Country Court

Country Court is a residential care home providing personal care to up to 34 older people living with dementia. At the time of our inspection there were 25 people using the service.

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

Systems were in place to record, store and receive medicines. However, information to support staff to safely administer medicines was not always available. Staff were trained and supported in their role to administer medicines.

Family and friends were not always involved or kept up to date with the running of the home. We have made a recommendation the provider engages with family and friends and acts on feedback given.

People told us they were safe. Staff had an awareness of safeguarding and knew what to do to make sure people were protected. Risk assessments were person centred and contained enough information to guide staff in their practice.

There was enough competent staff across the service to meet people’s needs. Recruitment processes were robust and appropriate recruitment checks were carried out. A relative said, “Quite a few staff have joined the home, it seems much better.”

Infection, prevention and control was managed well. Some areas of the home required decorating; however, the provider had an action plan in place outlining timescales for further re-furbishment and minor repairs.

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.

The registered manager and staff created a positive culture, that was person centred and empowering. Staff spoke positively about the registered manager and the nominated individual.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 July 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.

We also recommended the provider strengthens their quality assurance and documentation systems. At this inspection we found improvements had been made.

Why we inspected

We carried out an unannounced inspection of this service on 18 May 2021. A breach of legal requirement was found. We undertook this focused inspection to follow up on action we told the provider to take at the last inspection 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.

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.

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. This is based on the findings of the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Country Court on our website at www.cqc.org.uk

Recommendations

We have made a recommendation about the safe management of medicines.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Country Court is a large single storey residential care home providing personal and nursing care to a maximum of 34 older people and people living with dementia. At the time of the inspection 20 people were using the service.

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

Medicines were not always managed well. Some people had missed several doses of medication as these had not been ordered or received in a timely manner. Codes used to identify if medicines had been given were not always consistent.

Quality assurance systems were in place but did not always identify actions which needed to be taken to address shortfalls and ensure people were being supported safely. We have made a recommendation about the quality assurance processes.

People told us they felt safe. Safeguarding processes were in place and staff were knowledgeable about how to raise any concerns.

Care plans and risk assessments for people’s health needs contained detailed person-centred information and informed staff how to manage and mitigate potential risks to people.

Safe recruitment processes were in place. Staff completed an induction, they received relevant training and told us they were well supported by the manager.

People told us they liked the meals provided; They were offered choices and alternatives to ensure nutritional needs were met.

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 had access to a range of health professionals, which included GP’s, district nurses and dieticians, when required.

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 03 February 2021).

At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 03 December 2020. Two 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 safe care and treatment and governance.

We undertook this focused inspection to follow up on specific concerns which we had received about the service in relation to staff training and nutrition and 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 and Well-led which contain those requirements.

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 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 Country 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 will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the management of medicines 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.

Country Court is a residential care home providing personal for up to 34 older people and people living with dementia. At the time of the inspection 25 people were using the service.

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

Medicines had not been managed safely. During the inspection we found gaps on MAR sheets, stock levels were not appropriately managed and protocols where not always in place or did not have enough information for staff to administer ‘as and when’ medicines safely.

There was a clear lack of systems and processes in place to monitor the quality and safety of the service which placed people at risk of receiving a poor-quality service.

Accidents and incidents were not effectively monitored to consider lessons learnt and reduce the risk to people.

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.

The service worked well with local agencies. Staff spoke highly of the manager and felt they were making positive changes to 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

The last rating for this service was good (published 26 November 2018).

Why we inspected

We received concerns in relation to the management of medicines, infection control and staffing. As a result, 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.

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 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 that the provider needs to make improvement. Please see the safe and well-led relevant key question 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 Country 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 will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines and governance 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 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.

Country Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Country Court accommodates up to 34 older people who may be living with dementia in one adapted building. At the time of our inspection 33 people were using the service.

There was a manager in post who registered with CQC in May 2018. 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.

Although a quality assurance system was in place, further development of this was required to ensure systems within the service were being operated effectively. Further auditing was required to ensure meetings with staff to discuss work performance (supervisions) were carried out in line with the providers policy. Actions from surveys completed by people using the service and their relatives needed to be developed, to demonstrate what had been put in place following people’s feedback. We recommend the quality assurance systems are developed further to ensure these are robust.

Medicines were managed in a safe way and people received them as prescribed. People using the service and relatives confirmed that staff were caring and looked after people’s health and nutritional needs well. Risks to people’s health and well-being were monitored and health care professionals were contacted for their help and advice when required.

People’s dietary needs were met. Food served looked appetising and nutritious. Staff provided support to people at mealtimes in a patient and sensitive way.

People’s care records were personalised and staff were aware of their preferences for care and support. People’s communication needs were known by staff and people were provided with the care, support and equipment they needed to remain independent.

There were sufficient staff to meet people’s needs and staff recruitment processes were robust. Staffing levels provided met people’s needs and they remained under review by the management team. Staff understood their responsibilities to protect people from harm and abuse. They had completed safeguarding training and had policies in place to guide them. Staff had access to a range of training. Accidents and incidents were safely monitored and appropriate action taken where this was required.

People told us staff respected their privacy and promoted their dignity. People using the service had their end of life wishes detailed within their care plans. Observations showed staff were compassionate, kind and caring and had developed good relationships with people using the service and knew people well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, policies and procedures in the service supported this practice.

A range of in house activities was provided and based on people’s preferences. People were supported to maintain relationships that were important to them.

The provider had a procedure for receiving and dealing with complaints. Issues raised were used as learning to improve the service provided. Staff spoken with were fully aware of their responsibilities in supporting people if they needed to complain about the service they received. People using the service had access to an advocate.

People using the service, relatives and staff told us the registered manager was approachable and supportive.

We gave feedback to the provider and the registered manager at the end of the inspection. The registered manager reviewed the supervision documents where we had identified that eight members of staff had not received supervision in line with timescales set in the providers policy. Following the inspection, the registered manager provided us with a plan for when these supervisions had been arranged for these members of staff.

This inspection took place on 24 March 2016 and was unannounced. The service was last inspected August 2013 and was found to be compliant with the regulations inspected at that time.

At the time of the inspection 33 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service was run.

People were cared for by staff who had received training in how to recognise abuse and how to report this to the proper authorities. They understood the importance of protecting people from abuse and knew what signs may be apparent if someone was the victim of abuse. Staff who had been recruited safely were provided in enough numbers to meet the needs of the people who used the service. The service was clean and tidy and there were no malodours. People’s medicines were safely handled by staff who had received training.

People who used the service were provided with a varied and nutritional diet which was of their choosing. Information had been recorded about people’s likes and dislikes and this was catered for by the cook. Staff closely monitored the nutritional intake of the people who used the service and made referrals to dieticians when needed. People were weighed on a regular basis. Staff had received training which equipped them to meet the needs of the people who used the service and this was updated regularly. People’s fundamental human rights were protected and legislation was used to protect people if their liberty needed to be compromised for their own safety.

People who used the service were cared for by staff who understood their needs and were kind and caring. Staff understood the importance of respecting people’s privacy and dignity, and encouraged people to remain as independent as possible. People who used the service or their representatives had been involved with formulating their plan of care and had been involved in reviews about their care.

The registered provider had a complaints procedure which was displayed in the service and provided in the ‘Statement of Purpose’ and the ‘Service User Guide’. This informed people who used the service or other stakeholders they could use the complaints procure if they wished to raise any concerns. All complaints were investigated to the complainants’ satisfaction and information was provided about other agencies to contact if the complainant was not happy with the way their complaint had been investigated. People were provided with a range of activities to pursue both in-house and in the local community. Information was available for staff to refer to which described the person and their preferences about the way they would like to be supported and cared for.

The registered manager undertook audits which ensured the service was well run. People who used the service and other stakeholders were asked for their opinions about how the service was run.

People were provided with a varied diet and their choices were respected. People told us they were happy with the food. Comments included; 'The food is really good', 'You just can't fault it' and 'My favourite is fish and chips, we have this every Friday.'

The environment was clean, tidy and free from clutter. People who used the service were satisfied with the level of cleanliness; comments included, 'I came here because it was nice and clean and it has a homely feel.'

There were enough staff on duty to meet people's needs. Staff had also received training which equipped them to meet people's needs. People who used the service were happy with the care provided; comments included, 'I just have to ring my buzzer day or night and the staff are there to help me', 'There are always enough staff on duty and they never rush me' and 'The staff are fantastic they help me to stay independent.'

There was a complaints procedure displayed in the home. Complaints were recorded and resolved where possible to the person's satisfaction. People who used the service knew they had a right to complain or raise concerns with the management team.

We found that staff had access to information about how to meet the needs of the people who used the service and this was updated as people's needs changed.

We found that people were protected from abuse and staff had received training about how to identify and report any issues they may witness or become aware of. People told us they felt safe at the home and were confident concerns would be supported by management. Comments included, 'I feel really safe here and the girls are so kind and caring' and 'I would go and see the manager or tell the staff if I had any concerns.'

We found that staff had received training about how to care for the people who used the service and this was updated regularly.

We found that people who used the service could have a say about how the home was run. Other people who had an interest in the welfare of the people who used the service were asked for their views as well.