Pottles Court

We found the following examples of good practice.

The premises were clean and work was taking place to update decor in communal areas. Cleaning schedules were in place and the provider ensured practices changed in line with new guidance. Hand sanitiser was readily available, and staff were wearing personal protective equipment (PPE) appropriately.

The provider and registered manager explained what steps were undertaken before people were admitted to the home, and how risk assessments were completed.

Staff had received training and support to work safely in a pandemic, such as COVID-19. Weekly briefings took place to update the staff team, and there was a focus on the well-being and mental health of the staff group following an outbreak at the home.

The provider and staff continued to ensure families were kept up to date on their relative's well-being and on the running of the home through letters and social media. They recognised the importance of providing reassurance for families and retaining their confidence in the quality of care at the home.

There was a clear procedure for staff to follow when arriving and leaving. For example, staff donned and doffed their uniform and put on their personal protective equipment (PPE) in a separate outside space before entering the main building.

A pod had been bought and placed in the courtyard to enable visiting to take place outside of the home.

Staff recognised the importance of maintaining people’s well-being, by meeting their social needs, to ensure they did not feel isolated.

Staff accessed regular testing. People who used the service were also supported to access regular testing and had been offered the vaccine.

Staff had completed infection control and prevention (IPC) training. The registered manager and the providers worked closely with the care team. This enabled them to observe staff to ensure they followed good practice infection control guidelines.

Infection control policies incorporated new guidance and checklists to inform staff how to manage COVID-19. There were strong connections with local resources, such as the Provider Engagement Network, to ensure knowledge and practice was up to date.

The provider and registered manager said the service was well supported by the local primary healthcare team, as well as the local authority and national agencies.

Pottles Court provides accommodation for up to 17 people and there were no vacancies when we inspected. When we inspected, the service did not have a registered manager as they had resigned in February 2017. 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. A manager, who had previously been the deputy, was working at the service at the time of our inspection. They had been the manager since the previous registered manager resigned. Since the inspection, there application to be a registered manager has been processed by CQC and they are due to be interviewed by CQC. A relative said the promotion of the deputy to the manager “was a great decision…she is a thoughtful lady.”

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection, applications had been made to the local authority in relation to people who lived at the service. Staff understood the importance of gaining consent and their legal responsibilities.

At the last CQC inspection in July 2015, we found a breach linked to recruitment. On this inspection, we saw improvements had been to the recruitment process to ensure staff were suitable to work at the home and there was no longer a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the last inspection, we judged the service was developing a caring approach which they have built on. The service continues to develop a very caring approach, where people were valued and respected. Dementia can create barriers for people to make their feelings and views known. Steps were taken by staff to go the extra mile to understand people’s own individual communication and recognise the importance of body language, for example monitoring pain. The values of the home were promoted by the management team; their approach helped staff transfer the home’s ethos into the way they worked. There was a commitment to learn and develop the service to the benefit of the people who lived there. A visiting medical professional wrote in feedback ‘Pottles Court really is the homeliest of homes.’ Visitors praised the welcome they received and the family feel to the home.

The provider, manager, supported by the deputy manager, held a strong belief of providing people with an enhanced quality of life which took into account individual wishes and beliefs so each person was valued and treated with equality. This inclusive ethos enabled people to feel part of the home’s community and maintain important relationships. The management team acted as role models for the staff team who were motivated to offer care that was kind, considerate and put people at the heart of everything they did.

The provider was proactive in driving the service forward to improve outcomes for living at the home. They worked in partnership with key organisations, both locally and nationally, to support care provision, service development and joined up care. The provider understood the need to provide staff with the skills, knowledge and tools to provide care that followed best practice. They invested in staff development to promote staff motivation and confidence to provide a high standard of care which promoted people's wellbeing and meant they had a meaningful life.

People complimented staff on their approach and compassion. People’s relationships were respected and celebrated. There were a range of interactions with people to help keep them interested in the world around them. Staff treated each person as an individual and respected their life history and experiences. Staff knew about people and who and what was important to them and significant events in their lives. Staff were able to tell us how they used their knowledge of people to engage and respond to them to show they were valued. Staff supported people to maintain relationships and build memories with family and friends who were important to them.

People told us staff were kind and we saw they had the skills to adapt their approach to each individual. People benefited from a staff group that were well trained and supervised. People had access to health services and staff recognised the importance of reporting changes in a timely manner. Care records were personalised, including information which could be shared if people needed care in an alternative setting, such as hospital.

Medicines were well managed. Risk assessments were in place for people’s physical and health needs. Staff in the kitchen worked alongside care staff to find food to meet people’s preferences and choices. They worked with care staff, discussing if a person’s appetite had declined, and what alternatives could be offered that might tempt them to eat. People looked confident as they moved around the home and people told us they felt safe.

The home was not purpose built but the provider said they had endeavoured to adapt the layout to suit the people that lived there. The ground floor layout enabled people to choose different areas to sit. Some people appeared to prefer to move around while others had a favoured spot in the conservatory or in the lounge. Accident and incident records were analysed and action taken. Staff knew how to report poor or abusive practice, and the management team responded to concerns appropriately. Staffing levels met people’s care needs and the atmosphere was calm and friendly.

There had been significant improvements in the quality of people's care records, which helped keep them safe and protect their rights. We saw the recording of health professionals' advice was well recorded and we received positive feedback from a GP and a relative about the quality of the care provided by staff. Changes had been made to improve the auditing of the environment and we saw a policy had been updated to provide guidance on Data Protection and record retention. We judged the service was now compliant.

We spoke with the provider on the day of the inspection and they told us the two named registered managers, which appear on this report no longer worked at the care home, although one still works for the company. They assured us they would ensure both managers cancelled their registrations with the Care Quality Commission so that our records were correct. They explained how they were currently recruiting for a new manager and confirmed the current interim arrangements to manage the home safely.

We found the home understood the need to assess people's capacity to consent to care and were taking action to do so. One person living at the home that we spoke with told us the staff did what they wanted them to do. They told us 'They listen to what I say. I trust them to do the right thing anyway but they always ask me if it is OK.'

We found people's healthcare needs were being met, and work was under way to develop a more person centred approach to activities and stimulation. We found enough workers on duty with the right skills to meet people's needs. Workers told us they received the training they needed. We saw workers had time to chat and spend time with people, and to respond to their needs in a timely way.

However we found some records or policies were not yet completed, comprehensive enough or left gaps where people's care needs might be missed.

We heard staff speaking to people in a friendly and relaxed manner and we saw that they managed people's behaviour due to their dementia in an appropriate manner. We saw that people's privacy and dignity was respected at all times.

We saw that activities and occupation were available to people throughout our visits.

We spoke with the representatives of three people who lived at the home. All three praised the staff for the care their friend or relative had received.

We spoke with the provider about the regulated activities that the home is registered for. It was decided that the home did not need to be registered for 'treatment of disease, disorder or injury' or 'diagnostic and screening procedures'. Only nursing homes require these regulated activities. The provider told us that they would be applying to have these regulated activities removed from their registration.

Prior to this visit we had received concerns about the care and treatment some people received at the home. These included, nutrition, pressure area care, toileting, dependency levels and staff's ability to care for people with dementia. We found no evidence to support these concerns.

Care staff supported people well and knew about their care needs. Records contained details of people's preferences. One member of staff told us they always remembered each person was unique. People had access to organised leisure activities. People were offered choices and staff had found out about peoples preferences in relation to their care. When care staff interacted with people they treated people with respect. The majority of interaction was limited to task based activities.

People were relaxed in staff company. Staff knew what action to take if they suspected abuse. Prior to this inspection we had received concerns from the South West Ambulance Service. We found the home had managed this situation satisfactorily.

Medication management was well managed and systems had improved.

The new manager had started to improve the home including managing the strong smell of urine. Improvements were still needed to present a more homely environment. We found locks on doors may cause access problems in event of fire. The manager told us they would seek advice regarding this.

There was an effective system of staff training and support in place. Staff told us they felt supported in their role and were able to discuss concerns and share ideas. There was a system of monitoring quality at the home.