We carried out an unannounced inspection of The Court Retirement Residence on 6 and 7 September 2018. The Court Retirement Residence is a ‘care home’ without nursing. Nursing care, if needed, is provided by the community healthcare team. The Court Retirement Residence also offers temporary respite stays and one person was staying as respite during this inspection with a view to permanent support. People in care homes receive accommodation and personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The Court Retirement Residence accommodates up to 21 people in one adapted building but the service rarely goes above 16 as they use double rooms as singles. At the time of our inspection there were 13 people living at The Court Retirement Residence. There was a registered manager at the service. A registered manager is a person who has registered with the CQC 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. They had worked at the home for many years and were planning to retire in early 2019.
The last comprehensive inspection was in September 2016; at that inspection the overall rating for the service was good and we found that people were safe. At this inspection in September 2018, people were not always enabled to take part in meaningful activities on a regular basis that reflected their needs, preferences and interests. There were no audits about how people were spending their day. Activities offered by staff and external entertainers, did not ensure each person had their social and leisure needs met.
Some checks and audits were carried out but these had not always identified issues that were found during the inspection. Audits were not completed around maintenance and room checks, care plan reviews or falls. At the last inspection in September 2016, we noted there were some elements of good quality monitoring systems but these were not fully evidenced and the provider was making improvements to ensure systems were effective. This was not shown at this inspection in September 2018. Care records did not always fully reflect people's risks and needs when changes occurred and staff relied on verbal communication and recording in the daily notes. When incidents had happened, plans did not always record how staff were to reduce the risks of reoccurrence, although they knew this information verbally. Although records were not always up to date staff were very knowledgeable about people’s needs through verbal communication and a small, stable staff team.
There was no system such as a dependency tool to enable the provider to know what level of staffing was required to meet people’s needs. Staff felt there was not enough staff and people told us they sometimes had to wait for support. In addition, staff did not have time to spend quality time with people and offer regular meaningful activities. We recommended that the provider use robust systems to ensure there were enough staff at all times.
This inspection was brought forward because of safeguarding concerns. Prior to our inspection, the service became part of an individual safeguarding relating to pressure area care. This meant the local authority safeguarding team had informed us of their concerns. We found this was substantiated and pressure area care management was not robust to ensure people were safe.
On the day of the inspection there was a calm and relaxed atmosphere in the home, with music playing in the entrance hall. Staff interacted with people in a friendly and respectful way and were keen to deliver good support, for example ensuring people received full personal care at their own pace. People were able to choose where they wanted to spend their day and staff respected their privacy. However, the service was not fully caring and improvements were required to ensure there was a homely feel rather than a workplace. Most people required one care worker to support them and preferred to stay in their rooms. This meant that some people spent long periods alone other than when staff completed tasks. However, people and relatives said they liked the staff and were happy with the service.
Staff ensured they had identified those who could not use their call bells easily, and they were checked regularly, other people used pendant call bells and these were answered promptly. People were encouraged and supported to maintain their independence and risk and independence was well balanced in the least restrictive, safe way. Staff engaged with people in ways which reflected people's individual needs and understanding, ensuring people mobilised safely from a discreet distance, for example.
People and relatives said the home was a safe place for them to live. Comments included, “I like it here, they look after me” and “[Person’s name] seems happy and we enjoyed playing ball. I can leave and not worry.” Staff had received training in how to recognise and report abuse. Any safeguarding concerns had been managed well with provider involvement and they had listened to any advice, and the service worked openly with the local authority safeguarding team. Relatives said they would speak with staff if they had any concerns or complaints and issues would be addressed. Staff knew people well, showing patience and understanding. Staff were genuinely happy when people were doing well, noticing improvements and chatting with people as they went about their tasks. People's human rights were protected because the management team and staff understood the Mental Capacity Act 2005 (MCA) and these records were good.
There were not always regular recorded reviews of people's health but there were many examples in daily notes of staff responding promptly to changes in need and accessing appropriate health professionals. People were assisted to attend appointments with appropriate health and social care professionals to ensure they received treatment and support for their specific needs. One person had seen paramedics and gone to hospital and they were now back at the home and doing well.
Medicines were generally well managed, except for recording amounts of medicines received into the home. The registered manager was ensuring this happened by the end of our inspection. Records were completed with no gaps, and there were regular audits of medication records and administration. Staff were well trained and there were good opportunities for on-going training and obtaining additional qualifications. There was a training programme covering a wide range of topics. The training matrix was being revised so management could easily see which staff required training. A comprehensive induction was completed by new staff and supervisions and appraisals were up to date and showed meaningful discussion. A matrix was being devised for this too, to ensure a consistent approach. The staff team was stable and many care staff had worked at the home for some years as the service was in a rural location.
People's privacy was respected. Staff ensured people kept in touch with family and friends and there was open visiting with people made welcome. Most people living at the service had family and friends able to visit. There was a home newsletter and the administrations manager was looking at ways to encourage easy ways to communicate such as by email, meetings and the staff photo board.
The management team said they were keen to give people good care and valued their staff team. The service was a family run business and the provider and their family lived on site. People living at the service had been included in the administration manager’s wedding in the village church (situated next door to the home) in recent years. Staff said they enjoyed working at the home and felt able to raise issues. The home was seen as important in the local area as it is in a small rural community. Although improvement was required in some records and quality assurance, staff delivered care in individualised ways. The management team immediately began to address our findings and acknowledged that there had been recent management changes which may have contributed to the need for improvement.
Observations of meal times showed these to be a positive experience, although only four people chose to eat in the dining room. People were offered a choice of meals to suit their preferences and dietary needs. They could choose where they wanted to eat their meals, and meals were offered at times of the day to suit their appetite. People were supported discreetly to be as independent as possible, using adapted crockery, having finger food or snacks when they most had an appetite. People’s risks relating to nutrition were addressed, although not always recorded.
The premises were clean and smelt fresh. The building was an older style premises but had been well maintained. The administrations manager was devising a more robust maintenance programme and room check system to address tidiness and storage issues to make the environment more homely. People and relatives appreciated the spacious accommodation and views over the countryside.
There were systems in place to share information and seek people's views about the running of the home, including relatives and stakeholders. The last survey had not been analysed to show actions taken from comments but the registered manager assured us that the current satisfaction survey would include an action plan which would be shared with people. There were no complaints from people or relatives.
We found four breaches of our regulations.
You can see what action we told the provider to take at the back of the full version of the report.