s experience of using this service and what we found
People did not receive their medication safely. Staffing levels had been increased during the night at Monica Court since our last inspection, however some of the feedback we received was that there were not enough night staff at Moores House. The registered manager informed us talks were underway with the local authority to recruit an additional staff member at night.
Auditing and governance systems were in place, however further improvements were required to ensure regulatory breaches identified at the previous inspection were rectified so the service could improve, particularly regarding medication.
People living Monica Court and Moores House and their relatives, told us they felt Monica Court was a safe place to live. Safeguarding allegations were reported to the local authority for further investigation and staff knew how to recognise potential safeguarding concerns. Safe infection control practices were followed and we observed staff wearing correct PPE throughout the day.
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 requires improvement (published February 2021) and the provider was in breach of regulations relating to good governance and staffing. At this inspection, not enough improvement had been made and the provider was still in breach of some regulations.
Why we inspected
We carried out an announced comprehensive inspection of this service in November 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when improve.
The inspection was also prompted in part due to concerns received about medication, people not receiving personal care and management/leadership. The concerns raised were specifically relating to the Moores House scheme. A decision was made for us to inspect and examine those risks.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.
Prior to this inspection we reviewed the information we held about the service. No areas of concern were identified in the other key questions (Effective, Caring and Responsive). We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We looked at infection prevention and control (IPC) measures under the Safe key question. We look at this at all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively. We only looked at certain aspects of infection control practices however, due to the building being managed by a housing provider who is not registered with CQC.
The overall rating for the service remains 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 Comfort Call Monica Court on our website at www.cqc.org.uk. You can see what action we have asked the service to take at the end of this report.
Follow up
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Enforcement
We have identified breaches in relation to good safe care and treatment and good governance. Please see the action we have told the provider to take at the end of this report.
Monica Court is an extra care scheme, there are two other extra care schemes attached to this registration, Mount Carmel and Moore's House. Extra care scheme's operate in purpose-built properties, which provide accessible and safe housing for older people who are unable to live completely independently. Each person lives in their own flat but has access to a shared lounge and communal dining area. Not everyone who used the service received personal care. Care Quality Commission (CQC) only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
The service had policies and procedures in place for the safe administration and use of medicines. However, these were not always followed. Medicines administration records (MARs) did not always clearly indicate if the dose of medicines administered was in line with the prescriber's instructions. People we spoke with told us they received medicines safely and on time.
Peoples records were not always up to date and we found gaps in repositioning charts and food and fluid charts, although when we reviewed people’s daily notes, we found these tasks were taking place.
Mental capacity assessments had not always been completed for individuals that may lack capacity. People were not always supported to have maximum choice and control of their lives and staff did not always 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.
Safeguarding policies and procedures were in place and staff knew how to access these. Safeguarding referrals were made when needed, however, lessons learned were not always taking place.
Peoples care records showed that risk assessments had been completed for various aspects of care but, there were no personalised COVID-19 risk assessments in place.
People told us they did not always feel the service was adequately staffed. For example, there were inadequate numbers of staff on duty at night time.
The service had adequate supplies of appropriate personal protective equipment (PPE) meaning that people were better protected against the risk of infection.
Relevant notifications were being sent to CQC for notifiable events.
Most staff told us they felt supported in their role and they enjoyed their work.
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 16 November 2018)
Why we inspected
We looked at infection prevention and control measures under the Safe key question. We look at this in all care settings even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
We undertook a focused inspection to review the key questions of safe and well-led only.
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 in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
We have found evidence the provider needs to make improvement. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Comfort Call - Monica Court on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.
We have identified breaches in relation to good governance and staffing at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will 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.
Monica Court is an extra care scheme, there are two other extra care schemes attached to this registration, Mount Carmel and Moore's House. Extra care provide accessible and safe housing for older people who have their own self contained flats and have access to a shared lounge and dining room if they wish.
At the previous inspection in August 2017 we had rated the service as requires improvement in two of the key questions, and overall. This was because we had identified a breach of the regulations in relation to governance. Following this the service had submitted an action plan which identified the actions they planned to take and by when, to ensure the two key questions improved to at least good. We found there had been significant improvements in the areas we had been concerned about and the service was no longer in breach of the regulations.
There were clear safeguarding policies and procedures in place, we could see the service had followed these when required. Staff we spoke with knew what might be safeguarding concerns and how they should raise them. This ensured people continued to be protected from the risk of harm and abuse.
People were supported to manage the risks in their daily lives. Where a person needed support to manage risk there was an assessment which identified the level of risk and a management plan to minimise the potential for harm to occur. People were supported in ways which had the least restrictive impact on their independence.
People living in the service told us they thought there were enough staff to support them safely. Staff we spoke with told us they always had enough time to support people safely, including those needing two people to support them to transfer. Some staff said they would have preferred to spend more time with people.
People who wanted to manage their own medicines were supported to do this safely. There were risk assessments completed to help identify the level of independence a person had, which were reviewed regularly to reflect any changes in a person's needs. Some people were supported by the service to manage their medicines. We found there could be some improvement made in relation to some aspects of this and have discussed this further in the safe domain. We were confident no one had experienced any harm.
There was personal protective equipment including gloves, aprons and hand gel available throughout the communal areas and in individual flats. This ensured people were protected from the risk of infection.
To ensure the service could be confident they could support people effectively, their needs had been assessed before they were accepted into the extra care scheme.
Staff received regular training in all the key areas required. There was additional training available for staff to improve their knowledge around areas of interest.
Supervision was provided regularly in accordance with the services' policy. The registered manager also provided additional themed supervisions when a member of staff needed support to improve their practice.
The team continued to work with their partners in housing, other extra care schemes and community based health professionals to ensure effective communication.
People were supported to maintain their health and wellbeing and, where required, had support to maintain their nutrition.
People living in the service told us the staff were kind and caring. Relatives we spoke with also praised the caring attitude of the staff. People were supported to maintain their independence and to make choices about their care. Many people continued to manage their own affairs and come and go from the service when they wished.
People received personalised care that was responsive to their needs. Care plans included details about what was important to the person and their preferences.
People were encouraged to raise their concerns through a variety of forums. There was a complaints process, however, most of the concerns people expressed had been responded to before becoming a formal complaint.
People living in the service and their relatives told us they thought it was well managed and they were able to approach the manager and the management team at all times.
Staff told us they were happy to work at Monica Court and praised the management team. Staff were aware of their responsibilities and the standard of professionalism expected of them. Staff spoke about how important their role was to them and how much they valued supporting people living in the scheme.
Regular audits and checks had ensured good governance. The registered manager had oversight of any issues as they arose and had an effective system in place to manage them.
The service continued to work in partnership with other organisations to improve and develop the service.
Monika Court Extra Care Scheme is the registered provider, however, attached to this registration are two more extra care schemes which are Mount Carmel and Moore’s house. Extra care scheme’s operate in purpose-built properties, which provide accessible and safe housing for older people who are unable to live completely independently. Each person lives in their own flat but has access to a communal room and dining area where their meals are prepared for them if they wish.
At the time of the inspection there was a manager at the service who had been in post since March 2017. 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.
Medicines were not always administered safely and accurate medicines records were not always completed effectively.
People told us they felt safe in their homes and staff had the correct skills to support them safely and effectively with their daily routine. People told us they received their care in line with their care plans and didn’t feel rushed.
Staff were knowledgeable around how to keep people safe and promote positive risk taking. They also knew how to respond to any concerns or safeguarding events, giving examples of when to raise concerns and whom to.
Staff had a sound knowledge around the needs and requirements of the people they supported and understood the importance of ensuring person centred care was delivered. Staff received a suitable amount of training appropriate to their roles and were confident that if additional training was needed this would be arranged.
The service ensured suitable risk assessments were in place to safeguard people using the service and its staff and visitors from risks which may be apparent from people’s household appliances, furniture, floor coverings and cleaning fluids. The service also liaised with the land lord of the scheme to ensure the building was in a good state of repair.
Staffing levels were sufficient to enable safe and personalised care and support to be provided to people using the service. Comments from people using the service and staff supported this.
Recruitment procedures were implemented to ensure appropriate steps had been taken to verify new employee's character and fitness to work. Induction processes ensured staff had the correct amount of support and training prior to commencing the role unsupervised. People we spoke with felt staff were knowledgeable about their support needs and cared for them effectively. Staff demonstrated a good understanding of their role and how to support people based on their individual need's and in a person centred way.
People had individual care files containing support plans, risk assessments and other relevant documentation. These records ensured clear information about people's needs, wishes, feelings and health conditions were documented. Daily log sheets were completed to ensure information was communicated between staff and people’s families.
Staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and the service had systems in place to protect people’s rights. We saw that people's capacity to make their own decisions and choices was considered within the care planning process. This was in line with the Mental Capacity Act 2005 (MCA) which provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves.
People we spoke with and staff told us the manager was approachable and we noted there was always a senior person in each of the schemes. An ‘on call system’ was operated to deal with any emergencies out of office hours. People told us any concerns they had were dealt with appropriately.
The service had quality assurance systems in place which monitored the effectiveness of the service. Audits were completed weekly, fortnightly and monthly and in addition to this quality assurance inspections were completed three monthly by the service quality team.