Providence Court

Providence Court is a residential care home providing personal to up to 61 people. The service provides support to older people, some of whom are living with dementia, in 1 purpose-built building. At the time of our inspection there were 41 people using the service.

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

At the last inspection we found concerns relating to people’s safety and welfare. Therefore, this was a follow up inspection as the service was in special measures. At this inspection we found there had been significant improvements and we were assured that people’s wellbeing was being promoted.

People said they were safe and well supported by the service. Individual risks were assessed, and staff were aware of these and supported people safely. Reviews of events and accidents were carried out and any actions needed were carried out. People received their medicines as the prescriber intended and staff had received training and competency checks. However, there were some points relating to medicines that required further development. Staff knew how to report any concerns about a person’s safety or welfare. People told us there was enough staff to meet their needs. Infection control systems were in place.

Staff received training for their role and people felt they had good knowledge and skills. Staff felt supported by the management team. People were supported to eat and drink well. People were involved in the planning of their care and were given choices that were listened to.

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.

People and relatives told us staff were kind and caring, they were happy living at Providence Court. Interactions observed were positive, staff responded to people in a way that anticipated their needs and demonstrated they knew people well. All observations found staff to be attentive and caring about the people they supported.

Staff told us things had improved at the home and people were happy and well cared for. Care plans included all information needed to support people safely and in accordance with their wishes and preferences. These were reviewed regularly. The management team had worked with staff to improve the culture and attitudes in the home. As a result, we found people were treated with dignity and respect. Staff communicated more effectively with people.

There were mixed views about activities from relatives. However, people and staff felt this was improving. Work was in progress to get care staff more involved with activities instead of only having planned activities.

The manager was well known in the home, they had recently returned to the home and applied to be re-registered having been in post previously, and prior to the issues arising identified at the last inspection. People, their relatives and staff spoke positively about them and the management team.

The monitoring processes in place were being used effectively to improve the standard of service. Quality assurance systems were used to identify any areas that needed further development and to help ensure remedial actions were implemented. Some points identified as part of this inspection were already being worked on by the manager and swift action was taken to address them.

People, their relatives and staff felt their views about the service were sought and listened to. People and staff told us that the manager was often around the home and the service was well run. Complaint processes were in place and the manager was encouraging regular contact with relatives.

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 the service was inadequate (published 10 February 2023).

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 10 February 2023. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to 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.

Please see all sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Providence Court 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.

Providence Court is a residential care home providing personal to up to 61 people. The service provides support to older people, some of whom are living with dementia, in one adapted building. At the time of our inspection there were 51 people using the service.

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

People’s safety was not always well managed. Infection control practices were not followed effectively even though the staff knew what they needed to do. This was in relation to cleaning regimes, handwashing and face mask wearing. Some carpets and chairs needed to be cleaned as they were grubby, and paintwork was chipped making cleaning more difficult. The home was in a COVID-19 outbreak at the time of inspection and the management team were not sure about the numbers of people Covid-19 positive in the home, or which units were affected. However, most staff did know who had tested positive.

Staff did not have prompt access to people’s individual needs and risks due to a shortage of handheld devices which gave them access to this information. Insufficient action had been taken to get these issues resolved. Changes to people’s health needs were not always recognised by staff and appropriate action was not always taken. We found several examples of relatives needing to prompt medical intervention.

Pressure relieving equipment to help support people’s skin integrity, was not always checked by staff to ensure it was set correctly. People’s needs were not always met in a timely way by staff to reduce risks. Medicines were not always managed safely. People had to wait too long for pain relieving medicines. People told us they felt safe and staff knew how to report concerns. However safeguarding risk management had not been followed in one instance.

People’s dignity was not promoted. Staff left a door open with a person in full view of a communal area while using the toilet and staff spoke loudly about supporting people with care needs.

People, relatives and staff said there was not always enough staff to meet people’s needs. People told us most staff were nice, but busy. We saw examples of people waiting for care needs and a member of the regional support team needed to step in to provide care. We also found that some staff training was not up to date or in place. For example, diabetes awareness. Some, but not all relatives were confident about the standard of care and told us staff were friendly.

People had access to food, drink and call bells throughout our inspection. However, while we saw that there were records kept of fluids consumed, for some people cared for in bed, we noted drinks did not change in quantity for most of the morning.

The management systems in the home were in place, however had not been effective to address the shortfalls found during this inspection. Feedback about the management was mixed, staff felt there was a lack of support, guidance and leadership which had impacted on morale and culture in the home. People and relatives gave mixed views about how responsive management had been to concerns and leadership. The home had had four managers in the past year. The new manager started the day prior to the inspection and was on their induction.

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 autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Rating at last inspection

The last rating for this service was good (published 6 June 2018).

Why we inspected

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.

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received standards of care, response to changing health needs, management and staffing. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with safe care and robust leaderships so we widened the scope of the inspection to become a comprehensive inspection which included the key questions of safe, effective, caring, responsive, and well-led.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding, dignity and respect, staffing and governance systems at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures:

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.

At the previous two inspections on 31 January 2017 and 17 October 2017 the service was rated as ‘Requires Improvement’ because the provider was found not to be meeting the required standards. At the last inspection in October 2017 we found that people had not consistently received person centred care that took account of their health, care and social needs and were not involved in planning or reviewing their care. We also found that people had not always received safe care and treatment and that the provider’s governance systems were not effective because they had not identified the shortfalls we had found.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve all the key questions Safe, Effective, Caring, Responsive and Well-led to at least good. The action plan was submitted 21 November 2017 and stated that actions would be completed by 01 March 2018 in order to ensure the provider was meeting identified breaches of regulations 9, 12 and 17 of the Health and Social care Act (Regulated Activities) Regulations 2014.

Providence Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. On the day of this inspection 45 people were living at Providence Court in one purpose built building.

The service had a manager who was registered with the Care Quality Commission (CQC). 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. However, at the time of this inspection the registered manager was absent from the home with no clear date for their return. In the interim a deputy manager from a sister home was undertaking management responsibilities with support from the regional manager and the quality team.

We found significant improvements from our previous inspection in October 2017. However, these need more time to be embedded into the everyday culture of the home. People were not aware of who was managing the home in the registered manager’s absence. Staff gave us mixed views about how effectively communication worked within the home. Staff felt supported by the current management team. The manager had developed an information sharing tool that was used to cascade learning from accidents and incidents through the staff team. There were quality assurance systems in place which included audits undertaken by the home’s management team and representatives of the provider. The management team worked closely with external organisations for the benefit of the people who used the service.

People told us that they felt safe living at Providence Court. Staff demonstrated an understanding about reporting incidents of concern. Potential risks to people's health, well-being or safety had been identified and reviewed regularly to take account of people's changing needs. We observed safe moving and handling practice. A successful recruitment campaign had resulted in more permanently recruited staff available to provide people with consistent care and support. People were supported by sufficient numbers of safely recruited staff. People’s medicines were managed safely. People had personal evacuation plans in place for in the event of an emergency such as fire and we saw that regular safety checks were completed. The home was clean and fresh and infection control practices were appropriate.

The service worked in accordance with the Mental Capacity Act 2005 (MCA).People told us they enjoyed the food provided for them. Assessments had been undertaken to identify when people may be at risk from poor nutrition or hydration and appropriate action was taken accordingly.

People told us that they received care from staff who were skilled and knowledgeable. Staff said they felt supported and were completely confident to approach the current management team for additional support at any time. People were supported to access healthcare support as needed.

Staff took action to help people if they were experiencing difficulty or discomfort. The management team had taken steps to help ensure people, or their relatives where appropriate were involved in planning their care. People told us that staff were kind and caring towards them. Staff and management interacted with people in a warm and caring manner. People were able to make choices about activities of daily living. People's care records were stored in a lockable cupboard in communal areas on each unit in order to maintain the dignity and confidentiality of people who used the service. Visitors to the home were welcomed and greeted brightly by the staff at reception.

People had received the support they needed to be comfortable and smart. People's care plans were sufficiently detailed to be able to guide staff to provide their individual care needs. A variety of activities were being developed to help provide stimulation and engage people. People and their relatives knew how to make a complaint. The provider had a robust overview of complaints made to the service and these were reviewed as part of the regional manager’s routine checks.

Providence Court provides accommodation for up to 61 older people, some of whom live with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 56 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run

People, relatives and staff felt that the management of the service needed improving. There were quality assurance systems in place; however these had not identified the issues found on inspection. Improvements were needed on how feedback was sought from people and their relatives and responded to.

People, relatives and staff felt that the lack of permanent staff was an issue. People felt safe but staff were not clear on how to report safeguarding concerns externally. Individual risks to people`s well-being were assessed but there was a risk of these not being adhered to by staff.

People did not always receive prompt support from health professionals in relation to reviews and updates to medicine needs. We found that people enjoyed their food but some people needed more support than they received. Staff were trained but there were mixed views about if they felt supported. People were supported in accordance with the principles of the Mental Capacity Act 2005.

People’s dignity and comfort was not always promoted and people were not involved in planning their care. However, people and their relatives told us staff were kind. We saw some positive interaction between staff and people. People were encouraged to make day to day choices where staff felt they were able.

People did not always receive care that met their needs and their care plans did not always include person centred information. Activities did not take into consideration hobbies and interests people had and were infrequent. People and relative knew how to make a complaint but felt they were not always listened to.

Providence Court provides accommodation for up to 61 older people, including people living with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 57 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

People’s medicines were not always managed safely. Although there were regular audits and checks in place, we found shortfalls in relation to accurate quantities, practice and record keeping.

People were supported by staff who knew how to recognise abuse and worked safely. There were sufficient staff who were recruited robustly. Staff had received the appropriate training and felt supported.

People had their rights respected and the service worked in accordance with the principles of the Mental Capacity Act 2005. People were supported to eat and drink well. We found that there was regular access to health and social care professionals.

People were treated with dignity and respect. They told us that staff were kind and attentive. People were involved in planning of their care and confidentiality was promoted.

People received care that met their needs and their care plans gave staff clear information on how to support them. Activities were an area that was under development. New activities organisers had been recruited and they were working on a plan to meet people’s social needs. People’s complaints were listened to and responded.

There were quality assurance systems in place and for the most part these were effective but these had not identified or therefore resolved the issues found in relation to medicine management. People and staff wanted to see the registered manager around the service more often to get to know them. Staff knew what was expected of them and worked to ensure they promoted the provider’s values.

Care records were personalised and gave staff clear guidance on how to meet each person's individual needs. Potential risks to people had been assessed and plans put in place to minimise the risks. Medicines were managed well.

On the day of our inspection there was a very relaxed, atmosphere at the home. The environment was well maintained and clean.

The recruitment procedures were robust and the staff files we looked at contained all the required information.