Connaught Court is a large detached building set in well maintained gardens and owned by the Royal Masonic Benevolent Institution. It provides residential and nursing care to men and women who are freemasons, or their dependants. The home provides nursing care or help with personal care. The service also provides care to people living with dementia. The building is on three floors, with lifts to access the different areas. All the people living at Connaught Court have access to outside space. The two dementia units have safe, well maintained gardens where people can walk at any time. The service can accommodate up to 90 people in four separately staffed units. There are 15 beds on Viking, the nursing unit; 16 on Knavesmire, a dementia care unit, 10 on Fred Crossland, a second dementia care unit and 49 beds on the residential unit, which is sub-divided into Fairfax, Ebor and Yorvik. The needs of people living on Knavesmire and Fred Crossland units are broadly similar. This means people with dementia care needs are admitted to whichever unit has the vacancy.
The home has 90 single bedrooms and there were 89 people living at the home on the day we visited. The home is situated in Fulford, a suburb on the south side of the city with regular bus services into the centre.
This was an unannounced inspection, carried out over two days on 8 and 9 October 2014. During the inspection we spoke with 12 people who lived in the home, five visitors, 16 staff with different roles and the registered manager of the home. 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. We last inspected Connaught Court in October 2013. At that inspection we found the service was meeting all the essential standards that we assessed.
At this inspection people we spoke with who lived on the residential unit, visitors to that unit and staff stated that there were not always sufficient staff working, to enable people’s needs to be met in a timely way. We observed that staff were very ‘stretched’ particularly over the mealtime period and we observed that call bells rang for a long time, before being answered. We have recommended the provider reviews the staffing levels on the residential unit at all times of the day, to ensure people’s needs could be more promptly met.
Additionally we found the service could not demonstrate that people were being properly and regularly consulted about the care and support they were receiving. We noted new electronic records meant written consent was more difficult to obtain. Nevertheless, we have told the provider to take action to evidence that people’s mental capacity was routinely being considered and people’s consent routinely sought, when decisions were being made about the care and support to be provided.
We found overall that people were contented living at Connaught Court. They felt they and their possessions were safe and the staff were kind and attentive. However we found the way some areas of risk were managed could be improved. We also found important information relating to people’s care, medication needs and monitoring fluid intake was either missing or inconsistently recorded. This increased the risk of people getting unsafe or inappropriate care.
We found the environment was clean and well maintained. The dementia care units in particular were planned and furnished in line with best dementia care practice. The staffing levels throughout the home were kept under review and extra staff were used when the need was identified.
Staff had the skills and knowledge to meet people’s needs safely and appropriately. People we spoke with told us staff were competent and knowledgeable. Staff were supported to attend training and their knowledge was checked in supervision and at annual appraisals. People’s mental capacity was considered when decisions were made about their support needs, although people’s care records did not readily evidence that people had consented to the care being provided for them.
The service ensured all staff employed at Connaught Court had completed dementia awareness training. This meant all staff, regardless of their role, had some understanding of the needs of people living with dementia. The service was also supporting staff to receive accredited End of Life Care training in order that they can provide appropriate and effective care for those people, and support for their visitors.
People were offered a varied diet and staff provided respectful support to those individuals who needed help to have sufficient to eat and drink. Specialist equipment was available for those people with assessed needs so that they could manage their meals and fluids without direct supervision. People told us the meals were hot and tasty. People were able to contribute to the menu choices as these were discussed by the resident’s committee.
People were treated with kindness, compassion and respect. The staff in the home took time to speak with the people they were supporting. We saw many positive interactions and that people enjoyed talking to the staff in the home. The staff team considered people’s privacy and dignity whilst providing personal care. Staff knocked on people’s bedroom doors and waited to be invited in. This showed they respected people’s private space.
The service prioritised person centred care as central to their care delivery. People’s care needs were assessed prior to admission and people’s backgrounds, life histories and likes and dislikes were explored with them and/or their families. Having this information helped to ensure people received the care they wanted and needed and staff were able to talk to people about things that mattered to them. However, the quality and detail of this information was variable.
The service provided a range of activities and interests that people could join in with. These included film afternoons and evenings, Bridge Club, various music and exercise classes, and weekly services in the home’s chapel. Staff employed to organise activities and events also spent time with people who either could not, or did not want to, join in these events. This reduced the risk of those people becoming lonely or isolated. People living with dementia were provided with a range of activities so they could lead stimulating and interesting lives. Those people had access to several animals like a dog, rabbit, cat and guinea pig. Staff were aware which people liked or did not want to pet or talk with these animals.
The service had a clear management structure which staff and people living there were mostly aware of. The managers were regularly seen throughout the home and people living there, staff and visitors told us the registered manager was approachable and available for them.
The service had an active resident’s committee which organised and held regular meetings and whose views influenced the way the service was being run. Surveys were used to gain the views of other people with an interest in how the service was operating. Feedback sessions provided by the manager enabled those surveyed to know what was being done as a result of the comments they made.
The service and provider carried out a range of regular checks and audits to satisfy themselves that the service was running well. A new electronic system of care records had been introduced in the past year. Audits on the record-keeping within these care files would help to identify whether some staff required more support to maintain these effectively.