Courthill Care Home

Courthill Care Home is a residential care home providing accommodation and personal care to three people with a learning disability and people aged 65 and over at the time of the inspection. The service can support up to six people in one adapted building.

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

People told us they felt safe and that staff were kind and caring towards them. People told us they felt supported with their healthcare needs and we confirmed this from records we reviewed.

People received their medicines on time and were supported to take their medicines independently should they wish to. The registered manager was undertaking a regular analysis of the reason ‘when required’ medicines were administered and healthcare professionals were involved in people’s care.

There were sufficient and suitably skilled staff at the service to support people with their needs. Staff were aware of risks associated with people’s care and the steps they should take to provide people with the most appropriate care.

Care and risk management plans were recorded in a comprehensive and person-centred manner. Safety checks of the premises and equipment had been undertaken and plans were in place to protect people in the event of a fire.

We were assured the service were following safe infection prevention and control procedures to keep people safe.

Staff were supervised and told us they felt supported by the management team. Staff were clear on the governance structure of the service and knew their roles and responsibilities.

There were systems in place to monitor the quality of care provided. People and relatives told us they knew how to complain and were confident concerns would be listened to and addressed by the provider.

Staff told us they felt able to approach the provider to discuss any ideas they may have to improve the service. We received feedback from healthcare professionals who told us the service worked in partnership with them to ensure people were able to access appropriate healthcare services.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions of safe and well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were supported with their independence. Staff had an understanding to enable people to live fulfilled lives.

Right support:

• Model of care and setting maximises people’s choice, control and independence

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives

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 February 2019). There were no breaches of regulation. At this inspection we found improvements had been made and the rating has now improved to good.

Why we inspected

This focused inspection was prompted by our data insight which assesses potential risks at services, concerns in relations to aspects of care provision and based on the rating at the last comprehensive inspection.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Courthill Care 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.

We found the following examples of good practice.

The provider had created a designated visiting room in a detached building in the garden. This meant relatives did not need to enter the residential areas of the care home when visiting. All visitors were provided with a rapid test for COVID-19 and were required to produce a negative result before entering the designated room.

Staff had worked together with the local GP practice link nurse to ensure people had access to regular medical treatment throughout the pandemic. Staff had completed infection prevention and control training delivered through the local clinical commissioning group (CCG).

Courthill Care Home is a care home without nursing providing personal care to up to six people living with learning difficulties and autism. At the time of the inspection four people lived at the home.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people who used the service could live as full a life as possible and achieved the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

Risks to people were not always consistently assessed and managed which could put them at risk. The provider’s personal emergency evacuation plans in conjunction with the fire policy and procedures did not provide staff with clear guidance on how to support people in the event of emergency. Staff were not reporting behavioural incidents as per the guidance in people’s support plans. Hence the behaviours were not analysed for any patterns or lessons learned.

The provider’s audits did not identify issues we found during our inspection such as lack of reporting of incidents, inconsistencies in records or actions needed around support with communication. The systems and processes were not robust enough to demonstrate the provider effectively monitored the quality and safety. This meant actions were not always addressed to reach best outcomes for people and continuously improve in line with legal requirements and national best practice guidance.

Following our inspection, the provider took action to review and improve their records and governance systems.

People felt safe at the home and staff knew how to protect them from abuse. The provider had safeguarding and whistleblowing policies in place and adhered to the local authority’s guidance.

Staff supported people to take their medicines as prescribed, and the provider had processes and systems to safely order, store and monitor medicines stock. Staff knew how to protect people from the spread of infections and were trained in infection control.

Staff supported people in person-centred manner. Care plans were personalised and included information on people’s needs, life story, interests and identity. Individual behavioural support plans provided detailed guidance for staff on how to support people when they were distressed. People were encouraged to live active lives and participate in activities matching their interests.

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. Staff asked people for their choices and involved them in their care.

The service applied the principles and values of Registering the Right Support. These ensured that people who used the service could live as full a life as possible and achieved the best possible outcomes that included control, choice and independence.

People were supported to eat healthily. Referrals were made to health care professionals where required and staff followed their guidance to ensure people received appropriate care.

Staff knew people well and addressed them in caring and respectful way. People were offered the opportunity to provide feedback and felt listened to.

Staff confirmed they felt supported by their manager and the provider. Staff were offered regular training and opportunities to develop their professional qualifications to be able to better support people. Multidisciplinary reviews of people’s care confirmed that this reduced people’s levels of anxiety and enabled them to live more active lives.

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 17 January 2019) and there was a breach of regulation 9 (Person centred care) 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 we found improvements had been made regarding person-centred care planning and the provider was no longer in breach of this regulation.

However, the service remains rated requires improvement. At this inspection we found evidence that further improvements were required. The provider’s quality and safety monitoring systems were not always effective in identifying actions needed to provide consistent and clear guidance for staff and ensure continuous improvement of the service. Following the inspection, the registered manager updated the records and took action to improve governance. We found no evidence during this inspection that people were at risk of immediate harm from these concerns. You can see what action we have asked the provider to take at the end of this full report.

This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan from 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.

Courthill Care Home 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.

Courthill Care Home accommodates up to six people in one adapted building. Care is delivered across two floors and people have access to a garden and sensory room. At the time of our visit, there were four people living at the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. The service was not too large and met the principals outlined in Registering the Right Support. However, we did identify areas for improvement around how people’s care and activities are planned. These are detailed within the Responsive domain.

There was 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’s care was not always planned in a personalised way. At the time of our visit, new care plans were being implemented in response to concerns raised by the safeguarding team. Whilst these records were detailed, there was a lack of evidence of people being involved in these. We also identified missed opportunities to support people to find new activities and express choices about their care. Care planning for end of life care was not taking place, although the registered manager told us they intended to introduce this following our visit.

People’s dietary needs were met and people liked the food they were served. Some improvements to how people were involved in menu planning were underway at the time of our visit and put in place following the inspection. We identified the provider could improve the way they reached out to the local community to create a more holistic approach to people’s care. We made a recommendation about community links.

People were supported by a consistent staff team who knew them well, which minimised the impact of some of the issues identified regarding care plans. Staff provided support that encouraged people to develop skills and independence whilst maintaining a good understanding of any risks. Where risks were identified, plans were in place to guide staff about how to keep people safe. Staff understood their roles in safeguarding people from abuse and the provider had carried out checks on staff to ensure they were suitable for their roles.

People were supported to access healthcare services when required and we saw evidence of healthcare professionals input to care plans. There was a system in place to ensure people received an assessment of their needs before coming to live at the service. People’s medicines were managed and administered in line with best practice, with detailed guidelines to inform staff about how and when to administer medicines to people.

Staff felt supported by management and there were a variety of checks and audits in place to monitor the quality of the care that people received. There was an ongoing plan to improve the service and this inspection found a number of improvements implemented, with some yet to be fully addressed. The registered manager knew when to notify CQC of important events such as deaths, injuries or allegations of abuse.

Courthill Care Home is a residential care home providing support to up to six people with learning disabilities and autism. At the time of our inspection there were six people living at the home, some of whom also had physical disabilities and mental health conditions.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Responsive and Well-led to at least good. The provider told us they would introduce additional monitoring of risks, audits to improve oversight and governance at the home and introduce more in-house activities for people. We found that these actions had been implemented by the provider when we visited.

Courthill Care Home 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.

Courthill Care Home accommodates 6 people in one adapted building.

There was a registered manager in post, but they were on leave on the date of our visit. 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’s care was planned in a person-centred way that reflected their interests and needs. Staff routinely assessed risks to people and plans were implemented to keep people safe, whilst encouraging their independence. Staff encouraged people to develop skills and confidence. People’s needs and risks were regularly reviewed to identify and respond to any changes. Where incidents had occurred, staff took appropriate actions to keep people safe. Staff had a good knowledge of safeguarding adults procedures. There was a complaints policy in place and people were regularly informed about how to raise concerns.

There was a variety of activities taking place at the service. People had individual activity plans and the provider had introduced a variety of in-house activities. People were involved in their care and were given opportunity to feedback on areas such as activities and food. Meals were provided in line with people’s preferences and staff involved people in shopping and menu planning. People’s legal rights were protected because staff followed the Mental Capacity Act (2005).

People were supported by kind and caring staff that had appropriate training for their roles. Staff completed training courses and these were regularly refreshed. Staff felt supported by management and had regular meetings to provide suggestions to improve the home. There were sufficient numbers of staff to safely meet people’s needs and the provider carried out checks on new staff to ensure that they were suitable for their roles. Staff knew people well and were respectful of people’s privacy and dignity when providing support to them.

People’s healthcare needs were met. Staff supported people to attend appointments and maintain their health. People received their medicines safely and in line with the guidance of healthcare professionals. Staff followed good practice in relation to infection control and regular checks were undertaken in this area. The provider carried out a variety of audits to identify improvements at the service. There was an ongoing plan to improve the service for people.

On the day of inspection we met the 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 inspection took place on 1st November 2016.

We found a breach of regulation. You can see what action we told the provider to take at the back of the full version of this report.

People and relatives said that Courthill Care Home was a safe place to live. Despite this we found a lack of managerial oversight of people’s overall support. We found examples where concerns with people’s support had not been pick up by the registered manager. This put people at risk of not receiving the care and support they needed.

We found that patterns and trends relating to epileptic seizures had not been picked up. These patterns and trends could have been used to manage risks more safely for this person.

Although relatives praised the activities that were offered to people the registered manager had failed to pick up that a person had not attended a favourite activity for a month. On the day of inspection we observed a lack of stimulating in-house activities for people.

We have recommended that the home review their in-house activities for people.

Staff supported people who were at risk of becoming anxious and distressed and staff responded to their needs and effectively reduced the impact of behaviours that may challenge. Staff understood how to report suspected abuse so that action could be taken if necessary. Incidents and accidents were reported and the registered manager reviewed reports to prevent them from re-occurring. When risks to people had been identified they were appropriately managed. People had risk assessments that staff followed to minimise risk and keep people safety.

Risk assessments had been completed to ensure the home was safe for people to live in and there were arrangements in place should there be an emergency. People were supported by sufficient numbers of staff who were recruited safely and had the skills and knowledge to support people.

People received medicines in a safe way. Staff had a good understanding of the medicines they were supporting people to take and medicines were stored and disposed of appropriately.

Staff had the knowledge and skills to support people with learning disabilities and understood how to support people who may display behaviours that challenge. Training was available to staff, which included training courses related to people’s needs.

Staff had regular supervisions with their line manager and felt supported in their role. The registered manager used supervisions and team meetings to ask supportive questions of their team to assess their knowledge.

The requirements of the Mental Capacity Act (MCA) were being met. Staff had a good understanding of MCA. The registered manager had submitted Deprivation of Liberty Safeguard applications, one of which had been granted and five being processed. Staff worked in line with the details of the applications that were still being processed to ensure an effective and safe service was being provided to all that was in line with best practice principles.

People’s nutritional needs were met and people had a varied diet. Staff ensured that people had enough to eat and drink. Staff ensured people were supported to maintain their health and wellbeing and people received support from healthcare professionals when required.

People were cared for by staff. People were not rushed by staff and were treated with dignity and respect. People were encouraged to maintain relationships with their family and those that mattered to them.

People were encouraged to be involved in how the home was run and people and relatives felt comfortable in raising a concern or making a complaint. Feedback from people and relatives was asked for on an annual basis. This feedback was very good.

The home was led by a registered manager who was a positive role model. An organisational value of providing ‘excellent care to clients with trained staff’ was understood by the staff team. The registered manager was approachable and visible. Relatives and staff said they would approach her if they had any concerns.

Some of the people who used the service had more complex needs which meant that they were not able to tell us about their experiences of using the service; we therefore used our observations to help inform our judgements. We observed staff interacting with people who used the service in a respectful manner, calling people by their first names and promoting their dignity and privacy.

People who used the service appeared relaxed, content and at ease in their surroundings. We found the property to be in a good state of repair. Following our inspection the provider took action to address the fact they were not routinely screening their water system for the presence of legionella bacteria.

Records demonstrated that staff had been well trained, knew how to meet the individual needs of people and provided care which was consistent with people's care plans.

The provider also demonstrated robust procedures for effectively monitoring the quality of the service to ensure that people received safe and appropriate care and support.