Archived: Cypress Court

Cypress Court is a care home providing personal and nursing care to 40 people at the time of the inspection. The service can support up to 60 people, in one adapted building across two floors. The home is located in a residential area, close to shops and local amenities.

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

People felt safe living at Cypress Court. Staffing levels were sufficient to meet people’s needs, however were set above assessed levels due to the level of occupancy. Risks were assessed, however we found that one person’s pressure relieving equipment was not set correctly placing them at increased risk of skin breakdown. Staff received training, and procedures were in place to protect people from abuse and avoidable harm. People’s medicines were administered safely by trained and competent staff. Checks were carried out to ensure that Cypress Court was a safe place for people to live.

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’s needs were assessed and regularly reviewed to ensure the service could meet them. Staff supported people to maintain their health and well-being with access to a range of health and social care professionals. People had access to the equipment they needed to be supported effectively.

We observed a warm atmosphere within Cypress Court and caring, friendly relationships between staff and the people living there. People were treated kindly and with respect, their privacy was respected. People were able to have their say and said they were listened to.

People had opportunities to experience a range of activities and most people were satisfied with what took place. Staff knew people’s needs, likes and dislikes well. There was a procedure to deal with complaints and people knew who to speak with if they had concerns. Complaints received had been dealt with appropriately.

Since the last inspection the registered manager had reflected on their role and taken opportunities to learn and improve the quality of the service. They were aware of areas that required further improvement and the need for improvements to be sustained. People and staff told us the registered manager was approachable and that they were listened to. The effectiveness of audits to monitor the quality of the service had improved. A feeling of teamwork had developed between the management and staff adding to the improved positive culture within the home.

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 31 August 2019) and there were multiple breaches of regulation.

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 that sufficient improvements had been made and the provider was no longer in breach of regulations. Although improvements were noted, the service remains rated requires improvement. The service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Cypress Court is a residential care home providing personal and nursing care to 54 people aged 65 and over at the time of the inspection. The service can support up to 60 people across two floors, each of which has separate adapted facilities. One of the floors specialise in providing nursing care.

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

Not all people had the necessary risk assessments or care plans in place to ensure they were receiving safe care and treatment and handover records were insufficient to demonstrate staff could support people safely.

Audits were ineffective at picking up the issues we identified during the inspection and the registered manager did not have sufficient oversight of people’s needs. We also found that improvements the provider was required to make following the last inspection had not been made.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Some people had not had their ability to consent to the care they received assessed and DOLS applications had not always been made.

Systems were in place to record accidents, incidents and complaints. People told us however that they didn’t feel that actions were always taken to improve and we have made recommendations that the registered manager reviews how these systems demonstrate outcomes and lessons learnt.

We have also made a recommendation for the service to consider how it improves the environment for people living with dementia.

We saw staff treat people with kindness and respect and most of the people we spoke with told us staff were caring, however some people told us they felt rushed with their care. People had the necessary referrals and input form health professionals where required.

Staff were recruited safely and had received the training necessary to do their job. However, the service was reliant on agency staff to provide nursing care.

Activities in the home had improved, this was being further developed by the activity team.

Health and safety systems including and regular checks were in place.

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 06 November 2018) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made/ sustained and the provider was still in breach of regulations. This is the second consecutive inspection when the home has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified continued breaches in relation to safe care and treatment, governance and how the provider ensures care is being delivered with the consent of people at this inspection. Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The last inspection on 16, 17 and 18 October 2017, found that the registered provider was not meeting the requirements of the Health and Social Care Act 2008 in relation to person-centred care; need for consent; safe care and treatment; safeguarding service users from abuse and improper treatment; receiving and acting on complaints; staffing and governance. The overall rating of the provider was "inadequate" and they were placed into special measures by the Care Quality Commission.

We conducted this inspection to review whether sufficient improvements had been made since the last inspection. We found that improvements had been made although the registered provider remained in breach of regulations relating to safe care and treatment, need for consent, person-centred care and governance. However, the inspection found that there was sufficient improvement to take the service out of special measures. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Cypress Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Cypress Court accommodates up to 60 people in one purpose built two storey building. It has a lift to the first floor and an open plan reception area. There are large lounge areas and a dining room to each floor. At the time of our inspection the service was accommodating 40 people.

We identified that the provider had not always delivered care and treatment in a safe way and was therefore in breach of relevant regulation. This was because professional guidance had not been followed with regard to a person’s risk of choking; we became aware of an incident of unsafe administration of medicines and risk assessments relating to people’s specific needs were not always in place.

The service did not have 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. Since the last inspection day to day running of the home has been overseen by one of the provider’s Resident Experience Managers (RESM). A new home manager had recently been appointed and safe recruitment checks were underway.

With the exception of one incident, we found that medicines management and administration procedures were established and safe. People received their medicines as prescribed.

Policies and procedures were in place to safeguard people using services from abuse and for staff to whistle-blow if needed. Staff told us that they felt able to raise concerns if necessary and that they would be listened to.

Staff told us and we observed that there were sufficient staff to meet the needs of the people living at Cypress Court although some people expressed that there were busy periods and this sometimes impacted on the care they received. For example, people told us that they could not have a shower as often as they wanted one. We discussed this with the management team on the first day of inspection and when we returned on the third day we saw people had improved access to shower facilities.

The service followed safe recruitment practices. Staff were complimentary about the management team and told us they were supportive and fair. Staff received regular supervision, appraisal and the training they needed to provide effective support.

The home was clean and tidy. We saw that health and safety checks were carried out to ensure that the home was a safe place for people to live. Staff used personal protective equipment, such as disposable gloves and aprons and had received training to prevent and reduce the spread of infection.

People’s privacy was protected, records were kept in locked cabinets. There was a policy in place to ensure that people were treated fairly and without discrimination. We observed that people were treated in a kind and respectful way.

People’s consent to their overall care was not always recorded and people told us that they had not seen or been involved in their care planning. People were only deprived of their liberty with legal authorisation.

Each person had an individual care plan folder, however examples reviewed were unwieldy as they had not been rewritten when significant needs had changed, relevant information was not always included and sometimes information was contradictory. The management team advised that work was ongoing in this area.

There was a policy and procedure in place to record, handle and respond to complaints. We found that most complaints had been recorded and responded to appropriately. However, during the inspection we became aware of a concern that had been raised with a member of staff which had not been documented. You will see further information about this in the Responsive section of the full report.

The service employed two activity co-ordinators. Prior to the inspection we had received information that indicated people did not have enough to do. During the inspection people told us that they enjoyed the activities taking place but would like more to do. Two people told us enthusiastically about how they had been supported by staff to go swimming.

At the time of the inspection the weather was very hot. We saw that people had ready access to fluids and that staff encouraged people to drink more. The management team had sourced additional fans to assist with keeping people cool which were situated around the building and they were in the process or ordering more.

There was a suite of audits used to monitor the safety and quality of the service which were carried out regularly by the RESM or deputy manager. We saw that the completion and effectiveness of audits had improved since the last inspection and that actions identified had been carried out. However, quality assurance processes were still not sufficiently robust to have identified all of the concerns noted during this inspection.

Cypress Court Nursing Home was previously inspected in January 2016 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Cypress Court is a purpose-built residential and nursing home in Crewe, Cheshire. The home can accommodate up to 60 older people, it has a lift to the first floor and an open plan reception area. There are large lounge areas and a dining room to each floor. At the time of our inspection the service was accommodating 49 people. Some refurbishment has recently taken place.

There was a registered manager in place at the time of the inspection. 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During the inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to: person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment; receiving and acting on complaints, staffing and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Procedures for protecting people from abuse and neglect were not sufficiently established or operated effectively. Staff reported a culture of fear of reporting or that concerns were not followed up when they did so.

We saw that accidents/incidents were not always recorded, investigated or followed up robustly.

Several people had experienced a high level of weight loss during 2017 and we saw that malnutrition risk assessments were not completed accurately. Although actions had recently been taken to review this matter, it was not identified in a timely manner and therefore people were left at risk of continued weight loss.

We found that medicines were not always managed satisfactorily; for example, we identified some discrepancies in stocks; that medicines were not stored as required and that manufacturer’s instructions were not always followed.

People using services, visitors/relatives and staff told us that they felt there had been insufficient staff to meet people’s needs although this had improved recently as staffing levels had been increased.

Risk assessment and a record of people’s consent was not always in place, for example, for the use of bedrails. We found that call bells were not always within reach leaving people unable to summon help in an emergency.

The registered manager had not carried out supervision or appraisal with staff as required.

Monitoring charts that were put in place were not completed effectively, for example for fluid intake to monitor the risk of dehydration and for positional changes, to reduce the risk of pressure damage to skin.

People’s likes, dislikes and preferences were not sufficiently reflected.

We found that the home had some systems in place to assess and monitor the quality of service that people received. However, these systems had not been sufficiently robust or managed effectively to identify the issues raised within this inspection.

People had access to a choice of menu. Records also showed that people had access to a range of health care professionals subject to individual need.

We observed staff interacting with people using the service in a caring manner although we observed that a person was spoken with abruptly on one occasion. Management took appropriate actions immediately and the member of staff offered their apologies.

Advocacy services were available for people who may need this support.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During the inspection the customer experience regional manager took prompt action to address concerns that were raised and engaged well with the inspection process. Immediately following this inspection the provider put in place alternative arrangements for day to day management of Cypress Court and we were subsequently informed that an internal investigation would to be carried out.

The provider took on board the findings of this inspection and additional regional management support was put in place to drive improvements forward quickly. A substantive action plan was submitted and weekly updates are being provided.

Cypress Court is a purpose-built residential and nursing home in Crewe, Cheshire. The home can accommodate up to 60 older people, at the time of out inspection there were 52 people living at the home. The home is a two storey building and has a lift to the first floor, there is an open plan reception area. There are large lounge areas and a dining room to each floor.

At the time of the inspection a registered manager was in place. 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 manager was available throughout the inspection and engaged positively with the inspection process. The manager was friendly and approachable, she operated an open door policy for people using the service, staff and visitors.

The service was safe. We found that there were sufficient numbers of suitably qualified staff to meet the needs of people living at the home. There had been a focus on the skill mix and staffing levels had been increased. New staff roles had been introduced which had improved the general organisation of staff.

Staff knew the importance of keeping people safe and appropriate procedures and systems were in place to prevent people from harm and abuse. Staff had received training about protecting people from abuse and harm. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

The registered manager and care staff used their experience and knowledge of people’s needs to assess how they planned people’s care to maintain their safety, health and wellbeing. Risks were assessed and management plans implemented by staff to protect people from harm.

People's consent was gained before any care was provided and the requirements of the Mental Capacity Act (MCA) were followed.

We found that people were well cared for and treated with compassion. Staff supported people in a caring manner. They knew the people they were supporting well and understood their requirements for care. People were treated with dignity and respect. People and visitors were very complimentary about the care that they received.

Care records were personalised and they reflected the support that people needed so that staff could understand how to care for the person appropriately. However not all care plans were up to date to reflect changes to a person's needs. The staff were in the process of re-writing people's care plans and were providing appropriate care. Daily charts were not always completed fully or at the time that the care was provided. We saw that staff responded to people’s changing needs and sought involvement from outside health professionals as required

People were able to take part in a range of activities should they choose to. Two activities organisers arranged an entertainment programme and also provided one to one support to individuals.

The home was well led. There were very good quality assurance systems in place, to enable areas for improvement to be identified. There was an excellent system in place for ensuring that people's view were sought about the care that they received.

The registered manager made notifications to CQC as required, however there had been an over sight in making recent notifications relating to DoLS authorisation

We spoke to 12 people who lived in the home and four relatives. We received very mixed responses regarding the care that people described and the staff who supported them.

We spoke to the new manager, the peripatetic manager, the regional manager and seven other members of staff. they all told us that they were very pleased with the improvements that had been made in the home.

We looked at how the home respected people's choices and supported them to make their own decisions. We saw that people's choices were now recorded clearly in people's care plans.

We looked at systems in place to manage people's medicines and saw that staff had all completed refresher training and had competency tests carried out to ensure that they were working safely in accordance with the home's policies.

We looked at the quality assurance arrangements in place and we saw that that these had significantly been improved. We also looked at the home's records and saw that some of these had improved.

When we arrived at the home the deputy manager told us that the manager was unavailable. We spoke with a senior manager who told us they had recently started supporting the home as the provider had recognised that concerns were not being dealt with. We also spoke with a regional manager who came to the home to assist with the inspection. During the afternoon we were informed that the manager of the home had resigned from their post.

We looked at how the home involved people in their care and we looked at the standard of care that people received and we saw that this was not of an acceptable standard.

We had not planned to look at medication but we did because we observed practices that were unacceptable. We saw that the home had taken steps to improve the arrangements to protect people from abuse and that staff had been trained and understood their responsibilities in relation to safeguarding vulnerable adults.

We looked at the quality monitoring procedures and the records and were not satisfied that these had been improved to an acceptable standard.

We met with the registered manager and spoke with five staff members during the course of the inspection.

During the inspection some staff raised concerns about the care practices of other staff members. These we reported to the manager and to the local authority safeguarding team for safeguarding procedures to be followed. We had received information from a whistle blower in that call bells were not always accessible to people at night. We visited the home unannounced at 5.30am and found that call bells were in place and accessible.

We saw that there were enough staff on duty and saw that the manager responded to staff sickness and absence promptly. We saw that people need more activity and stimulus. We also noted that the manager had advertised for an additional activities co-ordinator.

We found that the providers own quality assurance procedures at Cypress Court had not identified the issues found during the inspection.

We looked at records management and found we could readily access archived historical records. However we saw that accurate information was not always available within the care plan documentation in the files we reviewed.

During the course of the inspection, we spoke with 26 of the 48 people who used the service and nine family members/visitors to the home. The majority of people who used the service and their family members told us that they were happy with the care and support provided by the staff.

Relatives and visitors we spoke to said they felt they would if they had any be able to raise any issues or concerns about their family members care or support with the manager. We found that systems for assessing and monitoring the quality of service provision had improved.

One person who used the service said: "I love it here, they are good girls, very helpful." Another person said: 'The staff are kind and gentle I have no complaints." We spoke with one person who told us they had raised a complaint about the service via their family member. They did not wish to discus the details. The manager told us that they would address and investigate any comments or complaints raised in accordance with their policy and procedures.