Chosen Court

Updated 20 April 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 2 inspectors and an Expert by Experience. 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

Chosen Court 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. Chosen Court is a care home without 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.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. 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 used all this information to plan our inspection.

During the inspection

We spoke with 3 people who used the service about their experience of the care provided. We spoke with 8 members of staff including the registered manager, regional operational manager, regional operational director, 2 agency staff and 3 support workers. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included a sample of 3 people's care records, a variety of records relating to the management of the service, including a review of some policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at policy and quality assurance records. We sought feedback from 5 relatives and 2 professionals about their experience of the care provided.

Updated 20 April 2023

About the service

Chosen Court is a residential care home providing personal care to up to 11 people. The service provides support to people living with learning disabilities, autistic spectrum disorder or mental health needs. At the time of our inspection there were 9 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: We received mixed feedback from people and their relatives about the opportunities to engage in activities of interest. The registered manager told us that they were supporting people to reengage with activities after the pandemic. We have made a recommendation for the provider to review people’s activity preferences to ensure they remain current.

There was evidence of risk assessments for the building and environment. Regular health and safety audits and environmental checks were carried out to monitor the safety of the service

The environment did not meet the principles of Right support, right care, right culture as there were more than 6 people living in one communal home. However, despite the large environment, consideration had been given to the principles. The regional operational director told us, “All of the refurbishment and building work has taken place to personalise people’s environment. It has been needs based and we are making more space and a ‘break out’ area for people.”

People had not always been supported to take their medicines in accordance with their individual needs and preferences.

Agency staff had been used to ensure safe staffing levels had been maintained through a high level of staff turnover.

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.

Right Care: People's care records did not always contain the necessary detail to evidence the personalised care, support and treatment people received. A high level of staff turnover had meant the service had recently become more reliant on agency staff. Staff were not always able to explain their role in respect of individual people without having to refer to documentation. Therefore, the shortfalls we identified in relation to people’s care records meant that we could not always be assured people’s wishes and preferences would be met.

Right Culture: We received mixed feedback from people, relatives and professionals about the culture of the home. Some permanent staff told us they believed that, after a period of high staff turnover, things were now improving. The provider had put measures in place to make the necessary improvements and an agreed timeline for improvements had been implemented. More time was needed for this to be achieved.

Quality assurance processes included a variety of audits. These had been operated effectively at provider level, but internal home audits had not identified the concerns we found on inspection.

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 this service was good (published 7 May 2021).

Why we inspected

We received concerns in relation to the management of finances, diet and nutrition and people’s personal care needs. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chosen Court on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.