Archived: James Dixon Court

James Dixon Court is a residential care home for 30 people. It is a purpose built, single storey building, situated in a residential area of Netherton, close to local facilities and transport links.

During the inspection there were 17 people living in the home.

A registered manager was in post but was not in work during the inspection. 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. Feedback regarding the management of the service was positive.

We found that the safety of the environment was not always maintained within the home. A fire risk assessment of the building was in place and people who lived at the home had a PEEP (personal emergency evacuation plan) to ensure their safe evacuation in the event of a fire. External contracts were in place and internal checks were also completed to help maintain the safety of the building and its equipment. We found however, that chemicals were not always stored securely and fire regulations were not always adhered to as a fire door was wedged open.

People knew how to raise any concerns and felt confident that they would be listened to. There was however no complaints log available to evidence how complaints had been investigated and whether they had been resolved.

The registered manager completed a variety of audits, as well as a monthly care home checklist, which looked at the safety of the home. A member of the provider’s quality team also visited the home regularly to complete an operational compliance audit; however there was no evidence that all identified actions had been addressed. We found that although audits were completed, they did not identify all of the issues highlighted during the inspection. This meant that systems in place to monitor the quality and safety of the service were not always effective.

When there were concerns regarding people’s capacity to consent to care or make decisions, mental capacity assessments were completed. We found however, that they did not always follow the principles of the MCA. We found that necessary assessments and agreements were not evident for a person who received their medicines covertly (hidden in food or drink.)

Some staff had commenced an induction when they commenced in post, but no staff had completed this. Care staff had not received an annual appraisal and not all staff had regular supervisions to support them in their role.

We looked at how medicines were managed within the home. A medicine policy was available for staff to refer to and records we viewed confirmed that staff had completed training in relation to safe medicine administration and had their competency assessed. Medicines were stored safely, all administrations were recorded and stock balance checks were accurate.

People told us they felt safe living in James Dixon Court and their relatives agreed.

Staff were knowledgeable about adult safeguarding and how to report concerns.

Safe recruitment processes were followed when new staff were employed and staff only commenced in post once checks had been completed. People living in the home, their relatives and staff told us that there were sufficient numbers of staff on duty to meet people’s needs in a timely way.

There were no concerns raised regarding the cleanliness of the home. A recent infection control audit had been completed by Liverpool Community Health and the service had scored 99.68%.

We found that Deprivation of Liberty Safeguards applications had been made appropriately.

Regular training was provided to staff to help ensure they had the knowledge required to meet people’s needs safely.

People were supported by care staff and external health care professionals to help maintain their health and wellbeing. People told us staff arranged for a doctor in a timely way if they were unwell.

We received mostly positive feedback regarding the meals available in the home. One person we spoke with had a specific dietary requirement. They told us the chef sourced special ingredients to make their meals and that they were very happy with the food they received. Staff we spoke with were aware of people’s dietary needs.

People told us that staff were kind and caring and treated them well. We observed people’s dignity and privacy being respected by staff during the inspection and interactions between staff and people living in the home were warm and genuine.

We saw that care files containing people’s private information were stored securely in order to maintain people’s confidentiality.

Care plans were written in such a way as to promote people’s independence and people told us independence was encouraged. People told us they had choice regarding the care and treatment they received and could choose how they spent their day. Staff we spoke to knew the people they were caring for well and told us they were kept up to date about any change in people’s needs.

We observed relatives visiting throughout both days of the inspection and everybody agreed they could visit whenever they wanted to and could visit in private if they wished to.

Staff told us that if people had no family or friends to represent them, they would support them to access a local advocacy service.

Feedback regarding activities was mixed. Activities available were advertised within the home and external entertainers also visited the home on occasion. Most people we spoke with told us they spent a lot of time in their rooms watching television and some people told us they would like more activities. A staff member told us there was not enough resources available for activities and that the staff tried hard to ensure there were activities available for people that they enjoyed.

Plans of care contained person centred information, which showed that people had been consulted regarding their care. Relatives we spoke with were aware of the plans and told us they were involved in their family member’s care. Care plans were reviewed regularly and reflected people’s preferences.

Records showed that meetings took place and questionnaires were distributed in order to gather views from people living in the home and their relatives.

Staff meetings took place every few months. Staff we spoke with described these as ‘flash meetings’ and told us that they were not always planned or advertised. Not all staff had the opportunity to attend these meetings and a staff member told us planned staff meetings would be beneficial.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

The Care Quality Commission (CQC) had been notified of events and incidents that occurred in the home in accordance with our statutory notifications. Ratings from the last inspection were displayed within the home as required.

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

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the provider had taken action to improve the service since our last inspection visit and this has resulted in people receiving better and safer support with their health needs and with their medicines. However, we found improvements were still required to the management of medicines. A compliance action has been set for this and the provider must tell us how they plan to improve.

Is the service effective?

We found the service was more effective in recognising changes to people's needs and responding appropriately. For example systems were in place to ensure people at risk of weight loss or at risk of falls were more readily identified and action could then be taken to manage the risks.

Some improvements were needed to how information is recorded but this is an area which we know the provider is in the process of developing.

Is the service caring?

People who lived at the home told us staff were caring and we saw genuinely warm interactions between people who lived at the home and care staff. We saw that one person required a lot of care and attention and staff were very attentive to the person's needs.

Is the service responsive?

The provider had taken action to respond to concerns we found at our last inspection. It was evident that further developments were required but the main areas of risk in relation to the care provided to people were being managed more effectively.

A new manager had been appointed since our last inspection visit and they had implemented a number of systems to improve the service and ensure it was more responsive to people's needs.

Is the service well-led?

The provider has kept us informed as to their plans to improve the service and we have received regular updates on their progress.

Staff told us they felt listened to and well supported by the new manager. They felt improvements had been made to the service. Staff told us the home was now more stable and staff morale had improved significantly.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they felt safe and that if they had any concerns they would raise these with staff or with the manager. Staff had been provided with safeguarding training and they told us they felt confident to report any concerns or suspected abuse.

The way in which care was planned meant that people who lived at the home were at risk of not receiving the care and support they needed to maintain their health and welfare. Risks to people's safety were not always appropriately managed.

Medicines were not safely administered or managed and people were not always given their medication as prescribed.

The home was the subject of a number of safeguarding investigations at the time of our inspection. Providers have a responsibility to submit notifications of alleged abuse to CQC. However, we had not been notified of all current allegations.

Is the service effective?

People who lived at the home told us they were happy with the quality of the service they received. We also spoke with a number of visitors and they told us they felt the standard of care provided was good. However, we found shortfalls in the way that care was delivered. People did not always receive the care and support they required to meet their needs and maintain their health and welfare.

We found that care plans failed to detail people's needs sufficiently or to detail the care that had been provided to people. This meant people were at risk of not receiving the care and support they needed. This was compounded by the high use of agency staff at the home. The provider had not made sufficient improvements in this area since our last inspection when we raised concerns about a lack of appropriate care planning and recording keeping.

Is the service caring?

People who lived at the home told us staff were caring. People's comments included: 'The staff are very good' and 'It's great here, they're a nice bunch and I have no complaints.'

Staff told us they were clear about their roles and responsibilities to promote people's independence and to respect people's privacy and dignity. During the course of our visit we saw that staff interacted with people who lived at the home with warmth and respect.

Is the service responsive?

The provider was not able to demonstrate that the service worked well with other agencies to make sure people received the treatment and support they needed.

People who lived at the home told us they felt well supported and the home was visited by a number of health professionals during the course of our inspection. However, we found examples whereby staff had not followed the advice of health professionals in monitoring aspects of people's health. Alongside this, record keeping was poor and it was not always possible to establish what advice people had been given by health professionals and therefore whether this had been followed up.

Shortfalls at the home had been identified through some of the provider's own audits (checks) but we saw little evidence that these had been acted upon effectively or that sufficient improvements had been made to address practices.

Following our last inspection we told the provider they needed to make improvements to how records about people's care were maintained. During this visit we found that sufficient improvements had not been made.

Is the service well-led?

The service was not managed in a way that ensured people's health, safety and welfare were protected. The service did not have a registered manager and it had been managed by five different people over the past 14 months. The current manager was employed on a temporary basis from an agency and they had only been working at the home for three weeks. There was only one member of permanent senior staff working at the home at the time of our inspection as two other senior posts were being covered by agency staff as a result of staff absence.

The systems in place for assessing and monitoring the quality of the service were not effective. We saw evidence that some shortfalls had been picked up by quality checks but we saw little evidence that these had been acted upon appropriately.

We found that the people living at James Dixon Court looked well cared for and were dressed appropriately for the weather on the day. The people using the service who were able to tell us said that they were happy living in the home. Comments included; 'this is the next best thing to home', 'staff are great', 'staff are smashing, I am very happy here' and 'it is perfect, staff are lovely'.

We also received positive comments about the home and staff members from the visitors we spoke with. Comments included; 'staff are lovely' and 'staff are very respectful'.

People were provided with a choice of suitable and nutritious food and drink.

There were effective recruitment and selection processes in place.

Although we had some concerns regarding the care plans and people who used the service may be at risk of receiving inappropriate care because care plans were not being reviewed consistently we did not identify any actual issues or problems with the care being provided to the people living in the home.