Colonia Court Care Home

Colonia Court is a residential care home providing personal and nursing care for up to 123 people across 4 purpose built units, each with its own specialism.

Paxman House provides nursing care and support for up to 35 people. Mumford House accommodates up to 28 people who are living with dementia. Blomfield House is a residential unit for up to 30 older people and Amber Lodge provides specialist nursing care for up to 30 people diagnosed with Huntington's Chorea. At the time of our inspection there were 108 people using the service.

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

People and their relatives were positive about the service and the care provided. One person told us, “I need to tell you how marvellous it is here. They are wonderful. I couldn’t ask for better people to look after me. I really didn’t think it would be like this, but it really is a wonderful place to live. I feel very safe here.” Staff were highly thought of and were said to be ‘the best thing’ about this service. Caring attitudes, professionalism and welcoming manners positively impacted the lives of people using the service and family alike. Relatives stated many times how fortunate they considered themselves having their loved ones living at Colonia Court and they were so grateful for this.

The atmosphere within the home was friendly and welcoming and staff were warm and considerate towards the people they cared for. A relative told us, “[Family member] is looked after very well, all their needs are met. [Family member] has dementia, staff are very good to [family member] and [family member] likes them. Yes, they feel safe, they think of Colonia Court as their home now.”

Management and staff were dedicated and committed to the service. There were enough staff available to meet people’s needs. Relatives told us there were always staff around checking and interacting with people. Staff knew how to keep people safe and protect them from avoidable harm. A relative told us they had fought for their family member to come to Colonia Court because the staff understood their condition and were aware of the risks to their family member’s health and welfare, “They are constantly supervised and staff anticipate their needs”. Another relative said, “My [family member] has been here one week and the difference is staggering.”

People received their medicines as prescribed and systems were in place for the safe management of medicines.

The registered manager investigated incidents, accidents and complaints, and took actions where needed to improve practice and prevent reoccurrence. Relatives were considered partners in care and felt fully involved. Relatives told us they knew who to approach if they had a concern and were confident that anything raised would be dealt with.

The service was well led, the registered manager provided clear and consistent leadership. People and staff felt well supported. Systems were in place to monitor the quality and safety of the service.

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 (published 31 May 2022) and there were 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.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at 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.

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

Colonia Court is a residential care home providing personal and nursing care for up to 123 people across four, purpose-built bungalows each with its own specialism.

Paxman house provides nursing care support for up to 35 people. Mumford House accommodates up to 28 people who are living with dementia. Blomfield house accommodates up to 30 older people who require residential care.

Amber Lodge provides specialist-nursing care for up to 21 people diagnosed with Huntington's Chorea. Within Amber Lodge a designated wing of the bungalow, known as Catchpool, provides care and support for up to nine people living with dementia who also require nursing care.

At the time of our inspection there were 111 people living in the service .

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

The provider did not always have effective oversight of the safety and quality of the service. Risks had not always been identified and risk assessments did not always contain up to date information for staff to follow. Incidents in the service were not always documented appropriately and this meant the provider was not able to demonstrate what actions had been taken to minimise the risk of a reoccurrence.

People were supported by staff who knew them well and people’s relatives spoke positively about the care people received. However, the provider’s processes for monitoring the deployment of staff across the service were not always effective and had not ensured staff were always available to meet people’s needs.

People were protected from the risk of abuse. Staff had received safeguarding training and knew how to raise any concerns. People received their medicines as prescribed and the provider ensured staff were trained and competent to administer medicines prior to supporting people. People were supported to have maximum choice and control of their lives and staff them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff followed safe infection prevention and control processes and the service was environmentally clean. The provider had a detailed improvement plan in place for the full refurbishment of the service.

Relatives and staff spoke positively about the culture and management of the service. Staff felt supported and encouraged to develop professionally and relatives told us they felt involved in people’s care and kept up to date about any changes in the service. The provider had built strong working relationships with other healthcare professionals in order to support and improve people’s care.

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 17 January 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result of this review we undertook a focused inspection to review the key questions of safe and well-led only.

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. The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people’s safety and the oversight of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

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

We found the following examples of good practice:

• The service had experienced an outbreak in the early days of the covid-19 pandemic. At the time of our visit, all the people living at the service had tested negative for the virus. The registered manager described how they had worked tirelessly with the staff team to ensure people were safe from the risk of infection. Keeping people and staff within each unit in distinct "bubbles" was key to this achievement.

• The registered manager and staff told us they were not complacent and knew the importance of maintaining vigilance. The registered manager demonstrated a learning attitude and had adapted their practice following discussions with stakeholders early on in the pandemic. For example, their staff risk assessment had been adapted to consider the increased risks to Black, Asian and Minority Ethnic staff of getting covid-19.

• Families were supported to visit people at the service and different options, such as window or garden visits offered choice and flexibility to suit people’s needs and preferences. The registered manager had carried out detailed risk assessments to ensure risks to the spread of infection were minimised during visits. Two marquees had been set up in the garden, which could be reached without entering the properties where people lived. Visitors prepared in the first marquee, which provided information and protective equipment such as masks. They then moved through to the second marquee where they met the person they were visiting, separated by a plastic screen. A member of staff provided support throughout the visit.

Further information is in the detailed findings below.

This comprehensive inspection was unannounced and took place over two days, on the 6 and 7 December 2017.

Colonia 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.

Colonia Court provides care for up to 123 people including nursing care across four, purpose built bungalows each with its own specialism. Paxman house provides nursing care support for up to 35 people. Mumford House accommodates up to 28 people who have a non-nursing need who are living with dementia for long term or respite care. Blomfield house accommodates up to 30 older people who require non-nursing residential care for long term or respite care. Amber Lodge provides specialist-nursing care for up to 21 people diagnosed with Huntington’s Chorea. Within Amber Lodge a designated wing of the bungalow, known as Catchpool provides care and support for up to nine people living with dementia who also require nursing care. At the time of our inspection there were 105 people living at the service.

At our previous inspection in July 2016, the service was rated as Requires Improvement. We found staff were not appropriately monitoring or completing food and fluid charts for people who had been assessed at risk of inadequate food and fluid intake. This meant the provider was not fully meeting the requirements of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found some improvement had been made with systems now in place to ensure the safe management of people's nutrition and hydration needs were met. Risks to people’s health and wellbeing were assessed and regularly reviewed. However, whilst people’s fluid input was recorded we noted that for people diagnosed with Huntingdon’s Chorea their fluid output was not always monitored. This meant that there were ineffective systems in place to identify any deficits or circulatory (fluid) overload.

During this inspection we recommended the provider review the way in which they determine their staffing levels to ensure that people receive effective and meaningful engagement at all times and throughout the service. During our visit people were supported by sufficient numbers of care staff. However, staffing levels were allocated according to occupancy as opposed to being flexible according to assessed need. Due to designated activity staff absences we found insufficient hours allocated to provide people with group and personalised activities. This meant that people in particular those living with dementia, were left unoccupied lacking stimulation for significant periods of time.

We also recommended a review of the current arrangement whereby senior staff on individual units do not have easy access to IT equipment and resources they need to carry out their roles in a safe, timely and effective way.

There was 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.

Staff were trained to identify signs of abuse and supported by the provider's processes to keep people safe. Potential risks to people had been identified and appropriate measures had been put in place to reduce the risk of harm.

The service had a robust recruitment process which ensured that staff were recruited safely and an induction programme was in place to support new members of staff when they starting working at the service.

There were safe systems in place for the management of people’s medicines. People were supported to receive their medicines as prescribed. Staff administering medicines were regularly competency assessed to ensure people received their medicines as prescribed.

Lessons were learned and improvements made when things went wrong. The registered manager had systems in place to monitor accidents and incidents with action plans in place to minimise the risk of re-occurrence. The provider had in place a system for overall clinical governance and analysis of accidents and incidents to monitor for trends.

People received care and support from staff that were trained, skilled, experienced and knowledgeable within the roles they were employed to perform. Staff knew the people they supported well and had received the necessary training to equip them for their roles. People were supported by staff who were kind and compassionate in their approach.

The re-validation of nurses was closely monitored. There was a system in place for regular checks to ensure nursing staff maintained their registration and had been supported to keep up to date with clinical good practice guidance.

People were supported to live healthier lives and had access to healthcare services when required. We saw that there were good links with local GP’s and health care professionals with multi-disciplinary meetings attended by the management team to ensure planning to meet people’s health care needs.

The staff and registered manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Where people lacked the mental capacity to make informed decisions about their care, relatives, friends and relevant professionals were involved in best interest's decision making. Applications had been submitted to deprive people of their liberty, in their best interests; therefore, the provider had acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The majority of staff and people we spoke with were complimentary about the culture of the service and the management team support they were provided with. There were clinical governance systems in place to regularly assess, monitor and mitigate risks relating to the health, welfare and safety of the people who used the service.

The service was last inspected on 23 October 2013 and was fully compliant with all the outcomes inspected.

The service had a registered manager in post. 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.

Staff had received training in safeguarding people from abuse and understood their responsibilities to report concerns to the manager and outside agencies.

Risk assessments provided staff with guidance about how to support people living in the service and effective procedures were in place to monitor the safety of the environment and ensure that people received their medicines safely. However, we found that there were not always sufficient staff on duty to provide safe, person centred care and staff told us that at times they felt rushed and that the care provided was task focused.

The service had a robust recruitment process which ensured that staff were recruited safely and an induction programme was in place to support new members of staff when they joined the service.

Staff were provided with training and support to help them carry out their roles and increase their knowledge about the health conditions of the people they were caring for.

We found that the service was not consistently working within the principles of the Mental Capacity Act (MCA) 2005 and that where restrictions were in place for people the least restrictive option was not always taken. The MCA and Deprivation of Liberty Safeguard (DoLS) ensure that, where people lack capacity to make decisions for themselves, decisions are made in their best interests according to a structured process. Where people’s liberty needs to be restricted for their own safety, this must done in accordance with legal requirements.

People had access to a varied and healthy diet. Nutritional assessments had been completed for people and we saw that where appropriate staff supported people with their eating and drinking. However, we had some concerns that staff were not recording the food and fluid intake of potentially vulnerable people.

People had prompt access to healthcare professionals and relatives were pleased that changes in people’s wellbeing were communicated well.

We observed some very caring interactions between people living at the service and staff. Staff were warm in their interactions, communicated well and in general we saw that people were treated with dignity and respect.

There were not always enough activities available to meet people’s needs and activities were not personalised. We found that some people had access to a variety of activities and choices of how to spend their day. However other people, especially those who were nursed in bed or who chose to remain in their rooms did not have such a positive experience.

People and their relatives knew how to raise concerns or make a complaint and were confident that they would be responded to appropriately.

Quality assurance systems were in place to monitor the delivery of the service and we saw that where concerns had been raised the service had taken action to resolve the problem and mitigate the risk of reoccurrence.

Staff described the manager as approachable and supportive and told us that they felt valued by the management team. There was an open and honest culture at the service and it was clear that the registered manager was pivotal in maintaining this and creating fluid communication through the service. However, we had some concerns about the lack of support of the provider and the impact that this had upon the people living in the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found that people living in the home were happy to interact with us and were comfortable in the company of the staff. People who were able to speak with us were all positive about the care and support they received. One person told us: 'On the whole staff are very good, when you ring the bell they come. I go out in the bus, I have a choice of food and if you don't like it they will always get you an alternative. I have joined the painting class.' Visitors told us that they were involved in their relatives care and support.

We found that substantial improvements had been made to address concerns raised at our last inspection in February 2013.

People had up to date and detailed care and support plans in place that guided staff as to the care and support they needed.

The staff team and management worked well with other healthcare professionals to ensure people's healthcare needs were met. We found that the people living at the home were cared for by staff who received a good level of training and support from the provider and manager.

We found some parts of the environment and equipment in the home needed attention and we were given assurances from the manager that these were being addressed.

A small number of staff and practices we saw did not reflect the overall standard of care provided. Shortfalls were noticed in staff practices and care management.

Staff were trained to the appropriate level for the role they performed. There were sufficient numbers of staff on duty. The documented rota's seen during our visit supported this. A staff member told us, "It's a happy home, and we work well together as a team."