Archived: Atkinson Court Care Home

Atkinson Court is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 75 older people.

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

There was no activities lead at the service, and staff had not been trained in providing activities. Planned activities were not carried out, and staff said they were unable to ensure people received enough stimulation and entertainment on a day to day basis. However, the provider was in the process of recruiting an activities lead at the time of the inspection who was expected to plan and provide activities.

Although we found the service was generally clean, there were some areas which were not always well presented.

We have made a recommendation around cleanliness and the environment.

Staff received training to ensure they were competent to meet people’s needs, but staff did not always receive regular supervisions and one to one support.

We have made a recommendation about staff support.

People received their medicines safely and as prescribed. Systems and processes around medicines management were safe.

Safeguarding systems and processes ensured concerns were raised and investigated appropriately.

Care plans contained good person-centred detail and were regularly reviewed.

People said staff were kind and caring, and their privacy, dignity and independence was protected.

Risks to people were assessed appropriately, and regular environmental checks were carried out. People said they felt safe, and safeguarding issues were reported appropriately.

People had good access to health and social care professionals and actions from these visits were clearly recorded.

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.

There were adequate quality systems and processes in place to identify improvements. Although we found recording issues, actions were being taken in response to concerns identified.

There were regular staff meetings and meetings with people and their relatives. The provider did not use surveys and questionnaires to gather feedback and improve 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

The last rating for this service was good (published 2 July 2019).

Why we inspected

The inspection was prompted in part due to concerns we received regarding staffing levels, governance and medicines management. A decision was made for us to inspect and examine those risks.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Atkinson Court is a purpose-built care home for older people requiring general or specialist dementia nursing care. The service can support up to 75 people. At the time of the inspection there were 33 people using the service.

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

Medicines were usually managed safely and where we found shortfalls, these were addressed and rectified with immediate effect. There were overall sufficient numbers of staff. Some people said staff were very busy and they occasionally had to wait longer than they expected for call bells to be answered. Others said they had no concerns about staffing levels. Individual risks were managed appropriately and staff were aware of how to support people safely. People told us they felt safe and well looked after. The service was clean and staff followed good hygiene practices.

The service had an open and supportive culture. The management team continually considered ways to improve the service for the benefit people living there. Audits and checks were now fully embedded in the service and carried out to monitor the quality of care delivered. There was a commitment for improvement and learning from any actions identified. However, the provider had not always made sure notifications of safeguarding issues were sent to the Care Quality Commission (CQC) without delay. We have made a recommendation about ensuring timely submissions of notifications to the CQC.

People were 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. The provider and staff acted within the law when people lacked capacity to make their own decisions. People’s nutritional needs were met. However, the dining experience was not well organised on the first day of our inspection. Improvements were noted on the second day. We have made a recommendation about menus and the mealtime experience. Staff received induction, training, supervision and support to enable them to feel confident and be competent in their role. Records of these were not always clear. Staff worked with local health care professionals to ensure health care needs were met.

Staff were patient and friendly, and people's privacy and dignity was usually respected. People were happy living at the service and were very positive about the caring nature of staff. Staff valued people and knew how they preferred their care and support to be provided.

Care plans were kept up to date and reflected people's needs. Where we identified gaps in supporting documentation, the provider assured us these would be addressed. The provider was responsive to complaints and concerns. There were opportunities for people to discuss any concerns or suggestions they had about 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

At the last inspection the service was rated Requires Improvement (report published 15 May 2018). Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Caring, Responsive and Well-led to at least good.

During this inspection we found some improvements had been made in relation to the safe management of medicines and risk, safeguarding people from abuse and provision of dignified and person centred care. However, further improvements were still required and there continued to be a breach of Regulation 12, Safe care and treatment and Regulation 17, Good governance. We also identified a new breach of regulation in relation to staff training and support; Staffing, Regulation 18. You can see what action we have taken at the back of the full version of the report.

Atkinson Court is a purpose built care home for 75 older people requiring general or specialist dementia nursing care. The home is located in the residential area of Ings Road, Leeds. Atkinson Court provides a modern environment with single en-suite bedrooms arranged over three floors. At the time of our inspection, 49 people were using the service.

Atkinson Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC); however, they had left the service a few weeks previously. A temporary manager had been appointed by the provider. 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.

Risks to people who used the service were still not fully assessed. Risk management plans in place did not consistently contain the information staff needed to support people safely and manage all risks identified. Environmental risks had not always been assessed and we found areas of the service that should have been kept locked for people’s safety were not. This gave people access to areas with equipment and substances which posed a risk to their health and safety.

We checked the systems for managing medicines at the service and found they now minimised risks and kept people safe. However, some improvements in record-keeping were required. For example, more supporting information was required to protocols for some people’s ‘as and when required’ medicines.

We could not be assured staff had completed the training they needed to effectively carry out their role due to poor record keeping in this area. There were gaps in staff’s knowledge about current good practice in relation to the Mental Capacity Act (MCA) 2005. Records did not indicate specialist training in dementia care had been provided or that all staff had completed an induction. Some staff told us they had experienced difficulties in being able to complete training due to their workload. Most staff told us they now felt supported in their role; stating they felt positive about the new management arrangements in the service. However, records we were given did not show staff received formal supervision and appraisal of their role in line with the provider's policy requirements. We have made a recommendation about a review of training for all staff and the records associated with this.

Systems used to monitor the quality of the service were not fully effective in identifying concerns and protecting people from risks to their health, safety and well-being. We were unable to consistently see that remedial action was taken when issues were identified. Records regarding governance of the service were not readily available to us during the inspection and when provided were difficult to navigate. Accurate and robust records were not always maintained in relation to medicines, consent, training, complaints, accidents and an overview of safeguarding concerns. Some confidential information had not been kept secure.

Some people who used the service and their relatives did not think the service was well led and stated they had never met the manager of the service. Some staff told us they had not been introduced to the new management team and did not know who key senior managers were.

The provider was not always working within the principles of the MCA. We saw examples where a mental capacity assessment had been made for a specific decision and was followed by a best interest meeting to make and agree a decision. However, records indicated two people had plans for their medicines to be given covertly (disguised in food) and appropriate assessments and best interest decisions had not been carried out in accordance with the MCA. The provider made arrangements to rectify this.

People told us they felt safe at the service and were well looked after. Staff demonstrated their understanding of safeguarding procedures to ensure people were protected from harm. Staff were trained to safely manage incidents of behaviour that challenged the service and others.

There were, overall, enough staff deployed to meet people's needs. Some people told us there could be shortfalls in staffing at weekends but their needs were always met. Staff said they would like to be able to spend more time with people, but assured us people's immediate needs were met. Staff were recruited safely.

Overall, the premises were clean and free from malodours. Some of the décor looked tired and in need of renewal in places. The provider had a plan in place to ensure this happened.

People’s views on food in the service were mixed. The dining experience was not a positive experience for some people. The provider had recognised this; and a robust action plan was in place to ensure improvements in this area of service provision.

People were supported to access healthcare services and records showed appropriate referrals to health professionals were made when needed.

People told us they were happy and enjoyed living at the service. They told us staff were caring, helpful and supportive. People said they were encouraged to be independent and were treated with respect. They said their privacy and dignity were maintained. Our observations also reflected this.

There was a programme of regular activities and a weekly timetable of planned events such as singers or exercise classes. Some people told us they would like to get out more.

People's care records were up to date and provided staff with detailed information about their individual needs and preferences. Staff demonstrated good knowledge of people’s care needs and it was clear they had got to know people well. Daily records described how people had been supported and cared for each day and showed their needs had been met.

There were mixed views on people knowing how to make complaints; but all we spoke with said they felt confident to raise concerns. We found records of complaints did not always indicate if complaints had been responded to in a way which resolved the concern.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 namely Regulations 12, Safe care and treatment, and 17, Good governance. You can see what action we told the provider to take at the back of the full version of this report.

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with the Care Quality Commission (CQC) about the incident indicated potential concerns about the management of risks. This inspection examined those risks.

Atkinson Court Care Home is a purpose built care home for older people requiring general or specialist dementia nursing care. The home is located in a residential area of Leeds and is easily accessible. Atkinson Court Care Home provides a modern environment with 75 single en-suite bedrooms with shower facilities arranged over three floors. The home has 24 ‘intermediate care beds’ for people discharged from hospital who need more support before returning home.

At the time of our inspection, there was a registered manager in post. A registered manager is a person who has registered with the 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.

Our last inspection of the service took place on 3 and 8 November 2016 when we rated the service 'Requires Improvement'. We found two breaches of the legal requirements in relation to staffing levels and reporting notifiable events. During this inspection we found improvements had been made and the service was now compliant with these regulations.

During this inspection, we found the provider had failed to establish and operate effective governance systems. Audits undertaken in relation to people’s care plans failed to assess the quality of information provided to staff or drive improvements as required. Care plan evaluations were not always completed when required and were not an effective tool to identify shortfalls.

Internal ‘inspections’ carried out by the provider failed to highlight issues identified during our inspection and had not ensured compliance with Regulations 9, 10, 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People did not always receive safe care and treatment because known risks were not appropriately mitigated or planned for. Staff did not have access to relevant guidance to ensure care was delivered safely or consistently.

Staff, who had not completed relevant training, used physical interventions to deliver care and support to the people who used the service. The use of physical interventions had not been appropriately planned or reviewed.

People’s care plans did not always reflect their current level of need. We found people’s care plans did not always include relevant information to ensure staff could deliver person-centred care.

We found the principles of the Mental Capacity Act 2005 were followed within the service. However, appropriate records had not been created following best interest meetings which meant it was not always clear care and support was delivered in people’s best interests.

People were not always treated with dignity and respect by staff; we witnessed a member of staff talking to people in an inappropriate and uncaring way.

People were supported by suitable numbers of staff who had been recruited safely. Records showed staff had completed a range of training and received appropriate levels of one to one support as well as annual appraisals.

People received care and treatment from a range of healthcare professionals. People were supported to eat a balanced diet of their choosing. However, we found limited options for people who were vegetarian.

People were supported to make decisions in their daily lives. People we spoke with told us staff were kind and supported them to undertake activities.

People who used the service, their families or appointed representatives were involved in the initial and on-going planning of their care. The provider’s complaints policy was displayed within the service which, helped to ensure it was accessible to people.

Staff told us the registered manager was supportive and approachable. The registered manager was aware of and fulfilled their regulatory duties to report notifiable events that occurred within the service.

The provider was reactive to the concerns we identified during and after the inspection had taken place. We have taken this in to account when assessing and making judgements about the on-going level of risk at the service.

Atkinson Court is a purpose built care home for older people requiring general or specialist dementia nursing care. The home is conveniently located in the residential area of Leeds and is easily accessible. Atkinson Court provides a modern environment with 75 single en-suite bedrooms with shower facilities arranged over three floors. The home has 19 intermediate care beds for people discharged from hospital who need more support before returning home.

At the time of our inspection 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.

Staffing levels were not sufficient to meet the needs of people using this service. Rotas showed there were occasions when shifts were not fully staffed. People told us there were delays in staff responding to their needs. We found a high turnover of staff and consistent use of agency staff.

Staff inductions were not always completed within identified timescales and supervisions were not carried out in line with the registered provider’s supervision policy. Staff had received an annual appraisal. Training records showed staff received appropriate training to safely meet people’s needs. Recruitment practices were found to be safe as appropriate checks had been carried out.

Activities were not well documented and clearer information was required to ensure people had the opportunity to become involved. Care plans were sufficiently detailed to enable staff to provide effective care. People were not involved in their monthly reviews, although they participated in their annual review.

People were supported by staff to have access to healthcare professionals when needed. The administration and management of medicines was found to be safe. People had a positive mealtime experience. People felt safe and risks were appropriately managed and reviewed.

Staff received training in the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. People were given choices about the care they received, although formal records of their agreement had not been signed.

People were complimentary about regular staff who provided their care, although they expressed concerns about agency staff who did not know their needs. Privacy and dignity was respected by staff and people confirmed this happened.

Complaints were recorded and responded to appropriately. A programme of audits was in place which was found to be effective. Regular staff and relative meetings took place. People were given an opportunity to feedback about the service through surveys.

Notifications were not submitted to the CQC as required under the terms of the registered provider’s registration. We dealt with this outside the inspection process.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

People told us they were happy with the care provided. One relative told us, 'My Mum is getting well looked after, if she doesn't eat the meals, they give her different options such as a sandwich, my sister is involved in discussions with staff and she gives consent for my Mums care.' One person said, 'I feel valued as a person; staff help me all the time and make me comfortable.'

We saw the communal areas and the bedrooms were clean and free of any malodours. One person who used the service said, "It's always clean, someone is always cleaning my room every day." There were effective systems in place to reduce the risk and spread of infection.

During the visit we observed staff supporting people and saw that staff responded promptly to any requests for assistance. Staff told us the staffing levels were sufficient to meet people's needs.

One member of staff said, "I like working here, it's a nice home and I get a lot of job satisfaction."