Archived: Angel Court Residential Home

Angel Court Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 30 older people. At the time of the inspection there were 19 people living at the service, most of whom were living with dementia.

A registered manager was in post. 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 had not ensured that all incidents that may be considered as safeguarding concerns were identified, reported to the local safeguarding authority and investigated appropriately. People were not always protected from the risk of ongoing harm. Risks to people including those due to behaviours that can challenge, mobility and swallowing issues were not fully understood and managed safely.

People were supported by sufficient numbers of care staff although these staff were not always deployed effectively in order to ensure people’s needs were met. While some improvements had been made to medicines management systems, further improvements were still required. In particular around the management of creams and medicines that had been prescribed to treat those people with challenging behaviours.

People were not always supported by care staff who had been equipped with the skills and knowledge they required to support people safely and effectively. People’s consent to their care was not always obtained and steps were not taken in people’s best interests in line with the law where they lacked mental capacity. People’s basic nutritional needs were mostly met although improvements were still needed.

While care staff had good intentions, the care people received was not always caring. People’s dignity was not always upheld and people were not always treated with respect and empathy. People’s independence was not always fully promoted and they were not given maximum control over their choices and lives.

People did not always receive fully personalised care. They were not always involved in planning the care they received and care staff did not fully understand people’s needs. People did not have sufficient access to the leisure opportunities and they were not encouraged to pursue personal interests.

People were not encouraged to complain and share their views about the service in order to ensure improvements could be made.

People were not cared for by a staff team who were fully supported by the provider. People did not feel the culture within the service was open and that it was safe to speak out about concerns they had. People were not living in a service where a culture of continuous improvement was present. Further improvements were still needed to quality assurance and governance systems which remained ineffective.

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.

The provider was in breach of the regulations surrounding safe care, person-centred care, the need for consent, dignity and good governance. You can see what action we told the provider to take at the back of the full version of the report. 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.

Following the last inspection, we met with the provider to ask the provider to complete an action plan to show what they would do and by when to improve each of the key questions of Safe, Effective, Caring, Responsive and Well Led to at least good. The provider submitted this action plan to us and we reviewed this during the inspection. We found that although some of the actions recorded were in progress, it was clear that the provider had not had much input into the action plan and as a result concerns were raised about their ability to make and sustain improvements at the service.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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.

Angel Court Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Angel Court Residential Home accommodates up to 30 people in one adapted building. At the time of the inspection there were 19 people living at the home.

There was a registered manager in post. The registered manager was also the registered provider of the service. 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 were not supported to manage risks to keep them safe. Where actions had been identified to mitigate risks, these actions were not being consistently applied and this left people at risk of harm. Staff were not always safely recruited and there were not always sufficient amounts of staff available to support people other than to support with immediate care needs. Staff knew how to report concerns where people may be at risk of abuse and medications were given in a safe way.

Staff received training and supervision but it was not clear if this included training in people’s individual needs. People had their dietary requirements met but the choices of meals lacked variety. The decoration of the service required improvement to ensure people were able to move around independently. People had their rights upheld in line with the Mental Capacity Act as staff understood the need to gain consent and the actions to take where people lacked capacity.

Although staff were caring, the culture at the service meant that staff did not often have time to spend with people in order to develop friendly relationships with them. People were not consistently treated with dignity and there was instances where privacy was compromised. People who were able were supported to maintain their independence.

There was a lack of activities available that met people’s individual interests and hobbies. People felt unable to make a complaint and the complaints procedure was not consistently applied by the provider. People were given opportunity to express their preferences with regards to their care.

The provider had not made sufficient improvements to the service following a previous inadequate rating. The quality assurance systems in place were ineffective and the provider lacked oversight of the service as a result of this. Feedback given by people was not acted on in a timely way. The provider had not ensured that records held were up to date and accurate.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

Angel Court Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Angel Court Residential Care Home accommodates up to 30 people in one adapted building. At the time of the inspection, there were 21 people living at the home.

There was a registered manager in post who was also the provider. 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.

Potential safeguarding concerns were not always acted upon by the registered manager. Risks to people were not always accurately recorded or acted upon to keep people safe. Staff were recruited safely and action had been taken to ensure sufficient staffing levels to support people. Improvements had been made to the cleanliness of the home and people were supported with their medications in a safe way.

People were supported by staff who had received training and supervision in order for them to support people effectively. Assessments completed did not consistently consider peoples protected characteristics under the Equality Act. People were supported by staff who understood how to seek consent but staff knowledge of people who required Deprivation of Liberty Safeguards varied. Records held in relation to the Mental Capacity Act were not always accurate or complete. People had their dietary needs met but improvements were required to people’s dining experience. People had access to healthcare services where required. We have made recommendations about ensuring a Dementia friendly environment.

People felt that although staff were kind, they did not always make time to spend with people. There were instances where people’s dignity was not respected and people were not always involved in their care or given choices. People had been supported to access advocacy services where required.

People were involved in the planning of their care but had not been involved in reviews. Staff knowledge of people’s preferences with regards to their care varied and care records did not always hold personalised information about people’s wishes; particularly in relation to end of life care. People had been informed on how to complain but some continued to be concerned about repercussions of raising complaints. Complaints procedures were not available in an accessible format for people.

People did not feel the home was well led. Audits were being completed but these were not robust and did not show where actions had been taken to make improvements. Feedback had not been sought from people in relation to their experience of care. Records had not been consistently maintained to ensure the information held was up to date and accurate. Staff reported they felt supported by the registered manager and notifications about incidents that occurred at the service had been sent as required. However the registered manager has no systems in place to keep them updated about good practice and innovations in care, resulting in the service been reactive to feedback from other agencies .

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

Angel Court Residential Home provides accommodation and personal care for up to 30 people. At the time of the inspection there were 28 people living at the service, most of whom were older people living with dementia. There was a registered manager in post. The registered manager was the same individual as the registered provider. 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 had failed to ensure people were sufficiently protected from the risk of harm to both their physical and emotional well-being. Safeguarding concerns were not always identified and investigated appropriately. People were exposed to the risk of harm such as injury due to inadequate risk management processes. People were not protected due to inadequately maintained premises and equipment.

People were not supported by sufficient numbers of care staff. People were not being supported by care staff who had the training, skills and knowledge to support them effectively. Pre-employment checks were completed for new care staff although some improvements could be made.

People received medicines such as tablets as prescribed by their doctor. We were not able to confirm people received their creams as needed due to the administration of these medicines not being recorded.

People’s rights were not protected by the effective use of the Mental Capacity Act 2005. The risks associated with people’s nutritional needs were not always monitored and effectively managed. People did have contact with healthcare professionals to maintain their health, however, this was not consistent and people sometimes did not receive interventions as required.

People were not supporting in a kind and caring way. Their dignity and independence was not protected and promoted. People were not supported to be actively involved in choices around their care.

People were not involved in developing their care plans and care provided did not always meet their needs and preferences. People were not enabled to access meaningful leisure opportunities and to choose how they wanted to spend their time.

People did not feel they were able to raise complaints. People did not feel their complaints were heard and addressed appropriately.

People were not protected by effective quality assurance systems that identified areas of improvement and ensured the required actions were taken. People were not sufficiently involved in the development of the service and discussing issues that affected them. People did not feel their views were heard.

People were being cared for by a staff team who felt unsupported in their roles. The culture within the service was not open and transparent.

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.

The provider was not meeting the requirements of the law relating to person centred care, dignity and respect, consent, safe care and treatment, safeguarding people, nutrition, premises and equipment, complaints, staffing levels, staff training and the effective management and governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

Angel Court Care Home is registered to provide accommodation for up to 22 people who require personal care and support. On the day of the inspection there were 21 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

The registered manager was registered to manage two homes and split her time between the two homes. To support the registered manager in the management of the home two deputy managers were in place to oversee the home on a day to day. Each deputy manager had specific areas of responsibility.

People liked the food provided and received the food and drink they required to remain healthy. Mealtimes were not always well managed and referrals for follow up on weight loss were not always actioned.

People were kept safe because staff knew the signs to look for and were able to escalate any concerns they had.

Risks were protected from harm because risks had been identified and plans put in place to manage them.

People received their medicines as prescribed.

People were supported by sufficient numbers of staff that had the skills, knowledge and experience needed to provide effective care.

People’s consent was sought before care was provided and systems in place ensured that their human rights were protected.

Arrangements for meeting people’s healthcare needs were in place.

People were supported by staff who were caring and treated them with respect and that supported people to be involved in making decisions about their care and support. People were treated with dignity and offered choices in a way they could understand.

People were able to express their views about the service they received.

People, relatives, professional visitors and staff felt the home was well managed. The provider had systems in place which monitored the quality of service the home provided.

We spoke with nine people that lived there and observed how people were supported by staff at lunchtime and in communal areas of the home. We spoke with two relatives, the provider and three members of staff.

Is the service safe?

All of the people and their relatives spoken with told us that they felt that the care provided was safe. A person living at the home told us, 'It's good here.'

We saw that people's care was planned and any risks associated with providing their care was assessed and managed appropriately.

Systems were in place to make sure that managers and the staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve.

We saw that the environment within the home was maintained to ensure that people lived in a suitable safe home. We saw that equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

Recruitment records that we looked at were mostly in line with the requirements of the regulations. Some improvements were needed in respect of obtaining references from previous employers and not relying on general letters of recommendation.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes and hospitals. We saw that people's rights were protected and they were safe because people were presumed to have capacity to make decisions. Only where people were not able to make decisions were relatives and other relevant people involved in making decisions in their best interests. No-ones liberty had been restricted.

Is the service effective?

Care plans were detailed and kept under regular review, so that staff had up to date information on how to care for people.

Health information was detailed so that staff had the information they needed to support people safely.

We saw that where people required equipment to support their care this was available and maintained to ensure that they were suitable.

All but one of the people and their relatives spoken with told us that they were receiving the care that they wanted. We saw that some people's needs were not always met in the way they wanted .

Is the service caring?

All of the people and their relatives spoken with told us that they felt that the service was caring. One relative spoken with told us, 'They (staff) are always kind and staff do their best.'

We walked around the home and watched to see how staff treated people. We saw good interactions between people and staff. We saw that staff were friendly and offered support and reassurance when people who lived there had disagreements. We saw that people were given the opportunity to see health care professionals. One person told us, 'The doctor keeps coming to see me but I don't need them.'

We saw that people were dressed in clothing appropriate to their age, gender and the weather. We saw that everyone living at the home looked cared for.

Is the service responsive?

All the people and their relatives that we spoke with told us that they had no concerns or complaints about the care provided. Both relatives told us they felt that they could raise any concerns they may have and that they would be addressed

We saw that staffing levels needed to be reviewed as people's needs had increased and we saw that people's needs were not always met at the time they wanted.

We saw that call bells were accessible to people so that they could summon support if needed.

We saw from care records looked at that the home involved other professionals in supporting people's care as required. For example, dieticians were involved for people who were not eating enough to maintain or increase their weight where needed.

People were able to practice their faith and religious beliefs and care plans were designed to ensure that people's diverse needs were recorded and catered for.

We saw relatives freely visited the home whilst we were there, so people could maintain relationships with family and friends.

Is the service well led?

All the people and their relatives that we spoke with had no concerns about the service.

Systems were in place to monitor the quality of the service. Where people had raised concerns we saw that these were investigated and resolved.

We saw that there was a good atmosphere in the home. People were consulted about the quality of service they received. We saw that comments and concerns were analysed and improvements were put in place where they had been identified. All staff spoken with said they thought that the home was well managed. They said that staff meetings were held and they were able to put forward ideas for improvement in the home.

We found that people received their medication as prescribed by their doctor. Medication was stored securely in locked cabinets. However most drugs are kept on the drugs trolley in the dining room where the temperature is above the manufacturers recommended levels. This can affect the effectiveness of the medication. This meant appropriate arrangements were not in place to ensure medicines were stored safely.

We found that the provider had not carried out appropriate checks to ensure that staff were fit to work with vulnerable people.

We found that staff received supervision however records showed that supervision focussed on concerns raised by service commissioners and the care quality commission. This meant that staff did not receive the guidance and support they need to carry out their tasks.

We found that people's files contained all the information staff needed to meet their needs. We observed care staff delivering support to people as described in their individual care plans. We saw that all personal records were stored securely, but were accessible by staff that needed them.

We saw that people's consent was always sought before any care and treatment was carried out. Staff said, 'I always check that people are ok with what I am doing with them.'

We saw that people's needs had been assessed and care plans had been devised to describe how people liked to be supported. Risks to people's health and well-being had been identified and measures had been put in place to protect people. Staff we spoke to was able to tell us about people's care needs so that they received support and care in a way that they preferred. Relatives told us they were kept informed about their relative's health so that they felt involved with their relatives care. One relative said, 'Staff always talk to me about their care.''

We saw that systems were in place to keep people safe from harm. A relative told us about their relative and said, ''She is very safe.'' Staff received a range of training so that they were able to support the people who lived in the home. One person told us, ''Staff are very good to me.''

There were systems in place to monitor how the home was run, to ensure people received a safe and quality service.

People did not have to wait as long for their breakfasts as previously; the cook was starting work earlier. Menus were available and displayed in the dining room. People were given choices of food and drink throughout the day and this helped to ensure people were not hungry and were well hydrated.

Medicines were administered appropriately and there were appropriate checks and records to ensure that medicines were safe.

There were enough care staff and ancillary staff to ensure that people had appropriate care.

There was a lack of contingency planning. This meant that when emergencies arose there were not clear plans or instructions to minimise the effect on people. On this visit one of the two heating boilers was not working and areas of the home were cold. On a previous visit the call alarms not working and clear checks were not being evidenced. Foreseeable emergencies such as whether the laundry could manage an infection outbreak effectively were not being considered.