Court View

Court View is registered to provide accommodation with personal care for up to five people. The service provides support to people with a learning disability. At the time of our inspection there were three people using the service. The service is located in a detached home in a residential area within close proximity to community facilities.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff to meet people’s needs. Staff had undertaken the necessary training and skills to carry out their role effectively.

People and relatives told us they had choice, control, and independence to carry out activities within the home and in the community.

Right Care

Risks to people were not always appropriately managed. A recent admission into the service did not have risk assessments in place, this was rectified immediately by the registered manager. There were risk assessments in place for other people residing in the service, which covered a range of personalised tasks and the environment. Staff knew people well and the risks associated with their condition.

Care provided was person centred and revolved around the needs and aspirations of people. Staff knew people well.

Right Culture

Some health and safety checks such as fire doors had not been checked since September 2022, appropriate action was undertaken by the registered manager during the inspection to bring these up to date.

There was an open culture, where people, relatives and professionals worked together to achieve good outcomes for people. People’s views were taken into consideration in the improvements to the home.

Staff, relatives, and people were engaged to provide feedback regarding the service.

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 12 January 2018). The service remains rated good.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

We looked at the key questions on whether the service was safe and well led. 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 continued to be rated as good based on the findings of this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection in November 2016, the service was rated ‘Requires Improvement’. At this inspection we found that the service was ‘Good’. At our last inspection, we asked the provider to take action to make improvements to the way medicines were managed and keeping better records. At this inspection we checked to see if the provider had made the necessary improvements. We found that improvements had been made.

The service had a registered manager. 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.

People using the service told us they felt safe living at Court View. People were kept safe from avoidable harm because the staff team understood their responsibilities. They knew what to look out for if they suspected that someone was at risk of harm and knew who to report their concerns too. The risks associated people’s care and support had been assessed and reviewed.

The insufficient information from the provider meant we could not confirm that all the recruitment processes were in place to make sure only suitable people worked at the service. The appropriate numbers of staff were available to support the person living there but risk to people and staff needed further assessments when only one staff member was in the home.

Processes were in place to make sure that when people needed support with their medicines, this was carried out in a safe way.

The staff team were appropriately trained and were supported by the management team through supervisions, appraisals and staff meetings.

Not all safety checks such as water temperatures, keeping cupboards with hazard substances locked or monthly audits were being carried out as required.

Staff were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected. People using the service had access to relevant healthcare services and were supported to attend appointments when required.

People had been involved in developing menus to include their own likes and preferred choices. Their dietary requirements had been identified and they were supported to follow a healthy and balanced diet.

Independence was promoted and people using the service were supported to make choices about their care and support on a daily basis. They were supported by staff in a kind and caring way and their dignity was respected. A relative supported this view.

A plan of care had been developed with people and with staff who knew them well. The staff team knew the needs of the people they were supporting because the necessary information was included within their plan of care.

People using the service were regularly reminded of what to do if they had a concern of any kind. Staff members felt supported by the management team and told us there was always someone available to talk with should they need guidance or support.

The views of the person using the service were sought. This was through informal chats and meetings. Systems were in place to monitor the quality of the service being provided and a business continuity plan was available to be used in the event of an emergency or untoward event.

Further information is in the detailed findings below.

Court View provides accommodation and personal care for four people. There were two people living at the service when we visited. People who live at the home have a learning disability.

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.

People could not be assured that their medicines were always managed safely. There were significant gaps in some records relating to the delivery of care and health and safety. This could put people at risk of unsafe care.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow these procedures. Systems were in place to ensure people were safe. These included risk management, checks on the environment and safe recruitment processes. The drive way was a potential hazard to people and staff using the service. Staff and a relative had also raised concerns about the driveway. Whilst it was evident this was being raised as a concern the social landlord had not responded promptly.

People’s rights were upheld and they were involved in decisions about their care and support. Where decisions were more complex these had been discussed with relatives and other health care professionals to ensure it was in the person’s best interest. Staff were knowledgeable about legislation to protect people in relation to making decisions and safeguards in respect of deprivation of liberty.

People had a care plan that described how they wanted to be supported. These had been kept under review. Care was effective and responsive to people’s changing needs. People had access to healthcare professionals when they became unwell or required specialist equipment. The registered manager was in the process of reviewing all care documentation to ensure it was accessible to the people living at Court View. There were no ‘hospital passports’ for people, which would give hospital staff in the event of admission important information about a person.

People were encouraged and supported to lead active lifestyles in their home and the local community. They had opportunities to take part in a variety of activities including going on an annual holiday. People were encouraged to be involved in daily household chores. There was an emphasis on encouraging people to be independent in all areas of daily living. People were encouraged to maintain contact with family and friends.

Sufficient staff supported the people living at the service. Staff had received appropriate training to support the people living at Court View. Staff were supported in their role and improvements were being made to ensure they received supervisions. Supervisions are where a member of staff meets with a senior manager to discuss their role, performance and training needs.

Systems were in place to ensure that any complaints were responded to. People’s views were sought through an annual survey that was completed by a representative from Milestones Trust. The registered manager was exploring how people’s views could be sought more effectively and they recognised this was not always easy for people who communicate using non-verbal communication.

The staff, the manager and a representative from Milestones Trust completed regular checks on the systems that were in operation in the home to ensure they were effective. Improvements had not always been completed in a timely manner. This was because people’s needs had changed and this been the staff’s priority in the last six months. The registered manager knew it was important to involve the staff in these improvements for it to work.

We found two 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. We saw that staff supported people to take informed risks with minimal necessary restrictions.

Systems were in place to make sure that people received their medicines as prescribed and there were clear procedures for giving medicines in accordance with the Mental Capacity Act 2005.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. People's human rights were therefore properly recognised, respected and promoted.

Recruitment practice was safe and thorough. No staff had been subject to disciplinary action. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People living at the home had complex needs and were not fully able to communicate their views and experience to us. Some of the care plans had not been reviewed regularly and information from local authority care plans had not been incorporated. Care plans were therefore not able to support staff consistently to meet people's needs. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and delivery of care.

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us that staff were 'a great help'.

Much of the mandatory training required was out of date and staff told us that supervisions were 'very few and far between'. This meant that staff did not receive effective supervision and training. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff receiving appropriate training, professional development and supervision.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. Staff showed concern for people's well-being.

The relatives of people using the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Care plans had not been reviewed since January 2013. This meant that care plans did not reflect current individual needs, choices or preferences. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning and delivery of care.

Is the service responsive?

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and they were protected from social isolation.

People knew how to make a complaint if they were unhappy.

Is the service well-led?

The service had a quality assurance system, records that we viewed showed that not all of the identified shortfalls were addressed promptly.

A warning/advice notice was served by a gas appliance inspector on 7th March 2014 for a gas appliance and there was no evidence that this had been dealt with. A contractor recommended replacements of smoke detectors, emergency lights and fire extinguishers. The member of staff with responsibility for health and safety told us they had not been made aware of this. The safety audit form dated 8 July 2013 stated that this should be revisited 12 September 2013, however there was no evidence that this has been done. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home.

We looked at care and associated records. We saw people's needs were assessed and their care and treatment was planned and delivered in line with their individual care plan. People had been supported by other professionals as and when required. Records of people's care and treatment were well maintained and contained clear and accurate information.

We saw the medicine administration records (MARs) and checked their accuracy to ensure people were receiving their prescribed medicines as directed. We confirmed sheets had been completed correctly and people's medicines were stored safely and securely.

People lived in a comfortable, clean and well-furnished home.

When we spoke to people living at the home they gave us one or two word answers, we asked people if they were happy with the staff support at Court View people told us 'I'm alright' another person nodded and indicated yes.

People living at Court View could not be fully assured that the administration, recording and handling of medication was done in a safe manner as stock held medicines had not been managed in line with the providers medicines policy.

People living at Court View would be supported to raise any complaints or concerns they had.

People living at Court View cannot be fully assured that information held about them was accurate as records pertaining to the support of people and the administration of medicines were not accurate.