Archived: Connors House

Connors House is a care home providing personal and nursing care to up to 47 people. The service provides support to older people with varying care needs including, dementia, diabetes and mental health needs. At the time of our inspection there were 38 people using the service. The service was spread across three wings, all ground floor accommodation. Although people living with dementia lived across the service, one wing supported people living with more advanced dementia.

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

Although the feedback from people living at Connors House and their relatives was mainly positive, we found the provider had ineffective systems in place to monitor people’s safety and well-being. Risks were not always identified and mitigated against. Accidents and incidents were not effectively reviewed and monitored to minimise the risk of them happening again. Medicines were not always managed well. Systems to monitor people’s medicines were not robust to pick up issues which meant people may not receive their medicines as required.

Staff did not have comprehensive and accurate guidance around people’s care needs as records were not updated regularly and contained information that was not consistent throughout the care plan. The environment did not meet the needs of those living with dementia and some areas of the service were in need of refurbishment.

People were supported to access support and advice from healthcare professionals. However, the outcome of people’s medical appointments and advice given was not always used to update care records and not consistently followed by staff. Changes in people’s health needs had not always been recorded to give staff clear information about how to support them safely given their changed circumstances. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Systems to monitor the safety and quality of the service people received were not effective. Action plans lacked detail and timescales for completion were not met. Audit systems were not robust and did not identify concerns. The provider did not have adequate management and oversight of the service.

People and their relatives told us they were happy with the support provided. The comments we received included. “ Yes, I get the care I need; showering goes smoothly”; “ I am confident in the staff they are patient, diligent and supportive” and, “Yes, the permanent staff do know how to support him as they know his issues”. People told us the food was good, they had snacks through the day and plenty to drink.

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 27 April 2019).

Why we inspected

We received concerns in relation to staffing issues, incidents, complaints and provider management and oversight. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. During the inspection, we found concerns in relation to the MCA 2005, so we also reviewed the key question effective.

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 inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

We stepped back from taking significant enforcement action following this inspection as the provider told us they planned to close this service. The provider has a plan in place with the local authority to find suitable alternative accommodation and care for the people living at Connors House. People are starting to move to their new homes at the time of writing this report. 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 Connors House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to effective risk management, medicines management, staffing, person centred care accurate record keeping and management and leadership at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service. We will meet with the provider following this report being published to discuss how they will make sure people receive safe care until they move to their new home. We will work with the local authority to monitor progress.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 following examples of good practice.

The provider was supporting safe visiting following current guidance. Checks were made to make sure visitors had carried out a test for COVID-19 before entering the service and a full supply of PPE was available to use. People could see their loved ones inside the service, supported by staff to maintain safety.

The service was clean. Domestic staff were employed who kept up to date cleaning schedules. This included regular cleaning, day and night, of high touch areas, such as door handles and light switches.

Staff were using PPE in accordance with current guidance. The provider had kept plenty PPE in stock. Staff had training in infection control. Audits and spot checks were undertaken regularly to make sure staff were compliant with infection control procedures.

Testing for COVID-19 was being carried out for people and staff following the current government guidance. People were admitted safely into the service.

support. There were 37 people living at the service at the time of our inspection. The service provides care for older people some of whom may be living with dementia. Connors House is a single storey residential care service located close to Canterbury city centre.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

The service met the characteristics of Good in all areas.

¿ People and their relatives told us they felt safe living at Connors House. People were relaxed in the company of each other and of staff. People and their relatives said the quality of care was good and the service was well managed. Their comments included, “I have made friends since I moved in. The staff are all lovely and I couldn’t ask for more. They help me do the things I can’t manage anymore” and “[My loved one] is so well looked after – I can’t thank the staff enough”.

¿ People were protected from the risks of harm, abuse and discrimination and people’s health was monitored to make sure they remained as healthy as possible.

¿ People were involved in making decisions about their care and felt in control of their day to day lives. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. They were encouraged to keep busy and were offered a wide range of activities.

¿ People told us there was a ‘family’ and ‘homely’ feel at Connors House. There was a relaxed, calm and inclusive atmosphere at the service where people and staff valued each other.

¿ Staff responded quickly to people’s needs and worked closely with heath care professionals promoting ‘joined-up’ care.

¿ Management and staff worked as a cohesive team, spoke with each other respectfully and promoted an open and transparent culture.

¿ The service was well-led. The registered manager promoted an ‘open door’ policy and was approachable to and trusted by people, relatives and staff.

¿ There were effective audits to monitor the quality and safety of the service. Identified shortfalls were acted on to continually improve the service.

Rating at last inspection: At the last inspection in November 2017 the service was rated Requires Improvement overall. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to manage the risks of people falling. The provider failed to ensure there were systems and processes operated effectively to include a record of the care and treatment provided. The provider failed to effectively audit the service. We required the provider to take action to make improvements. The provider sent us an action plan detailing how they planned to address the breaches of Regulation. During this inspection we found the service had made and sustained the improvements and the breaches in Regulation had been met.

Why we inspected: This was a planned comprehensive inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Abbeyfield Connors House provides accommodation for up to 47 people who need personal care and support. There were 41 people living at the service at the time of our inspection. The service provides care for older people and people living with dementia including some with other health and mobility needs. Some people had complex needs and were not able to communicate verbally with us. Connors House is a single storey residential care service located close to Canterbury city centre. The service is split into three units – Holly and Evergreen, which support people living with advanced dementia and higher needs and Cedar and Ash, which support older people and people living with dementia. The Maple unit is the newest part of the service and accommodates older people. In each unit there are communal areas such as lounges, dining areas and bathroom facilities, a conservatory and a well-equipped hair salon. There is an enclosed courtyard with safety rubberised flooring, patios with seating, a BBQ area, fishponds, floral and shrub raised planting as well as a separate vegetable garden.

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. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last comprehensive inspection in September 2016 the rating for the service was Requires Improvement overall and in each of the five key areas. This was because although risks to people had been assessed, they were not always reflective of people's changing needs. Medicines were mostly well managed, however, some records were not accurate and people did not always receive their medicines when they should. There was not always enough staff on duty to meet people's needs and at times people did not receive the support they needed, for example, to maintain their personal hygiene. Staff were not trained in topics that would help them provide care and support specific to people's needs, such as, End of Life Care and Palliative Care as well as Parkinson's and Epilepsy awareness. Care plans did not always provide staff with the most up to date guidance, so they could support people in an individual way. Assessed risks to people's health, such as monitoring food and fluid intake, monitoring weight or pressure reliving equipment were not managed effectively and, at times, people did not receive personalised care that enhanced their dignity. People were not always offered choices, and sometimes staff made assumptions about what drinks people would choose. The audits and checks carried out each month by the registered manager or a nominated person had not always been effective in identifying the shortfalls highlighted during our last inspection.

At this inspection we found improvements had been made, however, there were some areas that still required further work around risk assessment, record keeping, auditing and statutory notifications. A statutory notification is information about important events which the provider is required to tell us about by law.

Most risks to people had been properly assessed and actions were taken to minimise the likelihood of them happening. However, more action needed to be taken about people who experienced falls; including a more detailed audit processes to ensure risks were minimised. Other care plans were written in a person-centred way but had not always been updated to reflect people’s needs when they had changed.

Medicines were generally managed safely but records of the administration of topical creams needed to be managed more robustly.

Not all complaints had been logged, however, they had all been investigated and responded to.

People were safeguarded from abuse and improper treatment and accidents and incidents were thoroughly documented. Referrals to the local safeguarding authority had been made appropriately.

There were enough skilled and competent staff on duty and people had their needs met promptly. Staff received appropriate induction and training to ensure they had the skills and knowledge to support people. Staff had opportunities to discuss their work performance, training and development. Recruitment processes ensured that only suitable staff were employed to work with people.

People were supported to eat and drink when needed and they enjoyed the variety of food provided. However, some improvement was required to better cater for diabetic and vegetarian needs.

Weights were monitored and dietary advice sought where people had lost weight. People’s health care needs were met by the staff and through input from a variety of clinicians and professionals.

The service was mostly meeting the requirement of the Deprivation of Liberty safeguards (DoLS) and Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, the service had overlooked the renewal of a DoLS authorisation.

People’s dignity was respected by staff and support was delivered by them with consideration and kindness. They encouraged people to be independent when they were able and people and families were involved with care decisions. End of life care plans had been improved.

There was a wide range of activity available to people; who enjoyed meaningful entertainment and individual sessions.

Policies and procedures were available to offer guidance to staff. People, relatives and staff were positive about the leadership at the service. Staff told us that they felt supported and could raise any issues or concerns with the registered manager.

We found two breaches of Regulation. You can see what action we told the provider to take at the back of the full version of the report.

Connors House provides accommodation for up to 47 people who need personal care and support. There were 41 people living at the service at the time of our inspection. The service provides care for older people and people living with dementia. Some people had complex needs and were not able to communicate verbally with us. Connors House is a single storey residential care home located close to Canterbury city centre. There are 43 bedrooms, four of which could be doubles. The service is split into three units – Holly and Evergreen, which supports people living with advanced dementia. Cedar and Ash, which supports older people and people living with dementia. Maple is the newest part of the building and accommodates older people. In each unit there are communal areas such as lounges, dining areas and bathroom facilities. There is an enclosed courtyard, patio and garden area.

The service had a registered manager, who was present throughout the inspection. 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.

Risks to people had generally been assessed but were not always reflective of people’s changing needs. Medicines were mostly well managed however some records were not accurate and people did not always receive their medicines when they should. Medicines were stored appropriately.

There was not enough staff on duty at all times to meet people’s changing needs. At times this meant that people did not receive the support they needed, for example, to maintain their personal hygiene. Staff were not trained in topics that would help staff provide care and support specific to people’s needs. The registered manager did tell us they were seeking training in End of Life Care, Palliative Care, Parkinson’s and Epilepsy awareness. A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so.

The care and support needs of each person were different, and each person’s care plan was personal to them. Care plans, risk assessments and guidance were in place but did not always provide staff with the most up to date guidance, so that they could support people in an individual way. Assessed risks to people’s health, such as monitoring food and fluid intake, monitoring weight or pressure reliving equipment were not managed effectively.

At times people did not receive personalised care that enhanced their dignity. Staff were, however, kind and caring in their approach and respected people’s privacy.

People were not always offered choices, at times, staff made assumptions about what drinks people would choose. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

A number of audits and checks were carried out each month by the registered manager or a nominated person, but they had not always been effective in identifying the shortfalls highlighted during our inspection.

People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

Staff encouraged people to be involved and feel included in their environment. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives. Staff received supervisions and annual appraisals.

An activities co-ordinator planned and led an activities programme. They listened to the views of people and ensured a variety of activities were offered. People and their relatives were complimentary of the increased availability of activities.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted.

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

The manager told us that the home had established a link to Canterbury Christchurch University and students were encouraged to study and work within the home's framework. We saw that people had freedom of choice and were able to move freely around the home, enjoying the animals and birds as part of the life of the home. We saw a clean and tidy home. We saw storage issues, the home manager told us they were looking to increase available storage space.

We talked to the manager about consent issues and looked at care plans seeing strong family involvement. We were told that recent safeguarding concerns had been resolved with the individuals and their families using best interest meetings and advice from the local safeguarding team. One person told us they were 'content, the food was good, and that staff were available and helpful'.

We looked at staffing including recruitment and retention. Staff told us that Abbeyfield was a supportive and creative employer. We saw the complaints and compliments files, and were shown the paperwork supporting appropriate actions with simple leaflets and flowcharts.

People living at the home, visitors and relatives told us that they thought the home was clean and tidy. In addition they commented that they were treated with respect, kindness and dignity. Individual preferences concerning food were met, reviewed and changed if necessary.

People had the freedom of choice over how and where to spend their day in the home and were actively involved in the planning of the care they received. We observed that people who used this service were very relaxed and comfortable within the environment. They interacted well with the staff who worked with them and staff encouraged their independence.

During the inspection we found that there were appropriate numbers of suitable staff and staff were given the support they needed to carry out their role effectively.

People told us that they had brought in their own personal items to the home. We saw that people had personalised their rooms with their own belongings, which included photographs and ornaments. People and their relatives told us that they were able to visit at any time, which helped maintain their relationships with family and friends. The people we spoke with told us they were happy with the staff. One person told us "the staff are friendly and nice."