The inspection took place on 16 and 21 October 2018. Both days of the inspection visits were unannounced. Canning Court is a purpose built home which is registered to provide residential and nursing care for up to 64 older people living with dementia. The home has two floors, a ground floor unit called Hamlet, and the first floor unit called Gower. Most people who lived at Canning Court had limited mobility and/or a diagnosis of dementia. At the time of our inspection there were 51 people living at Canning Court.
Canning Court 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.
Canning Court is required to have a registered manager 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 and associated Regulations about how the service is run. At the time of this inspection, this service did not have a registered manager in post. A new manager had been appointed and had been in post for four months. The new manager was in the process of completing their application for registration with the CQC when we visited.
We previously inspected the service in June 2017 and the rating after that inspection was 'good'. This inspection was prompted following concerns from local commissioners which included information related to people falling, a lack of permanent staff and poor record keeping. During our inspection visit we found there were areas where the provider needed to improve the service. We changed the rating of the service to 'Requires Improvement'. We identified a breach of the regulations and you can see what action we have asked the provider to take at the back of the full version of the report.
On the first day of our inspection visit there were enough staff to keep people safe. However, there were often occasions when staffing levels as identified by the manager based on people’s assessed needs were not maintained, which impacted on the ability of staff to provide safe, responsive care. A lack of clarity around staffing levels meant senior staff were not aware of when they needed to follow the provider’s policies to report low staffing levels in the home.
The provider had systems in place for auditing the service to monitor and identify trends and better respond to risks to people using the service, but these had not always been effective and had not consistently identified risks to people living at the home. The provider was working towards a quality improvement plan in response to the concerns that had been identified.
The provider had taken action to improve the management of identified risks to people’s health and wellbeing. However, people in their bedrooms did not always have access to their call bells which put them at risk.
Staff monitored people’s health and referred them to other healthcare professionals if a need was identified. People received their medicines as prescribed and in accordance with good practice. The home was clean and tidy and staff followed good hygiene and infection control practices.
New staff had an induction into the home, however, the high turnover of staff meant the provider was constantly training new staff who needed time to gain the skills to provide effective care. Staff did not always feel supported but said their opportunity to speak to senior staff had improved recently.
People's consent was sought consistently by staff and the provider had made applications to the local authority for any restrictions that may be a deprivation of a person's liberty.
People were supported to eat and drink enough to maintain their health and staff were aware of those people who had been assessed as having risks around eating and drinking.
Permanent staff knew people well. They knew about their backgrounds and preferences and understood what was important to them. People received care from staff who were kind and caring and respectful and who understood how people’s background and life experiences might impact on their emotions. When staff assisted people, they showed patience and understanding. However, staff felt their responsiveness to people’s physical, social and emotional needs was inconsistent because they did not always have time.
The provider had improved the provision of activities in the home and there was more emphasis on providing meaningful engagement for people on a one to one basis.
The manager was still settling into their new role but felt confident because they had support from the provider to manage the changes needed to address issues and improve standards of care within the home.