Archived: Courtenay House Care Home

Updated 1 November 2018

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 is 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.

This inspection took place on 30 August and 7 September 2017.The first day of our inspection was unannounced.

On 30 August 2017, the team consisted of two inspectors, a specialist advisor in nursing care, and a medicines inspector. On 7 September 2017, one inspector returned to look at records associated with recruitment

This inspection was carried out in response to a serious safeguarding concern that had been raised about the home, and subsequent concerns raised by the local clinical commissioning group (CCG) and local authority. We also looked at any notifications the provider had sent us. The provider has to notify us of certain incidents such as serious injuries or allegations of abuse. We gained information about the home from the local authority and clinical commissioning group.

During the inspection, we spoke with two people living in the home and one visitor. We also spoke with a healthcare professional, three care staff, a nurse, the interim manager and the provider’s interim regional manager.

Some people living in the home could not verbally tell us about their experience of the care they received. Therefore we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also carried out general observation throughout the inspection. This included observation of people’s experience during their lunch and evening meal and how staff interacted with people.

The records we looked at included six people’s care records, four staff recruitment files and medicine records. Records in relation to staff training, the management of the premises and how the quality of care was assessed and monitored were also reviewed.

Updated 1 November 2018

This inspection took place on 30 August and 7 September 2017 and was unannounced.

Courtenay House Care Home provides accommodation and personal and nursing care for a maximum of 46 older people, some of whom may be living with dementia. At the time of this inspection, there were 35 people living in the home.

We had previously inspected the service in February 2017 and had identified five regulatory breaches. This inspection identified 14 regulatory breaches, five of which the provider had been in breach of at the February 2017 inspection. These repeat breaches related to safeguarding people from harm, staffing arrangements, person-centred care, the governance of the service and the requirement to report incidents to the Care Quality Commission (CQC). You can see what action we told the provider to take at the back of the full version of the report.

There was 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 2008 and associated Regulations about how the service is run. At the time of our inspection, the registered manager was absent from the service.

Incidents that required reporting to the local authority's safeguarding team were not always reported. Statutory notifications of certain incidents that are required in law to be notified to the CQC were not always completed. Risks to people's health were not always identified. When they were identified, the service did not always take appropriate actions to minimise the risks to people's welfare.

The numbers of staff on duty and their deployment was not effective in ensuring people’s needs were met in a timely way. People often waited for their care. Some care staff had been recruited without providing sufficient evidence to show they were suitable for the role. Medicines and prescribed supplements were not always managed safely so that these were available when people need them.

Staff training and checks of their competency, to ensure that they could meet the needs of people living at the home had not been fully completed. Staff had not had supervision to support them in their role, since our last inspection in February 2017.

There was limited understanding and application of the Mental Capacity Act other than at a basic level. Where significant decisions needed to be made assessments had not been carried out appropriately. Where people who had an application to deprive them of their liberty authorised, the conditions under which this was granted were not always followed.

Staff did not always respect and maintain people’s dignity, people received personal care that could be observed by others because doors were not closed.

People's care plans did not contain accurate, up to date or clear information for staff to help ensure that they provided a high standard of care and support to people. People’s preferences had not been identified so that staff could provide care in the way people wanted.

Complaints to the service had not been managed in line with the provider’s stated procedure. Complaints had not been thoroughly investigated, and responses to the complainant were not comprehensive.

The leadership within the home was poor. Effective communication was not always in place in respect of people’s needs and practices that were taking place in the home. Staff felt the registered manager was not visible, and many did not feel comfortable raising concerns with them. Staff were not confident that any concerns raised with the registered manager would be taken seriously.

The provider's auditing system was not robust and had not identified the concerns we found during this inspection. The provider had not made improvements since the February 2017 inspection.

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.