We carried out a review of the data available to us about Nevilles Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Nevilles Court, you can give feedback on this service.
Nevilles Court provides personal care for up to four younger adults living with a range of conditions. At the time of inspection four people were using the service.
People’s experience of using this service and what we found
The registered manager and staff team had made significant improvements at the home. We spoke with one person who told us, "I am in a much better place than I was when I first moved in."
Visiting relatives we spoke with said they enjoyed a good working relationship with the staff team saying, "We are treated as one of the family."
Care plans we viewed were person centred and we saw people's wishes were promoted. People were supported by staff who knew people well.
People told us the service promoted their well-being by ensuring their physical and mental health needs were well supported and monitored and records upheld this.
Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices, in particular, relating to COVID-19.
Quality monitoring systems had improved. Staff said the management team had made improvements and the culture had improved significantly. The service was working with local external partners such as the Care Academy, the local authority led training provider to develop staff skills further.
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 and update
The last rating for this service was requires improvement (published 14 October 2019) and there were two breaches of regulation. The provider completed an action plan after the last comprehensive inspection to show what they would do and by when to improve safe care and treatment and good governance.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements regarding safe care and treatment and good governance. This report only covers our findings in relation to the key questions safe, effective and well-led which contained those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Nevilles Court on our website at www.cqc.org.uk.
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 coronavirus and other infection outbreaks effectively.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
Neville’s Court is a residential care home for up to three adults living with a neurological, learning and physical disability. At the time of inspection three people were living at the service.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
Communication between the management team and the care staff at the service was poor. Staff were unsure of their roles and responsibilities which resulted in tasks not being completed. Some training had been allowed to lapse, training records were not maintained, supervisions had not taken place and medicines were not always managed safely at the service.
The management team had identified some failures in the management of medicines along with staff training and had started to address these matters.
Relatives and people we spoke with were happy with the service. One person told us, “It’s great here.”
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
The provider ensured people had a safe environment. Health and safety checks were regularly undertaken. A robust recruitment procedure was in place which included ensuring appropriate checks were undertaken before staff started work. Staff were knowledgeable about safeguarding and what action they should take if they suspected abuse was taking place. Systems were in place to learn from safeguarding concerns and accidents and incidents.
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.
Staff understood and applied the principles of the Mental Capacity Act (MCA), and were aware of people’s rights when they could not consent themselves. People were supported to access independent advocates.
People had enough to eat and drink and were supported to have choice in what they ate and drank. Staff promoted people to maintain a healthy diet.
People received person-centred care and were supported by staff who knew them well. Relatives told us they were regularly consulted and involved in the family member’s care discussions.
Relatives were complimentary about the care staff team. They told us staff were kind and respectful. Staff told us they worked as a team and were supportive of each other. The service worked with external healthcare professionals to support and maintain people’s health.
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 requires improvement with one breach of regulation relating to good governance, (Published on 07 December 2018). At this inspection we found improvements had not been made or sustained and the provider remained in breach of regulation relating to good governance and a further breach was found in regulation regarding safe care and treatment.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We received concerns in relation to the management of the service. As a result, we bought forward a comprehensive inspection.
Enforcement
We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 including safe care and treatment and good governance.
You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Neville’s Court on our website at www.cqc.org.uk.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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.
Neville's 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. Neville's Court can accommodate up to four people with a learning disability. At the time of our inspection three people were using the service.
We last inspected this service in December 2016, and found the service was complying with all the regulations and we rated the service as ‘good.’
During this inspection we found the service now required improvement. Records and governance needed to be improved. There was one breach of Regulation 17 of the Health and Social Care Act relating to this .
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The goal is that people with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The manager had been in post for four months and was in the process of applying to be registered. The manager was based at another of the provider's larger services located close by. 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.
Regular quality audits had not been carried out at during 2018 and so areas for improvement that we found in relation to care record reviews and supervisions for staff had not been addressed. The regional manager and manager began to address this on the day of our inspection and confirmed to us in writing the following day that a range of audits had been carried out.
Whilst we did not find any detrimental impacts on people who used the service [in fact, feedback was extremely positive], the provider needed have suitable systems in place to ensure adequate oversight of all aspects of the service including support for staff in the form of supervisions.
Staff had been trained in safeguarding issues and knew how to recognise and report any abuse.
People’s medicines were managed safely.
There were enough staff to meet people's needs. Any new staff were appropriately vetted to make sure they were suitable and had the skills to work at the service.
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.
Staff made most meals but if people wanted they could make their own in their own kitchen areas. People's nutritional needs were fully understood and people told us staff encouraged them to eat a healthy diet.
Staff were respectful of people’s individuality. We saw staff promoted people's dignity and respect. There were positive relationships between people, staff and relatives.
People were supported, where appropriate, to manage their health needs. Staff responded promptly to any changes in people's health and worked with other services to promote people's wellbeing.
There was an accessible complaints process and we saw the service provided access to advocacy services and one person was currently using advocacy support.
Nevilles Court is a care home which is registered to provide care for up to four people with learning disabilities and/or physical disabilities. The home has four apartments consisting of a bedroom, living area, kitchen and a bathroom.
The home does not currently have 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.
Although there was no registered manager in post at the home a new manager had been appointed and their intention was to apply to be the registered manager of the home. Management cover was provided this manager and by a care manager who worked at both this home and a nearby home run by the same provider. The service also had a team leader.
We found that the new manager had only just commenced in post and new management structures had not yet been implemented. Up to the point of our visit staff had been supported by the care manager and the team leader. Some staff and people who used the service told us they felt there had been a lack of regular management/provider oversight of the home.
People who used the service told us they felt safe and well supported by staff. Staff had received training in safeguarding. We found staff understood what actions to take if they thought people were unsafe.
Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.
The premises were clean and well maintained. People were supported to keep their own apartments clean and tidy. We saw that equipment was in place to maintain the health and safety of people and staff, and were checked both by the service and approved contractors when required.
We found that some very recent fire checks had been missed. These were brought to the manager and care manager’s attention and we were given reassurances these would be completed with immediate effect.
There was a process for managing accidents and incidents to ensure the risks of any accidents re-occurring would be reduced.
Staff employed by the registered provider had undergone a number of recruitment checks to ensure they were suitable to work in the service. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Individual support plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm.
We found people who used the service and their representatives were asked for their views about the service, both through surveys and individual meetings. Survey results were broadly positive. We saw that there had been some improvement in the way the home analysed and responded to feedback about the service but that this could be developed to set targets for when improvements would be made.
There were quality assurance systems in place to ensure the effective running of the service, however we saw that compliance checks previously completed by the provider had not been completed since the last inspection of this home.
The home had established and maintained good links with health professionals.
We previously inspected Nevilles Court on 17, 18 and 21 July 2014 and informed the registered provider they were in breach of two regulations: care and welfare of people who use services and; assessing and monitoring the quality of service. The provider submitted an action plan in February 2015.
Whilst completing this visit we reviewed the action the registered provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the registered provider had ensured improvements were made and that they were compliant with the relevant regulations. We found the registered provider had ensured improvements in three areas previously rated as requiring improvement.
Nevilles Court is a residential home close to central Durham providing accommodation and personal care for up to four people with learning disabilities and/or physical disabilities living in their own apartments. There were four people using the service at the time of our inspection, although one person was in hospital at the time for a scheduled review.
The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like directors, 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 saw that, since the last registered manager had left the service, the registered provider had recruited two interim managers who had since left the company. The current manager was going through the process of applying to be registered with CQC.
There were sufficient numbers of staff on duty in order to safely meet the needs of people using the service and to maintain the premises. All areas of the building were clean.
Staff were trained in safeguarding and displayed a good knowledge of safeguarding principles and what they would do should they have any concerns.
People who used the service and their relatives expressed confidence in the ability of staff to protect people from harm.
Effective pre-employment checks of staff were in place, including Disclosure and Barring Service checks, references and identity checks.
The storage, administration and disposal of medicines was safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). There had been particular improvements in relation to topical medicines (creams).
Risk assessments had also been improved and staff displayed a good knowledge of the risks people faced and how to reduce these risks.
People received the treatment they needed through prompt and regular liaison with GPs, nurses and specialists.
Staff training had been updated to ensure staff had a good working knowledge of people’s physical needs. Staff had also received refresher training in areas the provider considered mandatory, such as safeguarding, risk assessment, fire safety, first aid, epilepsy awareness and infection control.
Staff received regular supervision and appraisal processes as well as regular team meetings.
We checked whether the service was working within the principles of the MCA. Staff displayed a good understanding of capacity and consent and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.
The atmosphere at the home was relaxed and welcoming. People who used the service, relatives and external stakeholders told us staff were patient and dedicated and we observed staff interacting with people in this way.
Person-centred care plans were in place and people pursued hobbies and interests meaningful to them with the support of staff. We saw regular reviews took place with the involvement of people, their family members and advocates.
Staff, people who used the service, relatives and an external professional we spoke with had confidence in the staff team, the care manager and the compliance manager. We found the new manager had yet to gain an oversight of the service and the role of team leader was currently vacant. The compliance manager assured us this role would be filled.
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.
Nevilles Court provides accommodation and personal care for four people with learning and physical disabilities living in their own apartments on one floor. Each apartment consists of a kitchen, dining area together with a bedroom, a sitting area and a bathroom.
This inspection was unannounced and took place 17, 18 and 21 July 2014. At our last inspection in May 2013 we found the service we found the service to be meeting all the regulatory requirements looked at during the inspection.
The registered manager was also registered in respect of other services owned by the provider and was not based at Neville’s Court. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
We found people were not always protected against the risks associated with their diagnosed conditions, although they were safe through the appropriate use of medication. The provider’s policy on medication did not include topical medication.
People were supported to undertake a weekly food shop and maintain a balanced diet. However we saw that this was not always put into place by staff.
People who used the service, their relatives and staff all told us there were sufficient staff at the service. We found staff were used to task based practice when supporting people who required additional support. For example staff were aware
The managers who were present at the time of the inspection and the staff were able to describe to us Deprivation of Liberty Safeguards (DoLS). We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards.
Staff received training and supervision to assist them in undertaking their role. However we were concerned staff did not always receive training to allow them to perform their role with sufficient competency and skill. For example staff were caring for people with medical conditions about which they had not received any training or given any information.
People were supported to access appropriate health professionals where they experienced a change in their health and well-being.
Care was not always delivered in a way that was responsive to people’s individual assessed needs.
People who had not had any reason to complain told us they were aware of how to make a complaint if necessary. We saw in one person's file if they became angry about an issue they were to be given an opportunity to complain.
Quality monitoring processes did not always identify shortfalls in the quality of care planning and risk assessments.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.
Nevilles Cross comprises of four separate apartments with a communal lounge. Each apartment is self contained, with a kitchen and living area, bedroom and en-suite bathroom. During our visit we looked around the building and found it to be clean and well maintained.
We observed how staff asked people for consent. For example, before entering someone's apartment, staff asked the person if it was OK to go in. We saw another member of staff asking someone if they wanted help to sit down.
We spoke with several people who lived at the home and some of their relatives. People were very happy with the care provided. Comments included 'I like the staff, everything's fine and I'm doing well' and 'They are the best.'
We spoke to some staff, people who lived at Nevilles Court and their relatives about staffing levels. They all said they thought there was enough staff on duty. However, some said they would prefer to have more male staff to support them. One person said 'There should be another male; (resident's name) prefers a male carer to help them with personal care.'
People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would speak to them, they would sort it out.' Another said 'I haven't had to complain but I know what to do.'
People also told us how their social needs were met. One person told us that he was a keen football supporter and that staff frequently took to him to watch the team he supported. Another person explained that he enjoyed going to see comedy shows and staff supported him to go to these.
One person said 'I can go swimming or ride my bicycle if I want to'