Background to this inspection
Updated
9 July 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
Three inspectors and one Expert by Experience carried out this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience made video calls and telephone call to people and their relatives.
Service and service type
North Court is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement dependent on their registration with us. North Court is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was no registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 13 people who live at North Court and three family members of people who live in the home. We also spoke with the manager, deputy manager and 11 staff.
We reviewed a range of records. This included care records and medication records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We requested some further records after we had visited the home so that we could conclude the inspection.
Updated
9 July 2022
About the service
North Court is a care home providing both personal and nursing care to up to 65 people. The service provides support to older people, some of whom live with dementia, younger adults and adults with physical disability. At the time of our inspection there were 42 people using the service.
North Court is close to the town centre of Bury St Edmunds. The home is an ex local authority care home building. There are two floors. Downstairs is for older people living with dementia. They have access to a courtyard garden and a small café that is open from time to time. The top floor is nursing care. Each floor is separately staffed and has a nurse designated to each floor.
People’s experience of using this service and what we found
People did not have appetising, well presented food to eat. The kitchens were not managed to a high standard and food hygiene put people at potential risk. Fluid charts showed that one person was receiving a low intake of fluid.
Risks to people were not effectively managed. Risk assessments were not specific to the person and meaningful. Risks relating to moving and handling were not adequately managed. We observed poor practice that placed people and staff at risk of injury. Risk assessment instructions on moving and handling were confusing. Repositioning charts had gaps in them.
The quality assurance system had not been effective in identifying the issues we found during the inspection.
The current manager has had a positive impact on North Court and is liked and respected by staff. But there have been many managers in recent times and the changes and inconsistencies have impacted upon the running of the service. There is no registered manager and the current manager was leaving for another post.
There is still high use of agency (we were told this had reduced) The figures for June compared to May show an increase in agency staff for carers and support staff, but a decrease in agency nursing staff. Agency staff are used to ensure numbers of staff are maintained, but feedback and our observations show negative impact.
Infection control processors were good. There was strong leadership in the housekeeping team and an infection control lead is in place.
Medicine management had clearly improved with learning from past errors. Audits have been effective and appear thorough. Medicines were safely managed.
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 The last rating for this service was good. (Published 2 November 2019)
Why we inspected
The inspection was prompted in part due to concerns received about medicines, staffing and moving and handling. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.
You can see what action we have asked the provider to take at the end of this full report. 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 North Court on our website at www.cqc.org.uk.
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 quality monitoring and assessing risk 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 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.