Country Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People’s needs were not always reflected in their care plans or risk assessments. Care plans and risk assessments gave contradictory actions and did not give direction for staff to follow. Support to manage people's increasing risks was not in risk assessments and the least restrictive option was not always explored. Monitoring forms were not always completed correctly and there were long gaps in re-positioning charts. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. People were not administered their medication safely. Staff were not trained to use the electronic system efficiently. Medication care plans and risk assessments did not provide guidance to give staff direction for administering medication. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Safeguarding’s had not always been reported, the service did not have a safeguarding log and we found incidents in people’s care records had not been reported which meant people had not been safeguarded. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe at Country Court, however there were mixed messages from relatives, one relative said, “I am not sure staff have the right skills to care for [Person’s name] as I have never seen a care plan, so I am not sure what they are supposed to do."

Staff told us they did not always feel supported or receive any feedback about incidents or safeguarding.

There was limited evidence of learning from accidents and incidents and any action taken when things go wrong.

Relatives told us they were kept informed about a person’s condition, however some were concerned about the amount of time their relative spent in bed, comments from relatives were, “I am generally happy with the care, but I do wish they [Staff] would get them up more often,” and “This is the first time [Person’s name] has been up, I wish staff would get them out of bed more often, it would improve their well-being so much.” People told us they felt safe and would know who to speak to if they had any concerns.

Staff told us they encourage the residents to be as independent as possible although they did not know what or how they could involve families more in their care, comments included “I don’t really know what we could do”, and “Staff don’t ask anything or listen to what people say.”

Professionals told us staff did not always follow care plans and risk assessments. Management plans that were implemented were not always followed and recommendations by professionals were not followed up in care plans and risk assessments for staff to ensure they were following best practice guidance.

Although admission assessments identified people’s needs this was not always followed through into care plans, for example people who had been identified as diabetic on admission did not have care plans and risk assessments in place to support this.

Most people told us they felt safe, comments from relatives included, “I believe [Persons name] is safe”, and “They [staff] have assessed [Person’s name] for safety and I am happy they are safe, I wasn’t when they were at home.” One person told us, “They push me to eat food and I have had 2 bad ‘dos’’ where it has got stuck, I was very frightened and they bring bread which is too thick to chew.”

Staff were trained in safeguarding and knew how to report a safeguarding incident.

Although we observed some good interactions between staff and people, staff demonstrated institutionalised behaviours and spoke of ‘feeding time, ‘and ‘pad change round.'

Although the provider maintained a safeguarding folder, we found incidents within people’s care records and the accident and incident folder which had not been reported to safeguarding.

People were not always risk assessed to live their lives to their optimum level. One relative told us, [Person’s name] wanted to use the loo, but they were told they had a pad on so they could go in that, but they wanted to go to the loo, we complained, and he has been assessed now.” People were assessed to stay in bed by care staff, there were no care plans or risk assessments in place to improve people’s mobility to enable them to get out of bed, A relative said “[Person’s name] is in bed 90% of the time, they could get out, but they don’t seem to want to try.”

Although staff knew where to access risk assessments most of them had not read a risk assessment and did not know how to support someone to take positive risks, comments from staff included, “There is not enough information in risk assessments to support someone”, and “I have never read them I have never had time, I rely on information from handovers!

We observed people spending long periods of time in their beds often with their doors shut and minimal interactions from staff. Buzzers were not always located near the person so they could contact staff if they needed to.

Processes were not in place to assess and mitigate risks to people. Health care needs identified on admission were not transferred to care plans and risk assessments including, dementia, diabetes and choking. Support to mitigate people’s increasing risks around challenging behaviours were not in risk assessments and the least restrictive option was not always considered.

People told us their room and home were kept clean and tidy and clear of hazards. One person said, “The home is always clean and no smell, this is a good home.”

There was no recording of wheelchairs, bed rails, etc, staff were not aware they had to record these were in working order and safe to use.

We observed decorating and minor repairs taking place throughout the home, however there were no action plans in place to identify the works that required completing and time frames for the work to be completed.

We identified there were no process in place to record the safety of equipment people used for example wheelchair checks. Window restrictors on one window in a bedroom was not in place, the provider acted immediately to ensure this was completed. Fire alarm checks and fire drills had not been completed in the previous months however the provider had just implemented a system to ensure this was completed weekly.

Mixed messages were received regarding staffing, some people told us there were enough staff, others told us they had to wait a long time for their buzzers to be answered. One person said, “I am not sure if there is enough staff around, especially at weekends. Another person said, “generally I am well looked after by staff but sometimes I don’t know the staff and I don’t like that, I like staff that know me.” However, a further person told us there always seems to be enough staff about and they are all very caring.”

Generally, staff were positive, some staff told us they could always do with more staff; however, no one could say what got missed in terms of low staffing. Other staff told us although they don’t have a lot of staff, they are getting better, and they feel they can meet everyone’s needs. Staff we spoke to told us they had not received supervision or had an appraisal.

There appeared to be enough staff on shift to care for people, however more attention was required to how staff were deployed at busier times. People who required support to eat often waited for long periods of time before they got their meals due to staffing over lunch time. We also observed buzzers going off for long periods of time.

Staff did not receive regular supervision and appraisals to support them in their learning and development. The training matrix showed significant shortfalls of staff completing training to support them to care for people safely.

People told us the home was clean and there were plenty of domestic staff to keep their rooms clean and tidy.

Staff could assess and manage the risk of infection. Staff told us they would wear the correct PPE to minimise and reduce the risk of infection.

We observed domestic staff working appropriately and adhering to infection prevention and control procedures.

Cleaning schedules were in place, however further documentation was required for shared bathrooms and showers. The home required decorating and some remedial work completing, we were told plans were in place for this, however there were no action plans in place to corroborate this.

People were not involved in their care plans and risk assessments for medication. If care plans were in place for the administration of medication, they did not detail people’s preferences on how they would like their medication administered

Staff had not received the appropriate training to use the system safely, they lacked knowledge where ‘as and when required’ protocols and body maps were held on the system. Staff told us they had not received the correct training to use the electronic medication system safely.

Processes were not in place to administer medications safely. Some medicines were not kept in secure storage. Temperatures were out of range and staff were not aware of the range or action to take. One person administered her own medication, there was no process in place for how this should be done or any recording of when they had taken their medication. There was no system in place for a person who was administered their medication covertly or a support plan in place to ensure it was administered safely.