Background to this inspection
Updated
25 December 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The first day of inspection took place on 05 June 2019. The inspection team consisted of one inspector, one assistant inspector, a Specialist Advisor who was a registered nurse and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
The second day of inspection took place on 06 June 2019 when the inspection team consisted of an inspector and an assistant inspector.
A third day of inspection took place 20 June 2019 when the inspection team consisted of an inspector and a medicines inspector.
Service and service type
Island Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service is required to have a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of this inspection there was not a registered manager.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed the information we had received about the service since the last inspection. We sought feedback from the local authority and external professionals that work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection-
We spoke with nine people who used the service and five relatives of people who use the service, we also spoke with the manager, the improvement manager, the improvement director, operations manager as well as two nurses, two care assistants, two senior care assistants, activities coordinator and staff from the housekeeping and kitchen teams. 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 reviewed a range of records. This included 12 people’s care records and multiple medication records. We looked at five staff files in relation to recruitment, training and supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After in inspection
We continued to seek clarification from the provider to validate evidence found. We looked at nutrition and hydration information and quality assurance records. We spoke to professionals from the funding authorities who had visited the service to gain their feedback on whether people were safe and well.
Updated
25 December 2019
About the service
Island Court is a residential care home providing personal and nursing care to older people and people with dementia. The accommodation is purpose built over two floors with the ground floor providing nursing care and the first floor providing personal care. The service can support up to 55 people. At the time of this inspection there were 46 people receiving support.
People’s experience of using this service and what we found
People were not effectively safeguarded from abuse. Allegations of abuse were not always investigated or referred to external agencies. Risks to people were not always well managed and the provider did not always put people’s safety first. This left people at risk of ongoing harm. People did not always receive their medicines as prescribed. A shortage of personal protective equipment impacted on the effectiveness of infection control. There were insufficient staff to meet people’s needs. People’s individual needs had not always been met with the right numbers of staff with the required competencies and skills.
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. The mental capacity legislation was not always followed. There was not an effective system to monitor the status of deprivation of liberty authorisations, (DoLS), Staff were not always gaining people’s consent to their care.
Some people’s nutrition and hydration needs had not been fully assessed and met. People were not always supported and encouraged to eat to maintain a healthy weight.
People were not always supported by staff that were caring. People were not always treated with dignity or afforded privacy. The provider’s staffing levels did not provide time for staff to display their caring values.
Some people spent long periods of time in their bedrooms. Activities were not personalised to individuals, where they were not able to take part in group activities.
The service was not well led. There was not a registered manager. The systems and processes in place identified areas for improvement. An action plan was in place to monitor improvement activity. This process had not always resulted in the required improvements being made and progress was slow. This meant that risks to people’s safety or incidents that left people at risk of harm were not acted upon by the provider. People’s and staff concern about the service had not been acted upon.
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 28 April 2017).
Why we inspected
This inspection was prompted in part by notification of a specific incident. This incident is currently subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.
The information the CQC received about the incident, indicated concerns about the management of risk to people’s health and safety and administration of medication. This inspection examined those risks.
We have found evidence that the provider needs to make improvements.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified breaches in relation to keeping people safe, responding to allegations of abuse, numbers of suitable staff to support people to stay safe and meet their needs and good governance.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.