Courtfield Lodge is a purpose-built care home in a quiet residential area close to the town centre of Ormskirk. There are 61 en-suite bedrooms, 52 of which are single and nine which can be used for single or double occupancy. Accommodation is on two floors and two lifts are provided. Communal areas are available on both floors. There are outdoor garden and patio areas.

At the time of the inspection 59 people lived at the home.

The inspection visit took place on 25 July 2018 and was unannounced.

At our last inspection we rated the service overall Good. The effective domain required improvement in relation to staff supervision and appraisal. On this inspection, we found the service had improved to good in the effective domain and remained good in the other four domains. We saw supervision and appraisal were in place. The registered manager and staff we spoke with said they received regular supervision and appraisal. We also saw evidence of these in staff files.

We found the evidence continued to support the rating of overall good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager in place. 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.

As well as the registered manager there was an additional manager who had recently begun managing the home. People who lived at Courtfield Lodge, their relatives and staff were positive about the management support in the home.

People told us they felt safe and cared for by staff. One person told us, “On a scale of one to ten, I’d give it a ten.” There were procedures in place to protect people from abuse and unsafe care. We saw risk assessments were completed and kept under review. These provided guidance for staff in how to safely support people and reduced potential risks to people. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

Medicines were managed safely in most areas. They were ordered appropriately, checked on receipt into the home, given as prescribed and disposed of correctly. The temperature of medicines room was too high for safe storage but this was being rectified when we inspected. People told us they received their medicines when needed.

Staff had been recruited safely, and received training sufficient to develop the skills and knowledge required to support people with their care and social needs. There were sufficient staffing levels in place to provide the support people required. We saw staff were attentive to people’s needs and wellbeing and responded promptly to requests for assistance.

We saw staff provided care in a personalised way, taking people’s preferences into account. They were aware the importance of upholding people’s rights and diverse needs and treated people with respect and care. People told us they were supported in the way they wanted. They said staff provided care in a way that respected their dignity, privacy and independence.

People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Relatives told us staff were welcoming to people’s families and friends. People told us they enjoyed a variety of social and leisure activities that assisted their well-being.

People told us staff met their care needs promptly and referred them to healthcare professionals where required. We saw from care records

This inspection took place on the 21 October 2015 and was unannounced.

The last inspection of the service took place on 5 September 2014 which was a follow up inspection to a planned inspection in March 2014. The home was judged to be compliant in all the areas we looked at in September 2014 and had addressed the issues found during the inspection in March 2014.

Courtfield Lodge is a purpose built care home situated in a quiet residential area close to the town centre of Ormskirk. There are 61 en-suite bedrooms, 52 of which are single and nine which can be used for single or double occupancy. Accommodation is on two floors and two lifts are provided.

Communal areas are available on both floors. There are outdoor garden and patio areas.

The home had a registered manager in post although they were not present during our inspection due to them being asked to temporarily cover another home within the organisation. 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 told us they felt safe at the home and with the staff who supported them.

We looked at the personnel records of five members of staff. We found references highlighted some issues, such as long periods of sickness absence, and two references referred to performance issues within previous jobs. There was no indication within interview records or any other documentation of these issues being discussed. Another file had no record of a Criminal Records Bureau (CRB) or Disclosure and Barring (DBS) check recorded. We have made a recommendation about this.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns.

All the people we spoke with felt their medicines were managed safely and told us they always received them on time and when they needed them. We asked people if they felt care workers were competent when handling their medicines and everyone we spoke with told us that they felt staff were competent.

It was evident however from looking at staff files and from speaking with staff that formal support via supervisions and appraisals where not taking place and not all the staff we spoke with felt that they had the necessary support from the management team at the home.

The home catered for any specialist diets, whether that be for health or religious needs and that fresh produce was ordered on a weekly basis. The responses we gained regarding the quality of the food on offer were mixed with some people telling us that they were not consulted about they food they were offered.

People’s rights were protected, in accordance with the Mental Capacity Act 2005. People were not unnecessarily deprived of their liberty because legal requirements and best practice guidelines were followed.

People were treated in a kind, caring and respectful way. They were supported to remain as independent as possible and to maintain a good quality of life. Staff communicated clearly with those they supported and were mindful of their needs.

People we spoke with and their relatives told us they knew how to raise issues or make complaints. They also told us they felt confident that any issues raised would be listened to and addressed.

We saw little in the way of planned activities during our inspection and we received a few negative comments, mainly from relatives, in relation to activities. People living at the home however told us they were happy and had things to do to occupy their time.

We found most plans of care to be person centred, which outlined clear aims, objectives and actions to be taken. These provided staff with detailed guidance about people’s assessed needs and how these needs were to be best met.

People and relatives we spoke with told us they were encouraged to maintain their independence where possible.

The plans of care we saw incorporated the importance of dignity and independence, particularly when providing personal care. We observed staff on the day of our inspection treating people in a kind and caring way.

We saw within peoples care plans that referrals were made to other professionals appropriately in order to promote people’s health and wellbeing.

We saw minutes of a range of staff meetings, which had been held at regular intervals. The meeting notes were very detailed and displayed which members of staff had been in attendance.

A wide range of updated policies and procedures were in place at the home, which provided the staff team with current legislation and good practice guidelines.

A good range of audits were in place that feedback into service provision.

We found one breach of the Health and Social care Act 2008 (regulated Activities) Regulations 2014 in relation to the short falls in staff supervision.

You can see what action we told the provider to take at the back of the full version of the report.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

We spoke with nine people who lived at the home and five visiting relatives. All of the people we spoke with were able to tell us or indicate that they felt safe living at Courtfield Lodge. No one cited any issues regarding unsafe practices or unreasonable behaviour or attitudes of staff. During our observations throughout the day of the inspection there were no issues with how staff spoke to people living at the home or any issues with how staff assisted people.

Is the service effective?

A key-worker system was now in place within the home, each person living at the home had two key-workers who were their main point of contact. Families had been made aware of this as appropriate and care plans indicated who each person's key worker was.

Is the service caring?

Each person who lived at the home had a detailed life history in place via a document entitled 'My Life Story'. They included pictures and details of peoples past life, interests, hobbies and family ties and relationships. Each story built up a very good picture of the life that each person had led and meant that it was easier for staff to relate to people and reminisce with them, particularly for those people who were unable to fully converse.

We spoke with nine people who lived at the home and five visiting relatives. The vast majority of comments were very positive, some of the comments received were as follows;

"We have no issues at all. My mum is very happy so we are happy. We can see that a lot of improvements have been made over the last few months."

"I'm more than happy with the care my wife gets. Nothing is perfect in life and if there are any issues they are sorted out on the day."

"I can't fault the staff, they work very hard and are absolutely wonderful."

"Oh yes, I'm happy here. The staff are very kind."

Is the service responsive?

We found evidence of the involvement of, and referral to, other professionals such as the speech and language therapy service, incontinence service, GP's and opticians.

Is the service well-led?

We saw that weekly internal checks were carried out by Flightcare's Care Quality Manager. These reviews looked at different areas each cycle and included checks to the physical premises as well as equipment, policies, documentation and talking to people who lived at the service, relatives and staff. Some of the examples we saw included reviews of care plans, minutes of meetings, staff training, bedrooms and the information placed on notice boards. Any actions needed were noted progress from actions previously set were detailed.

People told us that the staff were friendly and helpful and they were happy with the home.

Relatives of people using the home said that it was welcoming and that staff knew each person and were always willing to talk and listen to them.

We observed policies and procedures being put into practice in ways which were appropriate and respected the rights and dignity of people.

We saw that care plans were appropriate and identified people's strengths and preferences as well as needs. We saw that people were encouraged to use their strengths and to exercise choice but that when people needed extra help or support it was available for them.

People we spoke with confirmed they were actively involved in all aspects of their care. They commented positively about the staff and said they were kind, caring and respectful. They said they felt safe in the home and were actively encouraged to express their views and opinions about the service. People said their care was provided to a high standard and confirmed that all their care needs were met.

On the 18th and 19th of September 2013 we inspected Courtfield Lodge and found them non-compliant with seven of the essential standards of quality and safety.

During this inspection, It was clear family and people who lived in the home had been involved with developing personal information with the activity coordinator.

The home had recently introduced new care plan information and tools. On the day of the inspection we found some of the same concerns within the new file information as we found on our previous inspection.

Staff continued to not have a clear understanding of restrictive practice and did not understand the steps to take before this practice was undertaken.

At this visit we found that appropriate arrangements were in place in relation to medicines administration and recording

Some new recruitment policies needed to be embedded with the management team to enable them to be completely implemented.

Staff had the time to speak to people and assess their needs as opposed to taking each person in turn to try and meet their needs.

We looked at the falls logs kept in people’s files. We saw in some cases falls that had been recorded in the log had not been added to the daily record or accident log for that specific month. We also found the opposite where falls had been recorded in daily records or the accident log they had not been recorded on the falls log.