Archived: Collingwood Court Care Home

Collingwood Court Care Home provides accommodation for up to 80 people who require nursing or personal care in one adapted building, split into three units. the time of our inspection there were 75 people using the service.

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

The provider had made improvements in relation to the areas of concern we found at our last inspection including safe care and treatment and statutory notifications submitted to the CQC. However we found records were not always consistently kept and we have made a recommendation to the provider about this. We have also made a recommendation in relation to the physical environment.

People using the service and their relatives were satisfied with the care they received from staff. They told us they felt safe at the service and care workers treated them with kindness. Risks to people were assessed and plans were in place to reduce the risk and keep people safe from harm. The provider contacted the appropriate healthcare professionals if referrals needed to be made. The provider operated robust recruitment checks which meant people were kept safe from the risk of being supported by staff who were not fit to do so. People received their medicines from staff in a safe way. The provider followed safe infection control procedures, including those associated with Covid-19. The provider recorded any incidents and accidents and used these as a learning opportunity and to make improvements.

Staff received training that was relevant to their role and regular supervision which meant they were able to carry out their roles effectively. The provider held regular staff meetings which provided an opportunity to give feedback. People were admitted to the service safely and the provider worked in collaboration with external healthcare professionals to ensure they met their health and dietary needs.

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 told us that staff treated them well and we saw some nice interaction between staff and people using the service. Care plans were person-centred and included details about people’s preferences, their likes and dislikes. Staff supported people in a dignified way, respecting their privacy.

Care plans and risk assessments were evaluated every month, these included end of life care plans. There was a varied programme of activities in place, which included both individual and group activities. However, some of these were on hold at the time of the inspection due to an outbreak of Covid-19. The provider recorded and followed up on any complaints that were received and there was a system in place to analyse these to try and identify any trends and make any improvements.

The culture within the service had improved since the last inspection, this was reflected in the feedback we received from both people and staff. There were thorough governance procedures in place, including a system of audits. The registered manager was supported by a deputy and clinical services managers and also an external quality and regional team which meant there was good oversight into all aspects 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 and update

The last rating for this service was requires improvement (published 02 October 2020) 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

This inspection was prompted by a review of the information we held about this service and the previous rating.

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.

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

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

Collingwood Court Care Home provides accommodation and nursing care for up to 80 older people, including some living with dementia. The home is split into three units. There were 35 people living at the home at the time of the inspection.

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

We found that records in relation to the management of people with pressure sores were incomplete and we could not be assured they were receiving appropriate and safe care. Although people using the service were generally happy with the care and support they received, we received mixed feedback from them about staffing levels within the home. This was reflected in the feedback from staff. Staffing rotas showed there were occasions when staffing levels were not consistent. People told us they felt safe and where concerns were raised, the provider engaged with the safeguarding process. People received their medicines as prescribed from trained staff and infection control practice within the home was safe.

Staff received training relevant to their roles, however they said they did not always feel supported by the managers. People’s needs were assessed on a regular basis and they continued to be supported by external health care professionals such as district nursing teams. Healthcare professionals raised concerns about poor communication from the home. The provider had taken these concerns on board and had arranged a meeting with them to see how they could work more closely in future to ensure people received good care, especially in relation to the management of pressure sores.

The COVID-19 outbreak had an impact on staff wellbeing and morale within the home. Staff did not feel respected nor valued. They also said support from managers was inconsistent. This had been acknowledged by the managers of the home and they told us they planned to take steps to understand staff concerns through a series of listening and drop in clinics facilitated by an independent HR employee. There had been some challenges within the home in relation to management cover during COVID-19, regional support was provided to the home during this time. The registered provider failed to submit statutory notifications to the CQC.

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 26 October 2019) and there was a breach of regulation in relation to staff training. 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 been made and the provider was not in breach of regulation 18 in relation to staff training. However, we found additional breaches of regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about management of pressure sores, staffing, and the competency of management. A decision was made for us to inspect and examine those risks. CQC have introduced targeted inspections to follow up on previous breaches or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We undertook a targeted approach to review part of the key question of Effective.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. 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 Collingwood Court Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care treatment and notifications of incidents 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Collingwood Court Care Home provides accommodation and nursing care for up to 80 older people, including some living with dementia. The home is split into three units. There were 55 people living at the home at the time of the inspection.

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

People told us they felt safe living at Collingwood Court Care Home. Family members we spoke with also agreed with this. Recruitment process were robust and although we received feedback around the high use of agency staff, there had been a recent recruitment drive and we saw records which showed the reliance on agency staff had reduced. The provider monitored any incidents and accidents and the clinical services manager held ‘lessons learnt’ meetings to try to prevent these from occurring in future. People were protected from the risk of poor infection control as appropriate measures had been taken. Risk management tools were used to identify and manage other risks to people.

Records showed staff had attended training to meet the needs of people, however it was not clear if they were being offered the opportunity to attend refresher training. There were also gaps in the frequency of staff supervision meetings. The provider worked with healthcare professionals to provide effective care to people and people had access to professionals such as a GP. People’s nutritional needs were met. 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.

Although feedback from people and their relatives was positive about the care their received, the mealtime experience was not person centred. People who needed support to eat were left waiting for their food for extended periods. We have made a recommendation about this and will follow this up at our next inspection. There was a pleasant atmosphere in the home, where people’s privacy and independence was respected.

People’s care was reviewed on a regular basis which helped to ensure their needs were met. However, end of life care plans did not always contain enough person centred information about how people wished to be cared for towards the end of their life. There was a program of activities within the home, however provision for activities in the community could be improved. We have made recommendations about these points and will follow this up at our next inspection. The provider was diligent in responding to any complaints that had been received.

There was limited engagement from people and their relatives, any feedback that had been received was limited. We have made a recommendation about this and will follow this up at our next inspection. The registered manager had recently left and a new manager had started in August 2019, feedback from staff about the new manager and clinical services manager was positive. There was a culture of continuous improvement, this was evident through the number of quality assurance audits and, reviews and quality metrics that were completed. There was a quality improvement plan which collated all areas for improvement in one document.

Rating at last inspection

The last rating for this service was Good (published 10 August 2017).

Enforcement

At this inspection we identified breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around staff training and supervision. Details of action we have asked the provider to take can be found at the end of this report.

Why we inspected

This was a planned inspection based on the 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.

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

We last inspected the service on 29 February and 2 March 2016, where we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 relating to medicine management, safeguarding people from abuse and unsafe treatment, dignity and respect, and good governance. The service was rated requires improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Collingwood Court Care Home’ on our website at www.cqc.org.uk. The provider sent us an action plan on how they would make the required improvements.

We undertook an unannounced comprehensive inspection on 22 June 2017. At this inspection, we found the provider had made the required improvements from our previous inspection and met the legal requirements. We rated the service Good at this inspection.

There was no 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.

People received their medicines in line with their prescription. Medicines were managed and stored securely to ensure they were safe. Controlled drugs received additional security audits to ensure they were not misused. Risk assessments identified issues that could pose risks to people’s health and safety, and management plans were in place to promote people’s health well-being.

People were safeguarded from the risk of abuse and improper treatment. Staff had received training on safeguarding and they were knowledgeable on the procedure to follow if they had any concerns. There were sufficient staff available to meet people’s needs safely. Staff knew the procedure to follow to respond to emergency situations and events. Recruitment practices were safe. Applicants underwent checks before they were allowed to work at the service.

People consented to their care and support. People’s relatives and, where needed, professionals were involved in best interest decisions. The service complied with the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff had been trained in these areas and understood their responsibilities.

People’s nutritional needs were met. People were supported to eat and drink as required. They were given choices of what to eat and drink and they had access to food and drinks throughout the day.

Staff were trained, knowledgeable and had sufficient experience to provide good quality care to people. They understood the needs of people and how to care for them. Staff received regular support and supervision to carry out their duties effectively. They liaised with various healthcare professionals to meet the needs of people. Healthcare professionals told us staff followed recommendations they gave.

People told us staff were kind and caring. We observed that staff treated people with respect and promoted their dignity. Staff communicated to people in the way they understood. They demonstrated an understanding of people’s likes and dislikes and preferences. Staff also provided care to people in line with their preferences and choices. People at the final stages of their lives were supported in line with their wishes and were cared for in a dignified way.

People were kept occupied and encouraged to participate in activities. There were a variety of activities available at the service to occupy people. People were supported to maintain their religious and cultural beliefs.

People had their individual needs assessed and their care planned in a way that met their needs. They received care that met their individual needs and promoted their well-being. Staff held reviews with people and their relatives to ensure they support they received reflected their current needs and care plans.

People knew how to complain if they were unhappy with the service. The service followed their procedure to respond to complaints. People and their relatives had opportunities to share their views and give feedback about the service and these were acted upon. Regular audits and checks took place to assess and monitor the quality of the service.

This inspection took place on 29 February and 2 March 2016 and was unannounced. We last inspected the service on 8 and 9 June 2015 when we identified shortfalls and breaches of the regulations. We found that staff did not receive appropriate support and supervision to enable them carry out their duties effectively and that accidents and incidents were not recorded and reported appropriately. The service received an overall rating of requires improvement.

The service had 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.

People were not always protected from abuse or the risk of harm. Accidents and incidents were not always recorded and the system to identify their occurrence was not robust. The service did not always raise safeguarding concerns appropriately.

People were not protected against the risk of unsafe medicine management We found errors in recording medicines administration and in stock control. However, medicines were stored safely.

People were supported by sufficient numbers of care staff and registered nurses to ensure their needs were met. The service carried out comprehensive recruitment checks prior to staff commencing employment.

Care records directing staff to use restraint were not written in line with the provider’s policy because health and social care professionals had not been involved, consent or best interests had not been considered and staff had no training in remaining techniques.

People were supported to make informed decisions. The service worked in accordance with the mental capacity act 2005 to seek authorisation for deprivation of liberty safeguards.

The service was not always caring and some people’s bedrooms were not a place of privacy. Several people living at ground floor level could be viewed by the public outside because the service had taken away their net curtains several months before and not replaced them.

We observed staff providing people with kind and sensitive support. Confidential and personal information was stored appropriately.

People were involved in the development of their personalised care plans which reflected their preferences for care and support. These were regularly reviewed. People were supported to participate in a range of activities.

Staff were unsettled by the high turnover of managers at the service. Conflict existed between staff at the service which was described as ‘bullying’ and which had not been dealt with by the registered manager. The registered manager did not feel supported by the provider to address their concerns about the attitude of some staff.

Quality and safety audits failed to identify errors in medicines, care records, accident reporting and safeguarding.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, their relatives, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We observed people being supported appropriately with mobility aids and equipment.

We saw sufficient staff were provided to deliver people's care needs and they received the training they needed to provide appropriate care and support however some relatives of people using the service expressed concern about staff numbers telling us, "there are not enough staff to spend time talking to people."

People's care records detailed information about risks and how these should be managed.

The provider did not have an effective system in place to analyse accidents and incidents in the home. This meant any learning from such matters was not always shared and improvements identified were not always acted upon. Records were accurately maintained, which meant the risk of people receiving unsafe care was minimised.

Is the service caring?

We observed people were mostly but not always treated with respect and dignity by the staff. For example, toilet doors were not always closed when people were using the facilities. In their discussions about people using the service, staff did not always refer to individuals in a respectful manner. We also observed people being supported appropriately and sensitively by staff. People told us they felt safe. We saw care workers showed patience and gave encouragement when supporting people. One person using the service told us, "they (the staff) always help me when I need something."

Is the service effective?

People's health and care needs were assessed with them, but there was limited evidence to show they were always involved in agreeing their care plans. This meant that people may not always have been supported according to their individual choices. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People we spoke with and their relatives told us they received the support they needed.

Is the service responsive?

We observed people were supported by kind staff however we saw some people were left unattended for long periods and staff were seen engaged in social discussion with one another rather than with people using the service. We found complaints were not always investigated and responded to in a timely manner.

We found the provider appropriately monitored people's weight and responded to changes in people's nutritional needs with regular input from a dietician. People's general health was regularly monitored and the provider ensured appropriate action was taken (such as calling an emergency doctor or ambulance) if a person had developed an infection or become unwell. However, the provider did not always ensure people had regular access to an optician or dentist. This meant people may have been at risk of developing eye or oral health problems.

We found staff were unclear about actions to take in the event of a fire and nearly half of all staff had either never or not recently undertaken fire safety training. This meant people may have been at risk of harm if a fire had occurred as some staff were unsure of the fire safety procedure.

Is the service well led?

We found that monitoring and reviews of the service were carried out however highlighted actions were not always completed in a timely manner. This meant the quality of the service could be not be assured by people living at Collingwood Court, their relatives and staff.

We found the service had recently had several changes in management. This meant we had concerns that systems and processes in place could not always be effectively monitored on a sustained level.

Staff told us they felt supported by the deputy manager. Comments included, 'She (the deputy manager) always listens to concerns.'

We observed that people were given a choice about aspects of their care and staff acted in accordance with their wishes. However, it was not clearly recorded as to whether people had the capacity to consent.

People's care and support needs were clearly identified. The care records we reviewed contained a range of assessments and care plans outlining how to support people using the service. The care plans contained assessments of a range of risk factors and how to manage them.

The staff worked with other providers, for example physiotherapists and occupational therapists, to ensure that people's health needs were met.

Medication was safely stored and administered. All medication administered was recorded on a medication administration record.

The complaints process was accessible to people using the service. We saw a record of complaints made and found that they were responded to and action was taken to improve service provision.