Comfort House

Comfort House provides accommodation for up to 42 people with residential care needs. At the time of the inspection, 27 people were using the service. Some of the people were living with dementia.

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

People and relatives had many positive comments about the service provided. They praised the care and kindness shown by staff. The home had a very welcoming and friendly atmosphere and staff morale was good.

Medicines were generally managed safely. However, we have made a recommendation about the storage of medicines.

People lived in a clean and tidy environment with staff following good infection control procedures. Some areas of the service needed an update, and this was planned to occur in the next six months. We have made a recommendation about this.

People’s care records and risk assessments were regularly reviewed to make sure their needs were met. A small number of gaps needed to be updated.

People told us they felt safe and were confident any concerns would be dealt with effectively. Staff had received suitable training, including to maintain people’s safety. There were robust recruitment procedures in place and enough staff to look after people, with call bells answered quickly. Staff received regular support and a suitable induction to the service.

People received a good range of food and drinks to meet their dietary needs, but the dining experience on the upper levels of the home were not as good as the ground floor. This was immediately addressed.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible and in their best interests; the policies and systems in the service upheld this practice.

A range of activities were in place and a new activity coordinator had been recently employed to further enhance this, particularly for people living with dementia.

The provider, registered manager and staff had worked hard to improve the way the service was run. There were systems in place to check the quality and safety of the service.

People and relatives said the registered manager was open and approachable. They were happy with the way the service was ran and felt included in this.

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 6 March 2019). The service has improved and is now rated good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

About the service: Comfort House is a residential care home that provided personal care for up to 42 people. At the time of the inspection, 32 people were living at the service.

People’s experience of using this service:

¿ People and their relatives were positive about the service and the improvements made since we last inspected. The registered manager and staff had updated many procedures for the benefit of people receiving care and support. We need to ensure this is maintained over a longer period of time.

¿ People's needs were assessed before moving into the service. Tailored care plans with associated risk assessments were also put in place to keep people safe and ensure their needs were met how they wanted.

¿ Safeguarding systems and processes were in place, including staff training and reporting of concerns appropriately. People told us they were safe and relatives confirmed this.

¿ Accidents and incidents were recorded and reported correctly. The registered manager analysed incidents to minimise the risk of them happening again and looked for any trends forming.

¿ There were enough safely recruited, trained and supported staff working at the service and this was monitored by the registered manager. The registered manager had booked further training to take place and we have made a recommendation regarding training in pressure damage (skin care).

¿ Medicines were generally managed well. We did find some recording issues, which were addressed immediately.

¿ People’s dietary needs were met, but we had mixed views on the food prepared. The registered manager had this in hand already.

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

¿ The service was clean, tidy and homely.

¿ Activities were occurring and had greatly improved and measures were in place to maintain this.

¿ The registered manager led the team with an open and honest approach. They were kind and caring as were the rest of the staff team.

¿ Complaints had been dealt with effectively, but some outcomes had not always been documented, this was to be addressed.

¿ The registered manager was very visible within the service and knew people and visitors well. Audits and checks were completed to ensure quality was monitored and continually improved upon. Links with the local community had improved.

For more details, please see the full report below and which is also on the CQC website at www.cqc.org.uk.

Why we inspected: The inspection was a planned inspection based on the previous rating. This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of special measures.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This unannounced comprehensive inspection took place on 3,4, and 5 July 2018. This meant that the provider, staff nor people who used the service knew we would be arriving.

At the last fully comprehensive inspection in September 2017, we identified two breaches of regulations which related to safe care and treatment and the governance of the service. Following the last inspection, we asked them to do an action as to how they were going to meet the regulations. We found whilst some improvements had been made, the service remained in breach of both regulations and during the inspection further issues were found.

There was no registered manager in place at the service. A deputy manager from another service had been in post a few weeks and managed the service daily as the previous manager had resigned very recently and the current deputy manager was not available. The temporary deputy manager had applied to become the manager of the service and it was confirmed during the inspection that they would be taking on this role and applying to register with the Care Quality Commission (CQC) in due course.

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 provider indicated in action plans that the management team at Comfort House carried out daily, weekly and monthly checks of the quality and safety of the service and were confident that issues had been or were being addressed. We did not find adequate evidence to corroborate these checks had consistently taken place or were completed robustly enough to identify the continued issues we highlighted during this inspection.

We found some irregularities with people’s finances within the service. At the time of the inspection, an internal audit was underway and police were investigating. We will monitor this and follow up in due course.

Record keeping had deteriorated throughout the service since our last inspection. The lack of accurate and thorough details recorded within care records meant that neither we nor the provider could ascertain if issues had been correctly identified and followed up properly with the necessary action. We found accidents had not always been recorded fully and people’s care records lacked the detail required to ensure they received safe care and treatment that met their needs.

Care plans reviewed were either not in place, up to date or were incomplete. There were also gaps in risk assessments. Monitoring of food and fluid intake was not always robust, with records not fully accurate. This meant that important information may have been missed and this put people at risk of harm through not receiving the appropriate care and support. Care records did contain person centred information, but further work was required to ensure people’s individuality was fully captured.

Medicines were not always managed safely. There were concerns relating to the ordering, administration, records and staff competencies.

Staff continued to be safely recruited. However, we found there was not enough staff, mainly relating to the upper levels of the service. We monitored call bells and found in some cases excessive amounts of time passed before they were responded to, for example over 15 minutes, more in some cases. We overheard one person being told not to use the bell. This was reported to the management of the service to deal with.

Induction was not at a suitable standard and staff training was overdue for some staff and refresher courses in key topics had not been routinely carried out. Although training was now taking place, this demonstrated that the provider had not assured themselves that people were supported by staff who had the skills and competence to provide safe care. In addition, supervisions were overdue and annual appraisals had not been conducted recently. This meant that staff had not been formally supported in their role or given a recognised opportunity to talk about their issues and any plans for development.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS). Applications had been made on behalf of some people to restrict their freedom for safety reasons in line with the Mental Capacity Act 2005. However, we found the service was unable to tell us who had been authorised and it was only with the help of the local authority that they were able to confirm which people had a DoLS in place. The monitoring system was not robust and had not been properly maintained. Consent was not always appropriately gathered from people or relatives (acting legally on their behalf) and it wasn’t always recorded in line with the principals of the MCA.

Activities were very poor with no stimulating activities taking place at all. There was no activity coordinator at the service as the role had recently been vacated but the provider was currently looking to employ further staff and were aware they needed to quickly improve in this area.

Complaints were not managed in line with the provider’s complaints policy. Although complaints appeared to have been dealt with, records were not always available which recorded action taken or to enable the provider to monitor complaints.

We saw some care workers did not always treat people with dignity and respect and we observed a number of occasions were staff did not show the kindness and compassion we would expect, including during moving and handling procedures and discussing people’s personal care in an open environment. However, we did receive many complimentary words from people and relatives for the kindness and caring nature of other care staff which should be recognised.

Despite the issues we found, people told us they felt safe living at Comfort House. Most relatives confirmed this. Most staff were trained in the safeguarding of vulnerable adults and through discussion they could demonstrate their responsibilities with regards to protecting people from harm. The provider had information to support staff in reporting safeguarding concerns, throughout the service.

The premises were generally clean and tidy but we found some areas in need of attention regarding refurbishment or maintenance, including the garden area.

A variety of foods were prepared at meal times, including hot and cold choices. A new chef was in place and aimed to review current menus with people. Recording and monitoring of people’s nutritional and hydration needs was not effective, with tools to support this not being used correctly and information not being fully available to all staff (particularly kitchen staff) or accurately recorded. This meant there was potential for people to be placed at risk of harm due to inaccurate record keeping and monitoring.

We have identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Two of which have continued from the last inspection. You can see what action we told the provider to take at the back of the full version of the report.

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.

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.

At this inspection, although all appraisals were not yet complete, the new manager had made improvements to ensure that staff received appropriate support and had planned to have the remaining appraisals completed in the near future. Staff had received supervision sessions to allow them the opportunity to discuss a variety of issues and development opportunities.

Comfort House provides residential care for up to 42 people, some of whom are living with dementia. At the time of our inspection there were 38 people living at the service.

The service had a manager in post who had applied to become the registered manager and was awaiting a decision. 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.

People received their medicines in a timely manner, however we found areas of concerns which needed to be addressed. We found thickeners which had been left in an unlocked room which posed a risk to people. Thickeners are usually powders added to foods and liquids to bring them to the right consistency/texture for people with swallowing difficulties. We also found medicines security, storage of unwanted medicines and staff not using information they had available regarding ‘as required’ medicines was of concern.

We found that moving and handling procedures were not always being carried out correctly which posed a risk of harm to people.

Maintenance of the home was undertaken, although recent lift failures had resulted in one person (unharmed) being trapped in the lift. We have been given reassurances that the lift was in the process of having some major repairs completed.

Staff were aware of their personal responsibilities to report any incidents of potential or actual abuse to the manager.

People told us there were enough staff at the service to support them and we confirmed this through viewing records, however, the use of agency staff had impacted on the day to day support given. The provider had recently recruited more care staff and they were due to take up their posts in the coming weeks.

We found call bells were sometimes slow to be answered. Call bell monitoring was difficult to undertake, because the system did not allow monitoring reports to be completed. The provider told us they were about to install new software to address this.

We found emergency procedures, including fire safety were monitored and staff knew what to do in an emergency. Accidents and incidents were recorded and monitored to identify any trends. The premises was not always as clean as it should have been. The manager confirmed after our feedback that they took action to rectify this, including deep cleaning, contact with infection control specialists in the area and appointing a new infection control lead.

We received mixed views from people on the quality of the food available. We found that kitchen staff did not have all the information they should have regarding people’s dietary needs. However, from observations people still managed to be provided with suitable diets appropriate to their needs. The manager dealt with this issue immediately.

We found staff were adequately trained. They received induction and supervision. Appraisals were being completed and there was a plan in place to ensure all staff received one this year. The provider followed safe recruitment procedures in order to ensure that staff employed were suitable to work with vulnerable adults. We noticed the provider had recently audited staff files and renewed some DBS checks.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements.

People told us staff were kind and cared for them well, however, through our observations this was not always the case. We saw on occasions people were not always treated with dignity and respect and some staff did not show consideration when supporting people, including the use of the word ‘please’.

Care was planned and person centred with associated risk assessments in place to keep people safe.

We found audits and checks were in place which helped the manager to monitor the quality of the home and had supported the provider to make a improvements since January 2017, however, issues that we had found were not always highlighted through these checks.

Relatives told us they liked the manager and the staff team and thought the service had better leadership than previously as things had improved. Staff told us they felt supported by their colleagues and the manager, although some staff felt that staff morale needed further improvement. Some staff indicated a divide between night and day staff; we discussed this comment with the manager who said she would look into this issue.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to safe care and treatment and good governance.

You can see what action we told the provider to take at the back of the full version of this report.

We spoke with people living in the home, who told us they would sometimes like to see more staff on duty, but did not feel their needs were neglected. Comments included, "Sometimes you think there should be more, but you get seen to, eventually", and, "Staff come quick when you need them."

People's care needs were properly assessed and care plans were in place to guide staff on how to meet those care needs. People told us they were very happy with their care in the home. One person told us, 'I'm happy, here. I'm well looked after.' Another person said, 'I feel like a queen, living here. They are so good to me.' A third person commented, 'There's nothing I don't like about the home.'

Appropriate arrangements were in place to make sure people were given their prescribed medicines at the appropriate times, and that medicines were properly recorded and safely stored.

Proper systems were in place to make sure that unsuitable staff were not employed to care for vulnerable people living in the home.

There were frequently not enough care staff to meet the assessed needs of the people living in the home.

Any complaints made to the home were responded to positively and appropriately.