Archived: Isle Court Nursing Home

At the time of this inspection, we did not look at the whole service, we solely inspected the areas that had been identified for the designated setting. This was a further inspection to the service for an additional five beds to accommodate 12 people and seven people were residing there at the time of inspection.

We found the following examples of good practice.

• People residing on the unit identified for the designated setting self isolated in line with current guidance. People were supported by a cohort of staff who worked solely on the self-contained unit.

• People who had tested positive for Covid-19 accessed the home through a separate entrance.

• Where people were required to move through a communal area, such as a corridor, clear procedures were in place to ensure the area was deep cleaned immediately.

• People were supported to communicate with their relatives through telephone and video calls on a flexible basis and there were processes in place to accommodate visits when the need arose.

• People had access to their own individual full en-suite facilities which reduced the risk of transmission of infection.

• People were supported by staff who wore Personal Protective Equipment (PPE) in line with current guidance and were fully trained in infection prevention and control.

• Infection prevention and control audit checks were in place and where actions were identified, they were addressed in a timely manner.

• Risk assessments identified staff who were disproportionately at risk of Covid-19 and appropriate action taken to maintain their safety.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

At the time of inspection, we did not look at the whole service, we solely inspected the areas that had been identified for the designated setting. This unit accommodated seven people and six people were residing there at the time of inspection.

We found the following examples of good practice.

• People residing on the unit identified for the designated setting self isolated in line with current guidance. People were supported by a cohort of staff who worked solely on the self-contained unit.

• People who had tested positive for Covid-19 accessed the home through a separate entrance. Where they were required to move through a communal area accessible by other staff, clear procedures were in place to ensure the area was deep cleaned immediately.

• People were supported to communicate with their relatives through telephone and video calls on a flexible basis. One person liked to speak to their relative multiple times per day so the provider arranged for a direct telephone line to be installed in the person’s room.

• People had access to their own individual en-suite facilities which reduced the risk of transmission of infection.

• People were supported by staff who wore Personal Protective Equipment (PPE) in line with current guidance and were fully trained in infection prevention and control.

• Infection prevention and control audit checks were in place and where actions were identified, they were addressed in a timely manner.

• Staff wellbeing was promoted by the provider and where risk assessments identified staff who were disproportionately at risk of Covid-19, they were not permitted to work on the unit identified as the designated care setting.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Isle Court Nursing Home is a residential care home that was providing personal and nursing care to 57 people aged 65 and over at the time of the inspection. The service can support up to 80 people across four separate units (known as households). One of the units specialises in providing care to people living with dementia.

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

People felt safe with the staff who supported them. People were supported by adequate numbers of staff who had been recruited safely. The provider’s systems protected people from the risk of abuse. People were protected from the risks associated with the control and spread of infection. There were safe systems for the management and administration of people’s prescribed medicines. People received their medicines when they needed them from staff who were trained and competent.

People were supported by a staff team who were trained and competent in their role. 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 lived in a comfortable and well-maintained environment. People were able to personalise their bedrooms. People were provided with meals and drinks which took into account their needs and preferences. People saw healthcare professionals when they needed. Before moving to the home people were assessed to ensure their needs and preferences could be met.

People were supported by staff who were kind, caring and considerate. People were treated with respect and their right to privacy was upheld. People could choose how and where to spend their day. Staff understood and respected people’s right to confidentiality.

There were effective systems in place to monitor and improve the quality of the service people received. People’s views were valued and responded to. The provider worked in partnership with other professionals to ensure people received a service which met their needs and preferences. People were cared for by a staff team who were well supported in their role.

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 4 June 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 and 16 April 2019 where 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 to improve in relation to staffing 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, effective, caring and well-led.

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.

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 changed from requires improvement to good. 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 Isle Court Nursing Home 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 visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Isle Court Nursing Home is a residential care home that was providing personal and nursing care to 61 people aged 65 and over at the time of the inspection. The service can support up to 80 people across three separate units. One of the units specialises in providing care to people living with dementia.

People’s experience of using this service

People were not always supported to have maximum choice and control of their lives. Staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice.

We have made a recommendation people, relatives and significant others are involved in care reviews.

We have made a recommendation that the management team ensure all staff receive formal supervision in line with company policy.

We have made a recommendation that the management team gather people’s experiences of care delivered on all three units of Isle Court Nursing Home.

We received mixed feedback on how people were treated with dignity and respect. People told us staff availability impacted on the care they received but staff were caring. We observed positive interactions and saw staff had a good rapport with people.

Medicines were managed safely. Infection prevention was managed to minimise risk and keep people healthy. Staff had received training on what constituted abuse and the actions to take should it be witnessed. There were robust recruitment procedures to ensure suitable staff were employed.

All staff received induction shadowing and mentoring to promote effective knowledge of their role. The registered manager worked with other agencies to promote positive health outcomes for people. People said the food was good and plentiful, with the appropriate support being offered. Isle Court Nursing Home was well maintained and free from hazards to minimise environmental risks.

Everyone at Isle Court Nursing Home had a care plan. These were under review to ensure people’s long-term needs were appropriately identified. Staff had received training around people’s communication needs. There was a staff member employed to co-ordinate activities for people. These included activities within the home, trips out and arranging visiting entertainers.

During the inspection process the registered manager post became vacant. The registered provider placed a senior manager on site as house manager to provide stability until a new registered manager could be recruited. The registered provider had created a new role of pastoral support co-ordinator to support people, families and staff. The registered provider advertised this role as a listening ear for everyone. Clinical and quality audits monitored the quality and safety of the service.

Rating at last inspection: At the last inspection the service was rated good (published 07 September 2016.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement: Action we told provider to take (refer to end of full report)

We have identified breaches in relation to staff availability to meet people’s needs and good governance to meet all statutory regulations at this inspection.

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 monitor the progress of the improvements working alongside the provider and local authority. We will return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Isle Court Nursing Home is registered to provide accommodation with personal care for up to a maximum of 55 people. There were 54 people living at the home on the day of our inspection. Some people were living with dementia, they lived on the Forget Me Not unit. The home provided a rehabilitation service for up to 10 people to help regain their confidence after a period of ill health or a fall.

There was a registered manager in post who was present during the inspection. 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 and their relatives felt people were safe and well cared for. Staff were knowledgeable about the different forms of abuse and discrimination and how to report concerns. Risks associated with people’s needs had been assessed and guidelines had been put in place to minimise the risks.

Staff knew how to deal with accidents and incidents and these were overseen by the registered manager who took appropriate action to prevent these happening again.

There were enough staff to keep people safe and meet their needs. The provider carried out recruitment checks to ensure prospective new staff were suitable to work at the home prior to them starting work there. Staff felt well supported and received training relevant to their roles.

People were supported to take their medicine as prescribed. Medicines were stored safely and accurate records maintained. Staff monitored people’s health and well-being and arranged health care appointments as and when required to promote good health.

People were impressed with the choice and quality of food provided. People’s nutritional needs were routinely assessed, monitored and reviewed. Staff were aware of people’s dietary and nutritional needs and supported people to feed themselves where required.

Staff sought people’s consent before supporting them. People were provided with information in a way they could understand to help them make decisions. Where people were unable to make certain decisions for themselves, these were made in their best interest by people who knew them well to protect their rights.

People were supported by staff who were considerate and kind. Staff had built up good working relationships with people and their relatives. People were able to spend their time as they chose to and their preferences were respected. Staff treated people with dignity and respect and promoted their independence.

The provider sought people’s views on the quality of the service and were confident that any concerns would be dealt with promptly. The provider had a clear complaints procedure which was followed by staff.

People and their relatives found the registered manager and senior staff approachable. The registered manager provided clear leadership and direction. The provider had systems in place for monitoring the quality of the service and to drive improvements.

During this inspection we spoke in private with people who used the service, staff and visitors. We also spoke with the registered manager.

People told us that they were treated with respect and had their dignity maintained.

Comments included, "Everybody's very kind and helpful'. 'I'm happy here'. 'On the whole it's jolly good'.

Staff had a good understanding of the care needs of individual's living at the home. People were able to participate in discussion and decision-making in connection with their care needs.

People told us they felt safe living at Isle Court. Staff were aware of their responsibilities to remain vigilant and to take action if they had any concerns about the safety or wellbeing of the people using the service.

There were enough suitably skilled members of staff to provide the level of

service that people living at the home required. People using the service told us, 'Staff are very good here'. 'They bring a tray of tea and cakes when your visitors arrive. It makes me feel quite special'.

There was a complaints policy and procedure in place. People we spoke with told us they knew who to raise any concerns with and they felt confident their concerns would be addressed.