Archived: Prestbury Court Residential Home

Updated 7 December 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We carried out this inspection because we had received concerns from the local authority about the quality of care being provided to people living at Prestbury Court.

This inspection took place on 18, 22 and 23 August 2017. The first two days of the inspection were unannounced.

The inspection team consisted of one adult social care inspector on the first and third days and two adult social care inspectors on the second day.

Before the inspection we gathered and reviewed information we held about the registered provider. This included notifications (about events and incidents in the service) sent to us by the registered provider. We also received information from the local authority’s Quality Assurance and Improvement Team (QAIT) who had been working with the provider.

In order to gather information during the inspection we spoke with the acting manager, 16 staff, one visitor and nine people living at the service. We also spoke with two visiting social and healthcare professionals.

Not everyone living at Prestbury Court was able to tell us about their experiences. Therefore we spent time in the dining room on the second day of inspection and completed a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

During the inspection we looked at a number of records including three people’s care records, the provider’s quality assurance system, accident and incident reports, three staff files, records relating to medicine administration for four people, complaints and staffing rotas.

Updated 7 December 2017

Prestbury Court Residential Home is a care home without nursing, providing care and accommodation for up to 48 people. People living at the service were older people, some of whom were living with significant dementia or long term health conditions. At the time of the inspection there were 31 people living at the service.

There was no registered manager for 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. An acting manager had been appointed in May 2017 and was in day to day control of the service.

This inspection took place on 18, 22 and 23 August 2017. The first two days of the inspection were unannounced. The service was last inspected in October 2016 when it was rated overall as Good, with the key question ‘Well-led’ being rated as Requires Improvement. Prior to the inspection in October 2016 the service had been inspected in December 2015 when we found significant improvements were needed. At the inspection in October 2016 Improvements had been made. However, at this inspection in August 2017 we found the improvements had not been sustained.

We carried out this inspection because we had received information that three safeguarding alerts had been made to the local authority in August 2017. The concerns had been raised about the care people received at the service. The local authority’s safeguarding team and commissioners were investigating the matters and working together to keep people safe.

The overall rating for this service is ‘Inadequate’ and the service was therefore placed in ‘special measures’ and enforcement action was considered. However, since this inspection the provider has applied to de-register Prestbury Court and asked for support from the local authority to help people move to other care services.. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

We found the provider had not taken sufficient action to ensure people received safe and high quality care from well trained and competent staff. The quality monitoring systems were not effective and failed to identify and address the concerns we found at this inspection. The acting manager had been working with the local authority’s Quality Assurance and Improvement Team (QAIT) since May 2017 and a Service Improvement Plan (SIP) had been produced. Some work had been completed on the SIP. However, the report from the visit by QAIT on 2 August 2017 identified a quality assurance system needed to be reinstated, monitored and maintained.

People were not protected from risks to their health and safety. Risks associated with people’s specific health needs were not always identified or acted upon in a way that reflected the urgency of the situation. The gates fitted across some people’s doors were at a low height and there was a risk that people could fall over the gates. Risk assessments did not always contain sufficient detail to help keep people safe. There was no clear care plan or risk assessment to support staff in understanding the needs of people with diabetes or epilepsy.

People were not supported to receive their medicines safely. Staff did not have a full understanding of what people’s medicines were for or when people might need additional medicines, for example for pain relief.

People were not supported by sufficient staff at all times. However, involvement of the local authority’s safeguarding and commissioning teams had reduced the risks associated with this.

People were not supported by staff who received sufficient induction and supervision to ensure they were competent to meet people’s needs. Staff had not received recent relevant training to support people living with dementia, diabetes or epilepsy.

People were not always supported to receive sufficient food and fluids. There were concerns that staff had not made sufficient attempts to encourage one person to eat resulting in significant weight loss. When the weight loss had been identified professional advice had been sought and the person’s weight had increased. Fluid intake was not always recorded to ensure people remained hydrated.

People did not always receive care that was respectful and promoted their independence, privacy and dignity. We heard some staff talking about people in front of other people, breaching their confidentiality. We saw one member of staff assisting two people to eat at the same time, while also supervising other people who were eating independently.

People were placed at risk of not receiving the care and support they required to meet their dementia care needs. Staff did not always address people living with dementia by name when they spoke with them or ensure they made and retained eye contact with them. Care plans did not contain sufficient detail for staff. There were no instructions on what form reassurance should take in order to help people who became anxious due to short term memory problems. Care plans did not identify and plan to meet people’s social care needs. People's records did not always contain up to date and accurate information about the care they received. People did not benefit from an environment that supported those living with dementia.

People were not supported to have maximum choice and control of their lives and staff did not always provide care in their best interests; the policies and systems in the service did not support this practice.

People were supported to receive regular visits from healthcare professionals.

Complaints were well managed. One relative told us they felt able to raise any concerns they may have.

People and their relatives were supported to be involved in planning their care if they wished.

People were protected from the risk of abuse, because staff had a good understanding of how to recognise and report abuse. There were robust recruitment procedures in place.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.