James Dixon Court

James Dixon Court is registered to provide residential care to up to 30 people with a variety of mental and physical health needs. At the time of our inspection 11 people were living at the service.

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

At our last inspection the provider had failed to ensure medicines were administered safely. We also found governance systems were not effective at ensuring regulations were met. We issued warning notices in relation to these breaches of regulation. Enough improvement had been made at this inspection and the provider was no longer in breach of Regulations 12 and 17.

Staff demonstrated kindness and respect in their interactions with people. It was clear they knew people well and provided care in an individualised manner. Individual and environmental risks were regularly monitored and reviewed. Medicines were stored and administered safely by competent staff. Where errors occurred, they were identified by the provider’s own systems and appropriate action was taken to reduce risk. The provider was developing systems and practice to generate further improvements. Accidents and incidents were analysed to identify patterns and trends and reduce risk. People and their relatives told us they felt the service was safe. Staff were safely recruited and deployed in sufficient numbers to keep people safe and meet their needs.

After the last inspection an action plan was submitted to CQC which included timescales for improvement. The necessary improvements were completed in accordance with this plan. The new management team worked closely with the local authority and CQC to ensure improvements were sustained. The service had robust and effective systems in place to monitor, assess and improve the safety and quality of service being provided. The management team were open and supportive during the inspection. Where minor concerns were identified they took immediate action to improve practice.

Rating at last inspection and update:

At the last inspection the service was rated requires improvement (report published 22 August 2019).

During the last inspection we found breaches of Regulations 12, and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 23 July 2019. Breaches of regulations were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained 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 James Dixon Court on our website at www.cqc.org.uk.

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 coronavirus and other infection outbreaks effectively.

Follow up:

We will meet with the provider to discuss our findings and how they will make changes to ensure they improve their rating to at least good. 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.

James Dixon Court is a residential care home providing personal care to 22 people at the time of the inspection. The service can support up to 30 people. The building is on one level and is used to provide services to people with both long-term and short-term care needs.

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

Medicines were not safely managed in accordance with the relevant guidance. Some care records were incomplete which meant that people were at risk of receiving care which did not meet their needs and preferences.

Processes for monitoring and improving the quality and safety of care were not robust. Important information was missing from care records and other information had not been regularly reviewed. Audits and other management processes had failed to address a wide range of concerns identified during the inspection. The action plan developed after the last inspection had not been properly implemented in accordance with the agreed timescales.

You can see what action we have asked the provider to take at the end of this full report.

Records did not always identify individual risk or instruct staff on safe practice. Risk in relation to emergency evacuation was not regularly assessed. Records relating to the management of environmental risk, for example the testing of emergency lighting, were not always completed in accordance with the provider’s schedule. There was no clear system in place for reviewing accidents and incidents which would reduce the level of risk going forward. We made a recommendation to improve practice.

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. However, the records relating to the assessment of capacity and decision-making were not completed to a consistent standard. We made a recommendation to improve practice.

We received mixed feedback regarding the choice of food and found people’s needs and preferences for food and drinks were not always met. We made a recommendation to improve practice.

The process for receiving and acting on complaints and concerns was not robust. We were told by some relatives they had raised concerns and made complaints in the past. Most people said they received a satisfactory response. However, only one complaint was recorded in 2019. We made a recommendation to improve practice.

People expressed their satisfaction with the way staff provided care and spoke positively about them. However, we saw evidence people were not always treated with care and respect. For example, leaving people without access to pain relief and failing to ensure they were properly hydrated.

Staff were deployed in sufficient numbers to meet people’s needs. However, some recruitment records were not maintained in accordance with legislation.

Visiting professionals spoke positively about the staff and how they supported people with their healthcare needs. James Dixon Court provided ‘reablement’ services to people who needed care and rehabilitation following a stay in hospital. We saw evidence that this aspect of the service had been successful in supporting people to return to their homes.

Information was available in a range of formats to help people understand. Staff told us they knew people’s preferred methods of communication which was recorded in most care records.

People were encouraged to maintain relationships and take part in activities. We received mixed comments regarding the activities available to people.

The service did not provide sufficient evidence of improvement since the last inspection. More work is required to achieve consistently good outcomes. Throughout the inspection managers were open and responsive when concerns were identified.

Staff took time to speak with people and discuss options before providing care or activities. Staff were attentive and supported people in a timely manner to promote their privacy, dignity and independence.

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 8 March 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for both inspections since a new provider assumed legal responsibility for the service.

The inspection was prompted in part due to concerns received about the administration of medicines. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

Enforcement

We have identified breaches in relation to the management of medicines, management of risk, record-keeping and audit processes at this inspection. We having issued warning notices in relation to the breaches. Full details can be found at the end of the full version of this report.

Follow up

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 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.

James Dixon 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.

James Dixon Court a residential care home for 30 people. It is a purpose built, single storey building, situated in a residential area of Netherton, close to local facilities and transport links. The service provides long term care for people; placement for people who require support on a short-term basis, whilst awaiting long term care; support at an alternative care service; or return to their own home. The service’s own staff support people with this placement, along with the local authority and other external health professionals, such as an occupational therapist.

A registered manager was 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.

During this inspection we found the provider was in breach of Regulation 12 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Regulation 12 was in respect of unsafe administration of medicines and Regulation 17 for concerns around the completion of records pertaining to care and the service’s governance arrangements.

Risk assessments were needed to protect people from the risk of harm and to support people’s plan of care. We found examples where risk assessments were not accurate to reflect current risks and the support needed to keep people safe.

People had a plan of care to support their care needs. The plan of care did not always record the care and support they needed, or had been updated to reflect relevant changes. It is important that information is recorded clearly and correctly, so that staff can safely, effectively and consistently support people with their current needs.

We found the service’s monitoring arrangements for a number of key areas of the service were not all robust and effective. For example, we raised concerns regarding the completion of people’s care documents, analysis of accidents and incidents, staff supervisions and safe administration of medicines. We were not fully assured by the governance to maintain standards and drive forward improvements.

Formal feedback from people who used the service and relatives was limited as they had not attended any recent meetings or given the opportunity to complete quality surveys to share their views about the home. The registered manager informed us quality surveys would be sent out in the near future and residents/relatives' meetings were planned this month. People and relatives told us the registered manager was approachable and they could meet with them any time.

Recruitment checks were carried out to ensure staff were suitable to work with vulnerable people.

Staff received induction and training to guide them in their role. .

There was enough staff to meet people's needs and keep them safe. Our observations showed calls for assistance were answered promptly.

People and their relatives said they received safe care and attention in accordance with their individual needs.

Our observations showed staff were kind, caring, polite and patient when looking after people. Support was given in a safe manner. Many staff had been at the service for a long time and knew people well. People and relatives spoke positively regarding the staff team.

People told us they felt safe and well cared for. Systems were in place for safeguarding people from the risk of abuse and reporting any concerns that arose. Staff had received training and staff we spoke with were clear about the need to report any concerns they had.

The registered provider worked in accordance with the Mental Capacity Act (MCA) 2005 and staff demonstrated a good knowledge around how this was applied in a care setting. Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act (MCA) 2005 were followed in that assessment of the person's mental capacity was made to protect them. This included applications to the local authority for a Deprivation of Liberty Safeguard (DoLS) for people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Arrangements were in place for checking the environment and equipment was safe and well maintained. For example, health and safety audits were completed where obvious hazards were identified and contracts were in place for utilities, such as gas and electric.

We found the environment to be clean and free from any odour. Staff had access to protective clothing such as, gloves and aprons to support the control of infection.

People’s nutritional needs were assessed and monitored. People told us the food was good and they enjoyed a varied menu.

The registered manager worked effectively with a range of other professionals to achieve good outcomes for people. People, relatives and staff spoke positively regarding the registered manager’s management of the home.

The service had a complaints policy and procedure. People living at the home and their relatives told us they would feel confident to raise a concern.

The service planned to provide end of life care that was respectful and dignified for people.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory notifications.

You can see what action we took at the back of this report.