Archived: Poppy Court

Poppy Court is an ‘extra care’ housing scheme. People live in their own homes where care and housing are provided under separate contractual agreements. CQC does not regulate the premises used for extra care housing. We only inspect the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating.

Poppy Court provides personal care and support to people within a complex of 48 apartments and 10 bungalows. Not everyone living at Poppy Court received personal care. At the time of our visit 31 people were in receipt of personal care from the provider.

The apartments are arranged over three floors with a lift and stairs to each floor. Staff provide care at pre-arranged times and people have access to call bells for staff to respond whenever additional help is required. People also have access to communal lounges and a dining room.

At our last comprehensive inspection in June 2017 the provider was not meeting all the regulations. We found a breach in Regulation 12, in relation to safe management of medicines, and improvements were required in the key questions ‘is the service’ safe, effective, responsive, and well led. We rated Poppy Court as ‘Requires Improvement’ overall.

We asked the provider to complete an action plan to show what they would do and by when to improve the key questions to at least good. At this inspection we found the provider was no longer in breach of the regulations and the required improvements had been made. We rated the service as Good.

Since the last inspection the registered manager had resigned. 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. Following the resignation of the registered manager, the provider’s area manager for Poppy Court registered as manager on an interim basis, until another registered manager was recruited. A new manager had been employed by the provider in May 2018 and was in the process of registering with us. The new manager supported this inspection and we refer to them as ‘the manager’ within the report.

People received varying levels of personal care and support depending on their needs. Some people only required wellbeing checks or minimal assistance with personal care. Others required assistance with administration of medication, continence care, showering/bathing, nutritional support and with mobility.

People felt safe living at Poppy Court and with the staff that visited them. Staff had completed safeguarding training and understood how to keep people safe from avoidable harm and abuse. Risks to people’s safety were assessed and plans provided guidance for staff about how to reduce known risks. People who required assistance to take their medicines, received these as prescribed by staff who had completed training to do this safely.

People had an assessment completed at the start of their service to make sure staff could meet their care and support needs. Staff received regular training that provided them with the skills and knowledge to support people’s needs and had regular checks on their practice to make sure they continued to support people safely. Recruitment checks were completed on new staff to ensure they were suitable to work with people who used the service. There was enough staff available to allocate all the visits people required and to meet people's needs safely.

People were visited by a team of staff that they knew and who they said were kind and considerate. Staff respected people's privacy and supported people to live independently in their own homes. Staff arrived around the time arranged and stayed long enough to do everything people needed without having to rush.

People's right to make their own decisions about their care were supported by managers and staff who understood the principles of the Mental Capacity Act. Staff respected people’s decisions and gained people’s consent before they provided personal care. When needed, arrangements were in place to support people to have enough to eat and drink and to manage their healthcare needs.

People were provided with care and support which was individual to them. The managers and staff had a good understanding of people’s individual needs and preferences. People’s care and support needs were kept under review and staff responded when there were changes in these needs. People were encouraged to raise concerns and were confident these would be responded to.

Staff were happy in their work and said they received good support from the management team who were always available to give advice. Staff understood their roles and responsibilities and had regular individual meetings and observations of their practice to make sure they carried these out safely.

The management team worked well together and were committed to providing a quality service to people. There were effective and responsive processes for assessing and monitoring the quality of the service. The manager used feedback from people to assist them in making improvements to the service.

This inspection took place on 8 June 2017 and was announced 24 hours before our visit to see if people who lived at the service would be available to speak with us.

Poppy Court provides an extra care service of personal care and support to people within a complex of 48 apartments and 10 bungalows. Staff provide care at pre-arranged times and people have access to call bells for staff to respond whenever additional help is required. The complex is spread over three floors with a lift and stairs to each floor. People have access to communal lounges and a dining room where they can have lunch or tea. At the time of our visit 45 people were in receipt of personal care from the provider.

We last inspected the service in July 2015. At our last visit we had rated the service as ‘Good’ overall. During this visit we found standards had fallen and the rating was now ‘Requires Improvement’ overall. We found however, that the provider was aware of most of the concerns found at this inspection, and had already started to take steps to improve the service.

The service did not have a 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 previous registered manager had left in March 2017 and the service was being overseen by the provider’s operations manager, a locality manager and a temporary scheme manager, whilst recruitment for a new scheme manager and care staff was underway. A new scheme manager joined the service two weeks after our inspection visit.

In early 2017, there had been significant restructuring of the provider’s management teams that supported the service. People told us they had found the recent changes in the management of the service unsettling and some felt the provider had not kept them fully informed. Some staff felt morale had declined and they had not felt supported by the provider. However others felt that the service was beginning to improve and that the new management team were approachable and supportive.

People received varying levels of support depending on their needs. Some people only required a minimal assistance with personal care. Others required assistance with administration of medication, continence care, nutritional support and with mobility.

People told us they felt safe living in their accommodation and with the staff who delivered their care. Staff were aware of the action they needed to take if they had any concerns about people’s safety or health and wellbeing. However, risks related to people’s health and well-being were not always fully or accurately assessed and care plans did not always include important information about risks to people’s health. Staff were however, able to talk confidently about how they managed those risks.

Medicines were not consistently administered correctly to people or managed well. The provider had identified this and was taking robust action to make improvements.

Staff allocation sheets showed there were sufficient staff to cover the scheduled calls to people. Some people told us there were occasions when they had to wait if they requested assistance between their scheduled calls. The provider employed agency staff to support staff numbers on each shift and was actively recruiting new staff to the service.

Staff received an induction and training when they started working at Poppy Court. Some training was out of date, but there were plans to ensure all staff completed the required training to ensure their work safely met people’s needs. Staff received supervision meetings to discuss their work and training needs.

Care plans were not consistently kept up to date and information was difficult to find. The provider was reviewing all the care plans to ensure they were accurate, focused on the person, and supported staff to deliver care and assistance to meet people’s individual needs.

People were mostly happy with the care they received and said staff were caring and friendly. Staff respected people’s privacy and maintained people’s dignity when providing care. The provider and staff understood the principles of the Mental Capacity Act (MCA) and gained people’s consent before they provided personal care. Some care records lacked detail around people’s capacity and best interest decisions, although staff we spoke with were knowledgeable about the people they supported.

All the people we spoke with clearly recognised that due to the support and care provided by staff, they were able to enjoy living relatively independently in their own homes. Staff supported people to maintain their independence where possible.

There were processes to monitor the quality of the service through feedback from people and a programme of checks and audits. The provider acknowledged these had not been consistently completed since our last inspection in 2015 and the quality of the service had not been monitored to the provider’s standards. A full audit of the service had been undertaken and an action plan devised to address all areas of concern.

Some of the provider’s policies and procedures had not been consistently adhered to and the provider had taken positive actions to address this.

The provider was open and transparent regarding challenges the service was facing and was taking proactive steps to improve the quality of the service provided. They had kept us updated regularly on developments and improvements at the service.

People we spoke with were happy with the care and support they received from staff. One person said, 'I'm very happy here. It is the best move I have ever made.' Another told us, 'I love it. I'm not moving. I'm quite happy here.' We saw records contained detailed instructions as to how staff were to support people in a way they preferred.

People were involved in making decisions about their care and support and signed records to confirm their consent.

Staff who administered medicines received medication training and had an assessment of their competency. There was a procedure in place for auditing medication records and for managing any adverse incidents in the administration of medicines.

New staff received an induction to the service. Staff were supported to gain qualifications in health and social care and provided with regular training.

The service had a complaints policy which was available to the people living their and their relatives. People told us they would refer any complaints to the manager.