Archived: Addison Court

Addison Court is a purpose built residential and nursing home providing personal and nursing care to up to 48 people. At the time of the inspection there were 34 people living in the home. There were three floors which accommodated residential care, general nursing care and dementia nursing care. Accommodation was provided in single bedrooms. There were several communal areas and a secure garden area.

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

People were protected from the risk of abuse and avoidable harm by robust policies and procedures. People told us they felt safe in the home. Medicines were managed safely by trained staff whose competency was checked regularly by the management team. Staff had been recruited safely, there had been an increase in staffing, which provided improved oversight and consistency. The home was clean and well maintained, people praised the housekeeping staff.

People's needs had been properly assessed, care plans described how people preferred their needs to be met. People were supported by trained staff who understood their needs and preferences. People told us they enjoyed the food and were given a lot of choice. Snacks and drinks were available throughout the day and at night. People were supported to have maximum and control of their lives and staff supported them in the least restrictive way possible and in their best interests.

People felt staff were kind and caring. Staff interacted regularly with people and were committed to treating people with respect. People were supported with dignity and felt reassured when receiving support with personal care. Staff understood how to involve people in day to day decisions about their care and sought their views regularly throughout the day.

People received person-centred care, their needs were reviewed and updated regularly to ensure care remained up to date. People said they could shower as often as they wanted and could get up and go to bed when they chose. People told us there was plenty to do and they enjoyed the activities available. Some people preferred to stay in their rooms. People could be supported at the end of their lives by trained staff.

The home was well-led. The registered manager ensured people received consistently good care by completing regular checks of care practice and records. Staff reported feeling motivated and well supported. People in the home told us they had noticed improvements and knew who the registered manager was. People were supported to share their views and the registered manager responded to people's wishes.

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

Rating at the last inspection

The last rating for this service was inadequate (06 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 6 August 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on our previous rating.

Follow up

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

Addison Court is a purpose built residential and nursing home providing personal and nursing care to up to 50 people. At the time of the inspection there were 44 people living in the home. There were three floors for; residential, nursing and dementia care. Accommodation was provided in single bedrooms. There were several communal areas and a secure garden area. There was a lift. People could move between floors if the chose.

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

Some people were at risk of harm because medicines had not been managed safely. Some people were at risk of harm because modified diets to prevent choking risks had not always been followed. Some people may not have had the right support to maintain their hydration because they regularly did not drink enough fluid and the service had not taken action to address this. Some people with diabetes had been at risk due to their care plan either not being present or not being followed. The governance systems in place had not identified the concerns we had found.

Records showed staff had been provided with training and had been supported by supervision from a senior member of staff. People told us staff knew what they were doing and seemed to have good skills. We saw training had been planned to ensure people were up to date. The service was compliant with the Mental Capacity Act and associated Deprivation of Liberty Safeguards.

People we spoke with were happy with the quality of the care they received and praised the kindness and friendliness of the staff. People were happy with the cleanliness of the home and told us how thoroughly the domestic staff cleaned their rooms. The home was well maintained and tidy with no unpleasant odours. People told us they were happy with the food provided and the choices available. People had a variety of activities and outings available which reflected their preferences and interests.

The service had clear values and were committed to providing person centred care, though this had not always been achieved. Staff we spoke with felt confident in the management team and able to raise any concerns with them. We could see there had been some improvement in leadership in the home. The manager in post at the time had been there for under three months. People's views were sought through surveys and meetings. The service worked with other agencies to provide consistent quality care.

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

Rating at the last inspection and update

The last rating for this service was requires improvement, (published 8 August 2018)

Some people were at risk of harm because medicines had not been managed safely. Some people were at risk of harm because modified diets to prevent choking risks had not always been followed. Some people may not have had the right support to maintain their hydration because they regularly did not drink enough fluid and the service had not taken action to address this. Some people with diabetes had been at risk due to their care plan either not being present or not being followed. The governance systems in place had not identified the concerns we had found.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of the regulations.

We have identified breaches in relation to safe care and treatment, supporting people to eat and drink and how the service was managed. You can see what action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is 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.

Addison Court is a nursing and residential care home registered to provide care for up to 50 people. Facilities for people who used the service were provided over three floors. The second floor was a small unit that cared for people living with a dementia. All of the bedrooms were of single occupancy and had access to en-suite facilities. There was easy access to a private garden with seating available for people during the warmer months. During this inspection there were 39 people using the service.

The service did not have a registered manager in place. 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. An interim manager was currently in place until such time as an appropriate manager was appointed.

We undertook an unannounced focused inspection of Addison Court Care Home on 9 May 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 5 and 6 February 2017 had been made. The team inspected the service against one of the five questions we ask about services: is the service safe? This was because the service was issued with a warning notice [a warning notice specifies the timescale by which the registered person must comply] in relation to Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as the provider had failed to deploy sufficient numbers of staff to meet the needs of people living at the home. We found the required improvements had been made.

At our comprehensive inspection of 5 and 6 February 2017, we found breaches of legal requirements in relation infection control, premises and equipment, good governance and staffing. We also made recommendations in relation to the management of medicines and activities. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements and by what date. The provider told us they would be compliant by the 24 April 2017.

During this inspection we found improvements had been made; however we found further concerns in relation to medicines. We also found issues with care plans and staffing levels; in particular the high use of agency staff and quality assurance systems failed to identify issues we identified.

All the staff we spoke with confirmed they had received training in safeguarding and knew their responsibilities to report concerns.

Medicines were not always managed safely. Prescribed medicines had not always been administered as directed.

We observed nurse calls alarms were sounding for long periods of time before being answered. We noted a high use of agency staff within the service. We discussed our concerns with the interim manager who told us they had been recruiting and were awaiting recruitment checks to be completed and new staff would be commencing.

All the people we spoke with felt the service was clean and tidy. All the staff we spoke with had completed training in infection control. We saw the service was clean and tidy. We saw staff wearing personal protective equipment as and when necessary.

All the people we spoke with felt that staff members were skilled and knowledgeable. Staff members told us they had received an induction when they commenced employment, although none had undertaken the Care Certificate. We saw a significant amount of online courses were available to staff and some staff had undertaken Diploma’s in Health and Social Care.

We looked at how often staff received supervision and found these were not as regular as specified by policies and procedures. The interim manager had identified this and improvements were noted from May 2018.

All the people we spoke with told us the meals were good at Addison Court Care Home. We saw people had a choice of different hot meals and cold options were also available. The service had received a ‘Good’ rating from the national food hygiene rating scheme which meant they followed safe food storage and preparation practices.

We observed interactions from staff that that were kind, sensitive and caring. Staff spoke kindly and sensitively with people when supporting them with their needs.

All the staff we spoke with understood what equality meant and how to apply the principles of this in their roles. We saw people were not involved in developing and reviewing their care plans to ensure their views were listened to and respected. The process of reviewing care plans helps people to express their views and be involved in decisions about their care.

We noted that that care records were held securely; this helped to maintain the confidentiality of people who used the service.

We found care plans were not person centred. The interim manager confirmed they were aware the care plans were not person centred and assured us this would be looked at as a matter of priority.

We received mixed views from people who used the service about activities. We observed a number of activities taking place throughout our inspection. Whilst there was a programme of activities in place, the activities co-ordinator told us it was not rigid and could be changed to meet people’s wishes. Activities were also available for people on a one to one basis such as hand massage.

The home had an up to date complaints policy and procedure in place. This would ensure both people who used the service and staff had the relevant information to support them in acting on and dealing with complaints.

Records we looked at showed a number of quality audits were undertaken within the service. Whilst improvements had been made since the interim manager came into post and these audits highlighted issues and actions taken to address them, they were not always effective.

We saw meetings were held with people who used the service to gain their views and feedback. Staff we spoke with also told us that meetings were held were they could voice their opinions.

Addison Court is a nursing and residential care home registered to provide care for up to 50 people. Facilities for people who used the service were provided over three floors. The second floor was a small unit that cared for people living with a dementia. All of the bedrooms were of single occupancy and had access to ensuite facilities. There was easy access to a private garden with seating available for people during the warmer months.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

We carried out an unannounced comprehensive inspection of this service on 5 and 6 February 2017. Breaches of legal requirements were found in relation infection control, premises and equipment, good governance and staffing. We also made recommendations in relation to the management of medicines and activities. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements. As there had been a previous breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 in relation to staffing we issued the provider with a warning notice. A warning notice specifies the timescale by which the registered person must comply.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements in relation to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Addison Court) on our website at www.cqc.org.uk

All of the staff we spoke with all told us they had no concerns in relation to staffing in the home and all were positive about the changes the provider had made since our last inspection.

We checked duty rotas and staffing analysis to check to the numbers of staff that were available to support people’s individual needs.

Addison Court is a nursing and residential care home registered to provide care for up to 50 people. Facilities for people who used the service were provided over three floors. The second floor was a small unit that cared for people living with a dementia. All of the bedrooms were of single occupancy and had access to ensuite facilities. There was easy access to a private garden with seating available for people during the warmer months.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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.

At the last inspection on 9 October 2015 we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing and records. We asked the provider to take action to make improvements and to send us an action plan. The provider complied with our request. During this inspection we found some improvements had been made. However during this inspection we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to infection control, the environment and equipment and good governance. We also made recommendations in relation to the management of medicines and activities.

We also found one continuing breach of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 in relation to staffing. You can see what action we told the provider to take at the back of the full version of the report.

We saw medicines were administered safely to people who used the service during our inspection. However we identified concerns relating to the storage of creams and the recording of maximum and minimum room temperatures where medicines were stored.

We saw safe recruitment processes in place. However we identified some concerns relating to the staffing numbers in the home during our inspection.

People who used the service told us they felt safe in the home and there was evidence of risk assessments in place to protect people from harm.

We had concerns relating to the environment, the storage of equipment and cleanliness in a number of areas of the home.

We saw evidence of reviews taking place by health professionals on people’s health and wellbeing where it was required.

All of the staff we spoke with had an understanding of the principles of the MCA and best interest’s decisions. Staff were seen asking for peoples consent before they undertook any care or activity.

Meals provided to people looked appetising and where people required a special meal, this was provided. Staff members’ were observed engaging positively with people who used the service and supported people respectfully in the dining areas of the home.

Staff treated people with dignity and respect. Staff were discreet when discussing care needs and it was clear they were familiar with people’s individual needs, wishes and choices.

Where people who could not make decision for themselves and had no family to support them, information on the use of advocacy service was available to support them, advocacy services was available and information on how to access this was displayed within the home.

Care files reflected people’s individual needs and demonstrated regular reviews had taken place to ensure they reflected people’s current needs. Care plans and risk assessments detailed guidance for staff on how to support people safely and ensure they received care that was tailored to their individual need.

We saw evidence of completed investigation’s when dealing with complaints. Staff understood their responsibilities when dealing with a complaint and there was a complaints policy in place to guide staff on the process.

There was details relating to activities in the home, however these were very difficult to read. People told us about the activities provided by the staff member responsible for this, however we saw little evidence of meaningful and enriching activities taking place in the home.

We received mixed feedback about the management arrangements and leadership for the service from staff. However people who used the service and relatives were very positive about the changes that had been made since the registered manager came into post.

We saw incidents and accidents were dealt with appropriately and records included actions taken as a result of the incident. There was evidence of audits taking place in the home. However a weekly audit failed to identify clutter in some of the communal areas of the home or concerns relating to the cleanliness in some of the bedrooms.

We did not talk to people about their medicines during this visit. We observed how they were given their medication and we spoke to the nurse and carer administering medicines on the day of our visits. We also looked at records about their medication and the medicines in the home for them.

We did not talk to people about their medicines during this visit. We observed how they were given their medication and we spoke to the nurses administering medicines on the day of our visits. We also looked at records about their medication and the medicines in the home for them.

We found that suitable arrangements were in place for the safe keeping and handling of medicines.

We saw that members of staff were attentive to people's needs and responded promptly when people required assistance. One person told us she didn't have to wait long when she rang the nurse call bell.

We noted that systems were in place to monitor the quality of the service provided. People using the service were involved with making decisions which affected them personally.

We were told that new members of staff were provided with induction training appropriate to their role. This ensures that people are protected from receiving unsafe care.

We found that staffing levels had been increased throughout the home in order to improve the standard of care provided and ensure people's health and social care needs were met.