Halcyon Court Care Home

Halcyon Court Care Home is a residential care home providing accommodation and personal care for up to 71 people, some of whom are living with dementia. At the time of our inspection there were 48 people using the service. Care is provided across 6 floors.

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

Risks to people’s health and safety were effectively managed, including Infection Prevention and Control (IPC) risks. People felt safe at the service and were safeguarded from the risk of abuse.

There were enough staff to meet people’s needs. Staff received support and training to fulfil their role and provide a good standard of care. Medicines were effectively managed.

The registered manager had oversight of the quality assurance processes at the service. Outcomes were shared with staff to inform improvement.

There was a positive culture in the service that achieved good outcomes for people. People were happy living at the service and spoke positively about staff and the care they received. The service worked effectively in partnership with other organisations such as the GP surgery and local authority.

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.

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 18 September 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of environmental risks. This inspection examined those risks.

The provider had taken action to mitigate the environmental risk to people.

The inspection was also prompted in part due to concerns received about staffing and medicines management. This inspection examined those risks.

We found no evidence during this inspection that people were at risk of harm from the concerns. Please see the safe and well-led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Halcyon Court Care Home on our website at www.cqc.org.uk.

Follow up

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

The home was mostly clean, however we found some dirty kitchen appliances. This was raised with the leadership team who agreed to take immediate action to resolve the issue.

We found the following examples of good practice.

Risks in relation to visitors had been assessed and action taken to ensure the service followed national guidance. Regular infection prevention control (IPC) audits were undertaken. The home's infection prevention and control policy was up to date and in line with current guidance.

Staff had access to supplies of personal protective equipment (PPE) and had received training to ensure they used this correctly. All staff had regular testing for COVID-19, and all had received their vaccinations.

Staff were trained on how to keep people safe from the risk of infection.

Halcyon Court Care Home provides accommodation for up to 52 people. People are accommodated with residential care over five floors in single rooms. On the day of inspection there were 43 people who used the service.

At our last inspection in December 2015 we rated the service as ‘Good’. At this inspection the service remained ‘Good’. As the rating of the service has not changed, we have written a shorter version of the report.

This inspection took place on 13 August 2018 and was unannounced. We returned on 14 August 2018 announced to complete the inspection.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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.

Staff promoted and respected people’s cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Care records could capture more information. We made a recommendation about gaining more information about people. Information was made available in accessible formats to help people understand the care and support agreed.

Systems and processes were in place to safeguard people from abuse; these covered staff recruitment practices and staff training and knowledge on safeguarding procedures. Staff were recruited safely and there were mostly sufficient numbers of staff available to support people. We made a recommendation around staffing levels on a night time in case of emergency.

The registered manager understood their legal responsibilities. They provided good leadership and supported staff and people who used the service. The area manager and the staff team were committed to providing quality care and welcomed feedback and suggestions to enhance people’s quality of life.

People were supported to stay safe. Risks associated with people’s needs had been assessed; safety measures were put in place and they were monitored and reviewed regularly. Staff were provided with clear guidance and information to follow to meet people’s needs.

People received their medicines as prescribed. Medicines were stored and managed safely. People’s nutritional and cultural dietary needs were met and they had access to a range of specialist health care support which ensured their ongoing health needs were met.

People were involved in decisions made about all aspects of their care. 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.

People had developed positive trusting relationships with the staff team. Staff respected people’s privacy and dignity and independence was promoted. The homely environment ensured people’s safety and privacy. People continued to receive good care and support that was responsive to their individual needs.

People took part in a range of social activities and events and were supported to say what they would like to do. This type of engagement had enhanced people’s physical and mental wellbeing, and their sense of belonging.

People and their relatives and friends all spoke positively about the staff team, management and the quality of care. People had a range of methods to express their views about the service. The manager used feedback and complaints to bring about changes to the service.

People knew how to make a complaint and were confident action would be taken. There were effective systems to handle complaints and appropriate action had been taken to improve the quality of care. Where issues had been identified during this inspection visit, the management team took prompt and appropriate action.

The provider’s governance system had been used effectively. Regular audits and checks were carried out and action taken when shortfalls were identified. There were arrangements in place to make sure action was taken and lessons learned when things went wrong, to improve safety across the service.

Systems were in place to ensure staff were supported and received training and supervision to provide care effectively. Staff training incorporated best practice. Staff worked in partnership with other health care professionals to enhance people’s quality of life.

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?

We found that the service was safe because people were protected against the risks associated with the use and management of medicines. People received their medicines at the times they needed them and in a safe way. Medicines were recorded appropriately and kept safely.

The provider monitored the environment and had action plans in place to address areas for improvement.

Staff employed to work at the home were suitable and had the necessary skills and experience. Although people who used the service and staff members told us there were enough staff on duty to ensure people's safety there were not always sufficient staff to meet people's needs in a timely way.

Although nobody living at the service required a Deprivation of Liberty Safeguards (DoLS) authorisation staff were aware of DoLS. The manager told us of a situation where the need for a DoLS authorisation renewal had been considered and ruled out.

Is the service effective?

We found care plans for managing medicines were detailed and gave clear guidance to care workers about how to administer and handle medicines appropriately.

People told us they were generally happy with the care they received and their needs had been met. However some people told us they sometimes had to wait too long to be supported to access the toilet. One person told us 'I wait and wait.The facility's terrible. You can wait an hour.' Another person said, 'They're busy.They're there to help you but they don't always come when you want to go to the toilet.'

From speaking with staff it was evident they had a good knowledge of the people they supported.

Is the service caring?

People were supported by kind and attentive staff who knew them well and spoke positively about people as individuals. Care records showed people were cared for using person centred approaches.

Staff were very knowledgeable about people's needs. One person who used the service told us, 'Staff are smashing. All of them.'

Is the service responsive?

People's needs were assessed before they were provided with support by the service. People's needs were regularly reviewed and their health monitored. Where necessary referrals were made to other health professionals.

Relatives of people who used the service told us they felt their suggestions were considered when making improvements to the service.

Is the service well-led?

We saw a system for quality assurance and monitoring of medicines management was in place. Action had been taken promptly by managers when any discrepancies, or failure to follow procedures, had been identified.

Staff had a good understanding of the ethos of the service and quality assurance processes were in place. People told us they felt involved in the running of the service and felt their opinions mattered. Staff were clear about their roles and responsibilities.

Records showed the management team worked with all staff and people who used the service to maintain standards and secure improvement.

We saw that people living in the home were prescribed medicines which needed to be taken before food. We found that these medicines were not given properly.

Records were made when doses of medication were changed. However the records showed that new doses were not given properly.

Many people in the home were prescribed medicines to be taken 'when required'. We found that there was no information recorded about how to give medicines prescribed in this way.

We saw that the stock of medicines for each person were not always accurate because staff failed to always carry forward any stock left over from the previous month.

We saw people were appropriately dressed, well presented and looked well cared for. Staff engaged warmly with people. Visitors to the home told us the staff were very friendly and caring. They said people were treated with respect. One said the home had a, 'Nice atmosphere' and the staff, 'Were friendly and helpful."

The provider had procedures to record people's consent to share personal details but consent to care and support was not always recorded. Care plans indicated whether or not people had mental capacity to make decision for themselves. However, the care plans did not make it clear whether this was all decisions or only some decisions.

People's needs were assessed and their individual needs identified. Care plans were person centred and included details of the support they required. Risk assessments had been completed and guidance was available for staff on how to support people.

The provider had procedures to obtain and store medicines. The manufacture's storage instructions were not always followed and some people were not given their medication appropriately. Records about the administration of medicines were not always accurate.

During our visit we saw that people's needs were met and calls for assistance were responded to promptly. People visiting the home told us there were always enough staff on duty and they were always helpful. The staff we spoke with did not have any concerns about staffing levels.

People who used the service, their representatives and staff were asked for their views about their care and treatment and these were acted upon.

We spoke with five members of staff. They expressed genuine concern for the care and welfare of people at the home. However, some members of staff said that at times they could be very busy and felt that they did not have enough time to sit and talk to people. Staff had access to training and support through regular supervision, however we noted that training in infection control and care planning was overdue for some staff.

People told us they felt safe. The staff we spoke with were able to explain what to look for and what they would do to safeguard a vulnerable adult. The care provider had systems in place to identify and review the quality of the service, identify risks and areas for improvement. There was evidence that learning from incidents took place and appropriate changes were implemented.

We also looked at cleanliness and arrangements to prevent and control infections. We found infection control procedures were inadequate and have issued compliance actions.