Quay Court Care Centre is a residential care home which provides accommodation and personal care for up to 38 people. It does not provide nursing care. People access healthcare through the local community healthcare services. This unannounced inspection took place on 9 and 10 June 2015 when there were 33 people living there, many of whom were living with dementia.
The service was last inspected on 19 March 2014 when it was compliant with the areas that were inspected.
A registered manager was employed by the service. 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.
Prior to this inspection in June 2015 we received concerns from one person’s representative about the care their relative had received whilst receiving respite care at the service. We discussed the issues with the registered manager who accepted they had not been able to meet the person’s needs. This was because the person’s needs were greater following admission than they had originally been assessed as. Following our inspection the registered provider’s group locality manager has visited the representative to discuss their concerns.
People’s medicines were not always managed safely. Medicine Administration Records (MAR) sheets were not always completed correctly. There were no clear directions for staff on when to administer all medicines prescribed to be taken when required.
People told us they felt safe at the home and with the staff who supported them. One person said “Yes I feel safe” and another said “Definitely” when asked if they felt safe. Risks of abuse to people were minimised because staff had received training in recognising and reporting abuse. People were protected from the risks associated with unsuitable staff because the registered provider had a robust recruitment system in operation. Staff were thoroughly checked to ensure they were suitable to work at the home. People were protected from the risks of financial abuse. Systems were in place to protect people from financial abuse where the service people’s managed.
Care plans contained risks assessments which outlined measures in place to enable people to take part in activities with minimum risk to themselves and others. Moving and transferring and falls risk assessments were in place and were updated when required. Pressure relieving equipment was in place to minimise the risks of people developing pressure sores.
People’s needs were met by sufficient staff in a timely way. On both days of our inspection there were 33 people living at the home. Rotas showed that staffing levels were maintained at nine care staff on duty during the morning. This reduced to seven care staff in the afternoon. Two or three care staff were awake at night according to dependency levels. Supporting staff such as a cook and cleaner were on duty each day and the registered manager was also available throughout the inspection.
People had differing needs and staff had received training to ensure people’s needs were met. There was a comprehensive training plan in place to make sure staff kept up to date with good practice and were able to undertake training appropriate to the needs of people who used the service. For example, staff received training in caring for people living with dementia.
Staff received regular supervision and appraisals. Supervision records showed that future training and development was discussed and planned for. Staff felt well supported by the registered manager.
People told us staff knew how they liked things done. Staff were able to tell us about people’s needs and how each person liked their needs to be met. People were always asked for their consent before staff assisted them with any tasks.
Staff had a clear understanding of the Mental Capacity Act 2005 (the MCA), including the Deprivation of Liberty Safeguards (DoLS) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.
People’s nutritional needs were assessed to make sure they received a diet in line with their needs and wishes. For example, staff described how they encouraged one person to eat and drink even though they didn’t like to sit at a table. People were offered plenty of snacks and drinks through the day. People told us the food was “Ok” and “average”, but that they always got a choice. The cook told us that they always cooked enough food for people to have a choice at the table. Special dietary needs were catered for.
People were supported to maintain good health and had access to healthcare services where required. Records showed people had seen a variety of healthcare professionals including GPs, district nurses and speech and language therapists.
People and their visitors told us staff were very good and caring and all the interactions we saw between people and staff were positive. People said staff were “Very good”, “Always speak nicely to me” “They are very good and kind” and “Are thoughtful, helpful and considerate”. One person told us they thought the home was “A remarkable place”.
Staff knew people well and were able to tell us how they supported individuals with their needs. Staff were skilled in speaking appropriately with people, including those living with dementia.
Not everyone was able to verbally express their views. Those who could knew about their care plans and said the registered manager discussed it with them. Some care plans contained signatures to show people had been involved in reviewing their care. People’s care needs were clearly defined in their care plans in sufficient detail to allow staff to carry out their role. Care plans were based on people’s assessed needs and reflected their needs and preferences.
People confirmed that staff always asked them what they wanted and how they wanted their needs met. One person told us they were “Very contented here”. Staff responded to changes in people’s needs. One person told us that when they had first been admitted they had been very ill. They told us “They looked after me very well” and that they now often went out into the local town on their own.
People were encouraged to take part in activities, and information was gathered on their pre-existing hobbies and interests. Records were kept that showed how much time people spent engaged in activities and how much time they spent dozing or alone in their room. This enabled staff to identify people who did not participate regularly in activities or spent a lot of time in their room. Staff could then discuss with the person f there was any type of activity they would like. Activities on offer included visiting entertainers, music therapy and exercise sessions.
The registered manager sought people’s feedback and took action to address issues raised. The last meeting for people had been held on 23 April 2015. People had previously said they wanted more outings. The registered manager told people that transport had been found that could take wheelchairs and outings were to be arranged.
People told us they would feel able to raise any concerns they had with the staff or registered manager. The registered manager recorded all complaints. Records relating to these showed they had been responded to in a timely manner, all outcomes had been recorded.
People, staff and visitors felt the service was well led by a manager that was open and approachable. The main office was located in a central position which enabled people to speak with the registered manager at any time. Staff said they felt extremely well supported and were able to make suggestions about the running of the home and the care they provided.
The registered provider carried out an annual survey to gauge the views of people using the service, staff and other interested parties. Results from the last survey showed a high level of satisfaction. One response indicated that more information about activities was needed. The registered manager had arranged for a noticeboard to be put up in the dining room so that information about activities could be easily seen.
Staff were clear about their roles and responsibilities. They told us they would report any concerns they had to a senior worker or the registered manager. Staff were clear about the culture of the home saying that it was to ‘promote independence’ for people living there. People confirmed staff encouraged them to be independent. Staff told us that the feeling within the home was ‘like a family’ with everyone ‘singing from the same hymn sheet’.
There were effective quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care. Where shortfalls in the service had been identified action had been taken to improve practice.