Court House Care Home

Updated 30 June 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 3 inspectors and a Specialist Nursing Advisor on 15 February 2023, and 2 inspectors on 20 February 2023. An Expert by Experience contacted relatives via telephone on 17 February 2023 to gather their views on the care their loved ones received. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Court House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Court House is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced. However, during the first day on site, we did give the provider notice we would be returning for a second day to complete our inspection.

Inspection activity started on 31 January 2023 and ended on 20 March 2023. We visited the service on 15 February 2023 and 20 February 2023.

What we did before the inspection

We reviewed information we had received about the service since they registered with CQC. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We sought feedback from the local authority and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.

During the inspection

We spoke to the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke to 11 staff including unit managers, nurses, senior care staff, care staff, activity coordinators, a cook and maintenance. We spoke to 8 people who live at the home, 8 relatives of people who use the service and 2 visiting professionals. We reviewed a range of care documentation, risk assessments and medicine records for people. We looked at documents around staff training and support. We reviewed a variety of records relating to the management of the service, including policies and procedures and quality assurance records.

Updated 30 June 2023

About the service

Court House Care Home provides personal and nursing care for up to 60 people. The home is split into 3 units; 2 were for older people and 1 for younger adults. At the time of our inspection there were 57 people living at the home.

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

People's individual risks were not always comprehensively assessed to guide staff on how to keep people safe. People were not always protected from the risk of harm. An effective system was not in place for reporting and reviewing accidents, incidents and near misses involving people. People's medicines were not always safely managed, this meant people were at risk of receiving medicines which may not meet their current needs.

Care documentation was not consistently updated and some staff were not trained to meet people's specific healthcare needs. The provider did not have robust risk assessments and had failed to consistently identify environmental risks to people's safety and wellbeing.

People's person-centred needs weren't always at the forefront of their support. However, some people were supported with a range of meaningful activities and staff were attentive to people's emotional and social needs. Quality assurance systems were not always effective for people. This meant the action taken by the provider had not always ensured people received consistent, good quality and safe care. Systems were in place to seek feedback and resolve people's complaints.

The provider had not ensured all requirements under the Mental Capacity Act (MCA) and authorisations under the Deprivation of Liberty Safeguards were fully met. Not everyone was supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support good practice.

The provider had not always sent to us statutory notifications which is their legal responsibility to do so for notifiable incidents.

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

Rating at last inspection

The last rating for the service under the previous provider was good (published on 14 March 2020). This service was registered with us on 08 February 2022. This is the first inspection under this provider since their registration.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines, infection control, and management oversight of the service. A decision was made for us to inspect and examine those risks.

This service had not been inspected since a change in registration; therefore, this inspection was also carried out to gain assurances about the quality of care and systems used to monitor and manage the service under the new provider.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

Immediately following our visit, we sent the provider a letter asking them to respond to the immediate concerns we found at our visit. We continued to seek their updates and assurances they had mitigated the immediate risks to people.

We have identified breaches in relation to safe care and governance and management oversight of the service at this inspection. At this inspection we recognised that the provider had failed to submit statutory notifications to us in line with their regulatory responsibilities. Please see the action we have told the provider to take at the end of this report.

At this inspection we recognised that the provider had failed to submit statutory notifications to us in line with their regulatory responsibilities. This was a breach of regulations 16 and 18 of the Care Quality Commission (Registration) Regulations 2009.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.