About the service: Court Nursing Home is a privately-owned care home situated in Rock Ferry, Wirral. It provides residential and nursing care to up to 31 people living with dementia or other mental health difficulties. The home has single and shared rooms. We inspected the service on 8 January 2019 and there were 26 people living in the home at the time.

People’s experience of using this service:

At the last inspection in November 2017, we found safe recruitment practices were not always adhered to, the environment was not safely maintained and medicines were not always managed safely. At this inspection we looked to see if improvements had been made and found that they had.

Staff had been subject to all required pre-employment checks before they began in post to help ensure they were suitable to work with vulnerable people. People told us and our observations confirmed, that there were sufficient numbers of staff on duty to meet people’s needs in a timely way.

Systems in place to manage medicines were safe and people told us they got their medicines when they needed them.

The environment was safe and a programme of refurbishment was in place to update areas of the home that required some attention.

At the last inspection in November 2017, we found the provider to be in breach of Regulation as systems to monitor the quality and safety of the service were not always effective. During this inspection we looked to see if improvements had been made and found that they had.

The registered manager and staff had a good understanding of their roles and responsibilities within the service. Relatives and health and social care professionals told us the service was managed well. Systems were in place to monitor the quality and safety of the service. Any issues identified were addressed to ensure quality of care was maintained.

People told us they felt safe living in the home due to the support they received from staff. Individual risks to people had been assessed and measures were in place to mitigate those risks. For example, sensor mats were used to alert staff when people were at risk of falling. Appropriate actions had been taken when accidents or incidents occurred.

Staff were knowledgeable about safeguarding processes and concerns had been referred to the local authority appropriately to help protect people from harm.

A system was in place to monitor applications and authorisations to deprive people of their liberty and any conditions attached to them. Consent to care and treatment was sought and recorded in line with the principles of the Mental Capacity Act. Staff supported people in the least restrictive way possible.

Care and support was planned, delivered and monitored in line with current evidence-based guidance, legislation, standards and best practice. Care plans were detailed and reflected people’s needs and preferences.

Staff were supported in their role and had access to relevant training to help ensure they had the necessary skills to meet people’s needs.

People received the support they needed to eat and drink and maintain a healthy and balanced diet. Staff knew people’s dietary needs and preferences and people told us they enjoyed the food available to them.

Improvements had been made to the environment to help ensure the environment was suitable for people living with dementia and the registered manager had plans to develop this further. Some areas of the home were quite tired and required work and redecoration and plans had been made for these improvements.

People told us staff were kind and treated them with respect. Staff knew the people they were supporting well, including their preferences and used this information to build effective relationships with people and encourage meaningful conversations.

Systems were in place to gather feedback from people, although not all people recalled taking part in meetings or surveys. People and their family members told us they felt confident to be able to r

This inspection took place on 22 and 23 November 2017 and was unannounced.

Court Nursing Home is a privately owned care home with nursing services situated in Rock Ferry, Wirral. The home provides residential and nursing care for up to 31 older people living with dementia or other mental health difficulties. At the time of the inspection there were 28 people living in the home, two of whom were in hospital.

At our last inspection in April 2017, we found that the provider was in breach of Regulations in relation to seeking consent, person centred care, care planning, risk management, safety of the environment, complaints processes, audit systems, systems to gather feedback regarding the service and safe recruitment of staff. The service was rated as requires improvement overall and we issued the provider with a warning notice in relation to Regulation 12; Safe Care and Treatment. This inspection looked to see whether sufficient improvements had been made to ensure the provider was meeting the fundamental standards of care.

In April 2017, we found that risks to people were not always managed appropriately as not all risks were assessed. During this inspection, we saw that detailed risk assessments were in place for specific risks. This helped to ensure that staff had access to clear guidance on the risk people faced and how this could be mitigated. The provider was no longer in breach of regulations regarding this.

At the last inspection we found that care records did not provide clear advice on what support people required and plans regarding the management of wounds were poor. During this inspection we saw that care plans were detailed regarding people’s needs. This included detailed plans regarding wound care. We saw a letter from a tissue viability nurse which congratulated staff in the home on the improvement in the care they provided to people with regards to wound management. The provider was no longer in breach of regulations regarding this.

At the last inspection we found that emergency evacuation procedures were not clear. During this inspection we saw that the provider had developed a new evacuation procedure and staff had been provided with training regarding this. Personal emergency evacuation plans (PEEPs) were in place for people and included detailed information regarding the support they required in the event of an emergency. We found however, that not all safety concerns addressed at the last inspection had been fully addressed, as fire drills had not been completed and not all legionella checks had been undertaken.

Systems were in place to help ensure that the environment and equipment within the home remained safe. However, we saw that not all fire doors closed appropriately within their frames and a radiator in the dining room was very hot to the touch and posed a burns risk should people lean or fall against it. Although improvements had been made since the last inspection we found that risk was still evident and further improvements were required and the provider was still in breach of regulations regarding this.

During the last inspection we found that there was a lack of assessments in place to establish whether people were able to make specific decisions regarding their care and treatment and best interest decisions were not evident for people who were unable to make specific decisions.

During this inspection we found that applications to deprive people of their liberty were made appropriately and mental capacity assessments were in place to establish if people could consent to live in the home. However, mental capacity assessments were not completed for all relevant decisions. This meant that the principles of the Mental Capacity Act 2005 were not followed.

In April 2017 we found that systems in place to audit the quality and safety of the service were ineffective. During this inspection we saw that the provider completed a series of detailed audits which identified areas for improvement. We

We carried out this inspection on 26 and 27 April 2016. The inspection was unannounced.

Court Nursing Home is located in Rock Ferry, Wirral and offers accommodation with nursing care for adults living with nursing and mental health needs. Accommodation is in single or shared bedrooms and some of the bedrooms have en-suite toilet facilities. There are 15 single and eight shared bedrooms. At the time of the inspection, 27 people lived at the home.

On the day of our visit, there was 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. The manager had been in post approximately 18 months at the time of our visit.

During this visit, we found breaches in relation to Regulations 9, 11, 12, 16, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risk, the implementation of the mental capacity act, poor care planning and recording keeping, lack of an adequate complaints procedure, poor recruitment practice with regards to staff and ineffective quality monitoring systems. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the care files belonging to five people who lived at the home. We found that people’s care plans did not cover all of their needs and risks and lacked clear information about the management of risks. Information about people’s care was unclear and where professional advice had been given, care plans had not always been updated to reflect this. This did not demonstrate that people’s health and welfare risks were monitored and managed safely.

We found that dementia care and person centred care planning was poor. Care plans lacked adequate information about people’s preferences and did not provide staff with person centred guidance on how best to support them when they became upset or displayed behaviours that challenged. Information relating to people’s like and dislikes, end of life wishes and support to remain independent was limited and did not show that people’s needs were properly assessed so that personalised care could be provided.

The home was clean, free from offensive odours and well maintained. Equipment was properly serviced and maintained. The risk of Legionella had been assessed but the water checks undertaken did not show that the risk of Legionella was managed safely. We also found that some of the hot water temperatures dispensed from taps in the home’s communal bathrooms were too hot and presented a scalding risk. There was no evidence any action had been taken to address this.

The provider’s fire evacuation procedure was unclear and information in place to assist staff and emergency services personnel in the event of a fire or other emergency evacuation was inadequate. This meant staff and emergency personnel lacked vital information to protect people from harm during an emergency situation.

Where people’s capacity to consent to decisions about their care was in question, the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguard legislation (DoLS) had not always been followed. People’s capacity to consent had not always been assessed to ensure legal consent was obtained. We saw people had access to independent mental health advice and support as and when required to help them understand and participate in decisions about their liberty which showed the beginnings of good practice.

People we spoke with said the food at the home was good and they got enough to eat and drink. We found however that some people had special dietary requirements which were not always met in accordance with dietary advice or i

We carried out an announced inspection of this service on 5 and 6 November 2014. We found the home was in breach of several of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These breaches related to the Care and Welfare of people using the service, monitoring the quality of the service, safeguarding of people, cleanliness and infection control and medicine management. We took enforcement action and issued the home with compliance actions. The home sent us an action plan in February 2015.

After the inspection on the 5 and 6 of November 2015 we received information about concerns in relation to the service. As a result we undertook a focused inspection on 23 March 2015. During this inspection we looked at these concerns.

Court Nursing Home is a privately owned care home with nursing services situated in Rock Ferry, Wirral. Accommodation is in single or shared bedrooms, some of which have en-suite facilities. The home provides residential and nursing care for up to 31 older people living with dementia or other mental health difficulties. There were 29 people living at the home at the time of this inspection.

Focused Inspection 23 March 2015.

Following our inspection on the 5 and 6 November 2014 we undertook a focused inspection to look into concerns raised about the service. People had contacted the CQC with concerns about the service being provided. We were told that people were not receiving any activities or stimulation and this was affecting their wellbeing. We were also told that the hygiene standards were not good in the home and staffing levels at times were not sufficient in meeting people’s care needs. The provider was still working on their action plan to improve the service.

We spent time talking with the provider, deputy manager four people living at the home and four care staff.

During the visit we looked at the staffing levels at Court Nursing Home we found them to be adequate for the 26 people currently living there. There were adequate staffing levels on duty and records provided informed that there was adequate staffing on all shifts to meet the care needs of the people on the rotas we looked at.

There was no activities programme in place. We spent time in the lounge area, the conservatory and the dining room and kitchen. We found areas of concern in relation to infection control. The environmental infection control procedures were not appropriately being monitored to ensure that the service was clean and hygienic for the people living there.

At our last inspection of Court Nursing Home on 3rd April 2013 we identified that risk assessments for people living at the home were not sufficiently managed and people were at risk of inappropriate care due to a lack of detailed and person centred information. We found that staff had not received training appropriate to their roles and there was no formal plan in place to supervise staff on a regular basis.

An action plan by the home outlined improvements they intended to make which included the removal from people's records of generic risk assessment information and the initiation of person centred plans. Arrangements had been made for staff to attend training relevant to their roles and a supervision plan was to be agreed.

During this visit we found person centred care plans and risk assessments had been introduced with information to staff about how care should be met and risk should be managed. 20 care staff had attended training in the managment of difficult behaviour and all qualified staff had the required mental capacity act certificates. Some supervisions had taken place since our last visit and there was a plan to continue these throughout the year.

People who used the service and relatives we spoke with said:

“I love it here, the staff are great, I just sing all day long”;

“It is a very good home and there is always a wonderful atmosphere”;

“Staff seem to understand people”; and

“We are very happy with the home. Mum is well looked after”.

We went back to Court Nursing Home to follow up compliance actions which had been issued in December 2012 and undertook a scheduled inspection.

A relative told us "It is more like a family here, people are not left in their rooms and the staff are happy and very approachable".

A person who uses the service said "It's a good place; they look after me well and the staff are all nice".

Arrangements had been put in place around consent to treatment and staff had been provided information on the Mental Capacity Act 2005 to read prior to attending a training course. We spoke to three staff who confirmed they were aware of mental capacity, deprivation of liberty and the need to obtain consent.

We looked at the assessment process and reviewed care records of six people living at the home. We found improvements were needed to demonstrate that staff had access to sufficient and up to date information about the care and support people required. We discussed this with the provider who was in the process of making improvements in this area.

We found there were systems in place to meet people's nutritional needs and manage medication and the provider ensured that standards of quality and safety were maintained by regular audits and quality assurance processes.

Supervision and training had been implemented to better support staff in their roles and training was planned to support staff in the management of people with challenging behaviour.

During our visit we made observations that indicated that staff were attentive and had a caring attitude towards the people who used the service. When people asked for support they received a good response.

We spoke with five people who used the service who said that they got the support and help they needed from the staff. Some comments made were:-

“The home is alright. I feel well looked after.”

“Its okay here. I’m quite happy.”

“The staff help when I need it. Any problems and I speak to the manager.”

We spoke to one relative who described the staff as caring and attentive.

We spoke to two social care professionals who said that a good service was provided.

We spoke to two health care professionals who said that the service referred people to them appropriately and followed any advice given.

We found that people experienced care, treatment and support that met their needs. The home was clean and safe. We found that there were suitable arrangements in place to manage complaints about the service.

We found that improvements were needed to ensure that the best interests and rights of the people who used the service were fully supported and promoted.

Improvements were also needed to the training provided to staff to ensure that they had the knowledge and skills to appropriately support the people who used the service.

No current information was available from Wirral Borough Council the time of writing this report.

We visited the home on 25 January 2012. We spoke with people who use the service and some relatives. They all expressed general overall satisfaction with the care and support given to them. They told us they felt involved in their care and treatment and were able to make choices in everyday living. Relatives told us they were sent a care plan review letter every month that they commented on and signed agreement to . One person who used the service told us how he had been supported by staff to undertake an information technology (I.T.) course at the local college.

People who use the service and their relatives told us they felt listened to by staff and were able to contribute views on the service. They told us they were always treated with dignity and respect. One person told us he liked having his own room, staff always knocked before entering and he had a key so he could lock his room when he was not in there.

Other comments made included “It’s very good here, they are a great support”, “It’s very good, and they are very attentive”, “They do a marvellous job to the best of their abilities”. They said it felt like a family and was very friendly. One relative said they were very pleased with the improvements in behaviour since their relative had lived at the home. They were very happy with the support given and would recommend the home.

Court Nursing Home is a privately owned care home with nursing services situated in Rock Ferry, Wirral. Accommodation is in single or shared bedrooms, some of which have en-suite facilities. The home provides residential and nursing care for up to 31 older people living with dementia or other mental health difficulties. There were 29 people living at the home at the time of this inspection.

This unannounced inspection took place on the 5 and 6 November 2014. We spent time with the 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 on how the service is run.

We last inspected Court Nursing Home on the 13 September 2013. At that inspection we found that the service was meeting all of the essential standards that we inspected.

People using the service told us they felt safe. Staff were knowledgeable in recognising signs of potential abuse and followed the required reporting procedures to inform the manager or senior on duty. However, we found that the provider did not have up to date policies, procedures and protocols for ensuring that any concerns about people’s safety were appropriately reported by staff. They did not have a copy of the local safeguarding protocols. The seven people told us they felt safe living at the home and with the staff who supported them. Comments included, “It feels safe at the moment” and “No problems, it’s safe here”.

Although people’s needs had been assessed and care plans developed these did not always adequately inform staff what they should be doing to meet people’s needs effectively in relation to providing stimulation and activities suitable for them. However all of the twelve staff we spoke with knew the people well and in discussions were able to tell us what care and support they provided. Staff also liaised with other healthcare professionals to obtain specialist advice to ensure people received the care and treatment they needed.

People were treated with kindness, compassion and respect. The staff took the time to speak to the people they were supporting. We saw positive interactions with staff and the people seemed to enjoy talking to the staff.

People had a choice of meals, snacks and drinks which they told us they enjoyed.

The home used safe systems for recruiting new staff. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at the home. There were adequate staffing levels on duty on all shifts to meet the care needs of the people on the rotas we looked at.

Although the provider monitored the service and planned improvements there was no formal quality assurance process in place to get feedback from people. The manager told us that the people living at the home, people acting on their behalf, staff and other visiting professionals had not been requested to complete feedback about the care and provision in a long time.

There were issues with how medicines were monitored and audited to ensure they were checked appropriately and stored at a safe temperature.

We found breaches of the Health and Social Care Act 2008 Regulations 9, 10, 11, 12, 13 and 15 in relation to not providing suitable fulfilling activities, protecting people using safeguarding procedures, not maintaining the home to a clean and hygienic standard, not ensuring the medicines were correctly stored and administered and not monitoring the quality of service. You can see what action we told the provider to take at the back of the full version of this report.