Agincourt Care Home

Agincourt Care Home is a care home which is registered to provide care and accommodation to up to 31 people. The home specialises in the care of people over 50 years old with dementia and mental health care needs. At the time of the inspection there were 28 people living at the home. The house is an adapted residential building with accommodation arranged over two floors.

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

We found further improvements had been made in the quality of care people received against the backdrop of continued challenges of the Covid-19 pandemic.

People were supported by staff who understood the risks they faced. Risks were safely managed and monitored. Staff had access to people’s risk assessments and care plans and were confident they knew how to reduce these risks. People received care and support from staff who knew them well and treated them with respect, compassion and dignity.

There were sufficient numbers of staff to meet people’s needs and keep them safe. The registered manager kept deployment under review as people’s needs changed.

People were supported to have choice and control of their lives and, where best interests decisions had been made, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Action was taken by the registered manager during our inspection to ensure staff fully understood when to involve people's legal representatives.

We were assured by infection prevention and control (IPC) measures in the home. Practices that protected people from cross infection of communicable illness were well embedded amongst the staff team.

There were ongoing maintenance works, and furniture replacement, scheduled to maintain and improve the environment.

Relatives spoke highly of their communication with the registered manager and staff team.

People were cared for by staff who cared about and supported their colleagues. Staff felt part of a strong team with a shared purpose. Staff felt supported by the senior team.

People lived in a home where oversight such as audits, monitoring and observation were used to improve the quality and safety of 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 and update

The last rating for this service was requires improvement (published July 2021) 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 enough improvement had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service in May 2021 breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve dignity and respect and good governance.

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, Effective, Caring and Well-led which contain those requirements and identified other shortfalls in provision.

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.

Follow up

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

Agincourt Care Home is a care home which is registered to provide care and accommodation to up to 31 people. The home specialises in the care of people over 50 with dementia and mental health care needs. At the time of the inspection there were 29 people living at the home. The house is an adapted residential building with accommodation arranged over two floors.

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

We found improvements had been made in the quality and safety of care people received during what had been a difficult year due to the Covid-19 pandemic. People received care and support from staff who clearly cared about the people they cared for, however, we identified that some improvement was still needed to ensure people were always treated with dignity and respect.

We were somewhat assured by infection prevention and control (IPC) measures in the home. Improvements were made during our visits and the Clinical Commissioning Group (CCG) provided refresher training and input to the home.

Oversight had improved, however, concerns related to IPC and the way people’s dignity was upheld had not been adequately addressed. Guidance had been given to staff but checks to ensure that learning was embedded in practice were not always sufficient to achieve the best outcomes for people.

Records had improved relating to most aspects of people’s care and support. These records enabled oversight and ensured care plans could be updated effectively.

People were supported by staff who understood the risks they faced. Risks were safely managed and monitored, and staff had access to people’s most recent risk assessments and care plans.

Some planned environmental changes had been delayed due to the Covid-19 pandemic, an activity area was planned in a downstairs communal area. The garden had been developed and provided an attractive and secure outside communal space.

People were supported to have choice and control of their lives and, where best interests decisions had been made, 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 were cared for by staff who were committed to their colleagues. Staff told us they had worked together through what had been a challenging year.

There were adequate numbers of staff to meet people’s needs and keep them safe. Following feedback related to people’s experience of support to eat, the registered manager made changes to the deployment of staff at lunchtimes.

There were organised activities and entertainment which provided people with social stimulation, however, some people spent sustained periods of time without purposeful activity. Recording around social support was not always sufficient to review if people were spending time unoccupied when they may have preferred to be doing something they found meaningful. The registered manager reminded staff to record the social support and interaction they had with people.

People were supported to maintain contact with friends and family members. This had been monitored during the pandemic to reflect both national safety guidance and the communication styles of people living in the home.

Relatives, professionals and staff spoke highly of their communication with the registered manager. Staff felt supported by the senior team.

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 January 2020) and there were multiple 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 enough improvement had not been sustained and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published January 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in November 2019 breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, person centred care, dignity and respect and good governance.

We undertook this inspection to check they had followed their action plan and to confirm they now met legal requirements.

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 see what action we have asked the provider to take at the end of this full report.

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.

We have identified breaches in relation to governance and how people’s dignity was upheld at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Agincourt Care Home is a care home which is registered to provide care and accommodation to up to 31 people. The home specialises in the care of people over 50 with dementia and mental health care needs. At the time of the inspection there were 27 people living at the home.

The house is an adapted residential building with accommodation arranged over two floors.

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

The registered manager was committed to person centred care and the staff team reflected this ethos of personalised care in a homely setting. During our visits we saw some kind and skilled interactions with people and heard about positive outcomes. However, there were a number of shortfalls which were impacting on the safety and quality of people’s care.

People lived in a home where oversight had not identified that the quality of care people received was not adequate. People were not always receiving care as outlined in their care plan. People looked unkempt at the start of our inspection and did not always receive responsive care. Staff did not always know important information about people.

Records were not sufficient to ensure safe and high quality care and whilst this had been identified prior to our visits it had not been adequately addressed.

Risks associated with the environment and people’s behaviour were not safely managed or monitored. The environment did not sufficiently enhance the experience of people with dementia. We have made a recommendation about this.

People were supported to have choice and control of their lives and, where best interests decisions had been made, 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 were cared for by staff who told us they were part of a strong team, They were committed to the home and had ensured there had been enough staff to cover a period of change in the team. There were adequate numbers of staff to meet people’s needs and keep them safe.

There were organised activities and entertainment which provided people with social stimulation. People were supported to maintain contact with friends and family members.

Rating at last inspection

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

Why we inspected

The inspection was prompted in part due to concerns received about the responsiveness of care people were receiving. A decision was made for us to inspect and examine those risks. We planned a focussed inspection to answer the questions “Is the service responsive?” and “Is the service Well-led?” During our inspection we gathered evidence that indicated that a full inspection was appropriate to check the quality of care people were receiving. We have found evidence that the provider needs to make improvements. Please see the full report.

You can see what action we have asked the provider to take at the end of this full 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.

The home 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.

Systems and processes were in place to maintain people’s safety and protect them from avoidable harm.

Where management spot checks or feedback had shown staff needed to improve their practice evidence showed they had been given coaching.

Staff had a good understanding of how to safeguard people from abuse and knew what signs to look for and how to raise a concern. The home had robust recruitment processes to ensure that people were supported by staff who were suitable to work with vulnerable adults. Medicines were managed safely. Staff were confident with this task and had regular observations to check their competency. The home conducted audits to ensure there was learning from incidents or issues and the chances of them reoccurring was reduced.

People’s needs and choices were assessed with their involvement. This included listening to them and noting aspects of their lives that were important to them and made them unique. This diversity was acknowledged, respected and supported. Reviews of the support people required were completed and included evidence that they were included in these discussions. People were supported by staff that had received training that gave them the skills and confidence to meet their specific needs.

People were supported to have a balanced and varied diet. People were supported to maintain their health and wellbeing. This included support to attend routine appointments or with visits from health and social care professionals. Improvements were being made to the home environment to make it more dementia friendly.

Staff understood the principles of the Mental Capacity Act 2005 (MCA 2005) and how it applied to the people living there particularly when they lacked capacity to make certain decisions affecting their life. The MCA 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. Records showed that people who required these safeguards had them in place and, where conditions were attached, they were being met.

People were supported by kind and caring staff who supported them to express their individuality and celebrate what they had done so far in their life. People were given the time and support they needed to express their views and wishes. Staff understood the importance of helping people to maintain their privacy and dignity. People were encouraged to maintain contact with their relatives and friends.

People received personalised care and support that was reflective of their current and emerging needs. People were supported to participate in a wide range of activities both in the home and local community. Staff recognised the importance of supporting people and their wider family when they required end of life care.

There was a positive culture at the home where everybody’s views were considered. Staff and relatives thought highly of the management at the home. Team meetings were well attended and demonstrated wide ranging discussions and shared learning. People and their relatives had the opportunity to feedback through annual surveys with this used to inform improvement planning. Local nursing teams had provided staff training in dementia care and best practice in managing challenging behaviours.

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.

The risks people took were understood by staff and in general terms had guidance on reducing those risks. However we found that the recorded guidance to staff in relation to supporting a person with unwanted behavior required to be clearer. The registered manager addressed this at the time of the inspection.

The home was clean but some areas of infection control needed to be improved upon. The laundry area needed cleaning and the storage of dirty clothes needed to be reconsidered. The registered manager addressed this at the time of the inspection.

The arrangements made for the dispensing of medicines in the home was safe but in one case required some further oversight. We looked at medicines records and found that the recording was generally safe but there was insufficient evidence of one person receiving their medicine. The registered manager acknowledged our observations and began to plan how best to improve the systems in place.

There were some outstanding maintenance work that required attention. However the provider told us about the plans they had in place to address these and that they hoped to complete some of the work in the new year (2017)

People were valued and well cared for by staff. The interactions between people living at the home and staff was observed as friendly and compassionate. People and their relatives told us staff were friendly and caring. Staff demonstrated a high commitment to their work and had built up positive relationships with people. People were treated as individuals and their diverse needs respected and met. One member of staff said “just to be able to combe their (people’) hair and make them feel good makes me feel good”.

People were cared for by staff with the appropriate skills and experience. Some staff had worked in the home for a number of years and told us they enjoyed their work. Staff were provided with opportunities to learn how to care for people with enduring mental health illness’. Staff told us about how they felt supported by the management and felt valued by the provider Agincare.

People and those important to them told us about how they felt included in their care plans. One relative told us about how well the staff had responded when they had concerns; another told us about being involved in planning the Christmas activities. This demonstrated that the service tried to include all people with regards to areas of running of the home.

People were provided with support to access health care services. When people became unwell staff made arrangements for a health care professional to visit.

People's individual needs were assessed and care was delivered to meet their needs. We spoke with three people and four people's relatives. All spoke positively about the home and the care provided to them. One person told us, 'They (the staff) do everything I need here.' Another person said 'The staff are good, there are no faults.'

The provider had effective systems to monitor pre-employment checks and recruitment procedures for staff.

The home had suitable systems to monitor the quality of service provided.

People who lacked mental capacity did not have their decisions or choices that they may have had when they had mental capacity explored or recorded. This did not comply with current legal requirements.

People's needs were assessed and daily care was delivered in line with their wishes. Staff had received training in safeguarding and knew how to report or respond to any concerns within the home.

We saw the home was clean and hygienic with an effective system to monitor cleanliness. Medicines were appropriately stored, administered, recorded and audited.

We saw that staff were supported by the provider through regular training and that staff were encouraged in their professional development.

The home had suitable systems to monitor the quality of the service provided and to assess and manage risks to the health, safety and welfare of people using the service and others.