We conducted the inspection from 10 July 2018 to 23 July 2018. It was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting. In September 2017, the local authority commissioners raised concerns around the operation of the service. The provider agreed to not accept new placements and this was regularly reviewed by the local authority and on 12 July 2018 this ended.
We completed a comprehensive inspection on 14 September 2017 and found the provider was meeting the fundamental standards of relevant regulations. We rated Philip’s Court as ‘Requires improvement’ overall and in all five domains. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, maintaining people’s privacy and dignity, providing personalised care and having good governance systems in place.
Following the inspection, we asked the provider to complete an action plan to show what they would do and by when to improve.
On 30 January 2018 we completed a focused inspection to check that improvements were being made. We found that although some improvements had been made and they were now compliant with the regulation related to maintaining people’s privacy and dignity. The provider however, continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action plan they had previously sent stated they expected to be compliant with the regulations by the end of June 2018.
Philips Court is a care home which provides nursing and residential care for up to 75 people. Care is primarily provided for older people, some of whom are living with dementia. At the time of our inspection there were 63 people using the service.
The service had a registered manager 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.
At this inspection we found that action had been taken to resolve the issues found at the last inspection.
We found practices had improved but the staffing levels on the downstairs nursing unit often prevent these from being fully implemented.
On the downstairs nursing unit staff were expected to complete 15-minute observation for six people on this unit, as they were prone to falling. We observed practices on the unit and found for long periods of time staff were not visible. The 15-minute checks were not completed but the records were retrospectively filled in to suggest this had happened.
We found there were insufficient staff to ensure effective observations were completed and the quality assurance processes had not identified this issue.
Four door sensors were in place across the service. We found only one was working and this had a warning light on suggesting the battery was running out. Staff believed all were working and were unable to tell us who was responsible for fitting sensors or how these were checked.
We found that staff were being supported to complete training but the provider needed to ensure there were sufficient qualified first aiders to cover 24 hours every day. Staff had not completed falls prevention training or being taught how to use bed, floor and door sensors.
During our visits we found that the temperatures in the service exceeded 25°c. The registered manager informed us that the provider had authorised them to have air conditioning units fitted.
We observed the meal time experience and found on the first day that the meal-time was chaotic and it took two hours for everyone to have a meal. Also, staff adopted poor practices when handling food such as leaving food with people who needed support for over 20 minutes then putting it back in the food serving trolley to warm until staff were free to assist.
Staff knew the people they were supporting but the care records still did not always reflect this. Staff needed to ensure that care plans did not act as an assessment and detailed the interventions. When other professionals suggested monitoring the impact of interventions staff needed to make sure there was a process in place to do this.
Staff understood the principles of the Mental Capacity Act 2005. We discussed how decisions made for people in their ‘best interests’ and how assessments could be enhanced to cover practices, which were imposed and restrictive for people who didn’t have capacity to make decisions.
Since the last inspection it was noted that improvements had been made in relation to the overall cleanliness of the service. Additional cleaners had been employed. However, staff needed to ensure the food serving and cutlery trolleys were clean.
We found that the registered manager kept information about complaints that had been made but there were no records about the investigations or resolution. We also found no records to show they investigated incidents or what lessons were learnt. However, the deputy manager could readily discuss what action had been taken and accepted better records needed to be maintained.
We found that improvements had been made to the management of medicines. However, staff needed to ensure all appropriate action was taken when medicine was given and different administration methods.
We found that the registered manager completed a range of audits but these did not pick up issues we found. Although they analysed incidents and accidents this was not completed fully so did not explore issues such as the number of unwitnessed falls for people who were regularly checked.
We found that the provider’s quality assurance system did not proactively support people to complete a critical and thorough review of practices.
The service had experienced problems with ants but we found action had been taken to deal with this matter.
Staff were familiar with the safeguarding protocols in place to help keep people safe.
We noted that improvements were being made to the environment. An additional maintenance person had been employed.
Plans were in place to re-create a dementia-friendly environment following the recent refurbishment.
People spoke positively about the staff at the service and their attitude. We found that staff were kind and caring.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to staffing; and having good governance systems in place.
This is the second consecutive time the service has been rated Requires Improvement.
You can see what action we told the registered provider to take at the back of the full version of the report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk