Archived: Francis Court

Updated 10 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008. As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of four inspectors.

Service and service type

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

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 13 people and 5 relatives to gain their views on the care provided. We spent time in the home whilst people were relaxing in the communal lounge, dining area and receiving support from staff. This gave us an opportunity to observe staff interactions with people. We spoke with 13 members of staff including the registered manager, two nurses, one team leader, one unit manager, one housekeeper and seven care assistants. We reviewed records that included care plans, risk assessments and medicine administration records. We also looked at records relating to the management of the service, including policies and procedures, quality assurance systems and staff rotas.

Updated 10 January 2023

About the service

Francis Court is a residential care home providing personal and nursing care for up to 87 people in purpose-built accommodation. The service provides support to older people, many of whom have dementia, and younger people with disabilities. At the time of our inspection there were 50 people using the service.

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

There were insufficient staff to support people’s needs. Sometimes people had to wait longer then they should expect for support from staff. People told us staff answered call bells quickly but would sometimes come back later to deliver care. This had a negative impact on people’s quality of life, but this had not been identified by the provider’s quality monitoring systems which only measured the response time for call bells.

People’s need for social stimulation was not consistently supported. People did not always have enough to occupy them, and staff were not spending quality time with people. The provider’s system for monitoring quality had identified this shortfall but improvements had not yet been made.

People who were receiving care at the end of life had not always received the support they needed. Shortfalls had been identified following a complaint and the registered manager had implemented additional training for staff and amended systems to address these concerns. These improvements were not yet fully embedded and sustained in practice.

Since the last inspection improvements had been made in the assessment and management of risks and the administration of medicines. Care records were being maintained consistently and reflected the care provided to people.

People told us they felt safe and staff were kind and caring. One person said, “They are all so kind.” A relative said, “The care assistants are very good, genuinely caring and supportive.” Staff demonstrated a clear understanding of their responsibilities for safeguarding people and knew when to report concerns.

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.

People, relatives and staff spoke highly of the management of the service. One staff member said, “It has been a difficult time, but we have been well supported.” The registered manager was open and transparent about challenges the service had faced and demonstrated the improvements that had been made since the last inspection.

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 12 February 2020) 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 we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

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, Responsive and Well-led which contain those 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.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Francis Court on our website at www.cqc.org.uk

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 and will take further action if needed.

We have identified breaches in relation to staffing, personalised care and monitoring and improving the quality of the service 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 continue to monitor information we receive about the service, which will help inform when we next inspect.