Courtyard Mews

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified two breaches of regulation for Safe Care and Treatment and Person Centred Care. People did not receive effective or safe care. The provider and registered manager had failed to ensure people's needs were assessed. This led to inadequate management of risk, and people were at risk of harm because of these failures. The registered manager did not ensure that each person received appropriate person-centred care and treatment that was based on an assessment of their needs and preferences. People did not always receive care and support that was evidence-based and in line with good practice standards. The provider had failed to use, or in many cases, failed to complete, care assessments tools to assess risk and to ensure people’s needs were reflected and understood. Staff did not have access to the information they needed to appropriately deliver people’s care, treatment and support. There were not effective systems in place to share information if people needed to transition to another service quickly, such as a hospital admission. Staff did not always work in a coordinated way and share information with leaders to ensure that guidance and care information was up to date. People were not always supported in accordance with the Mental Capacity Act.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s experience was poor as their needs were not robustly assessed prior to the service commencing. Some people were unable to recall whether they had received an initial assessment of their needs from the service. When asked if an assessment of had been completed, one person said, “I don’t think they did, no.” Another person confirmed that no one from the agency came out to assess their needs prior to the commencement of their care. In the absence of up to date care records, people and their relatives advised staff how to provide care and support. One person's needs had reduced and they no longer required equipment to support them, staff did not have an up to date assessment of their needs so provided support from verbal instruction. One person told us, "I tell them (staff) what to do." Records showed the registered manager relied on assessments completed by previous providers. For example, the registered manager failed to produce their own moving and positioning assessment for one person, but was using an assessment from another provider which was last reviewed in 2018. This meant the person was receiving care and support from an assessment which was produced at a different setting and using different equipment. The person's needs had changed from 2018 and the information was inaccurate leaving the person at significant risk of harm.

The registered manager was responsible for completing assessments of people’s care and support needs prior to them receiving care. People's health conditions were ignored by the registered manager, and not considered as relevant and important. The registered manager demonstrated a lack of understanding, and regulatory responsibility to conduct assessments that included all known risks to people. Therefore, staff did not have all the information they needed to ensure they provided effective and safe care. Staff were not equipped with robust written information to include how to support people's complex needs. These needs included but were not limited to, type 2 diabetes, high blood pressure, hyperthyroidism, paraplegia, pressure areas, depression, dementia, risks relating to nutrition and hydration, chronic kidney disease, osteoporosis, and acquired brain injury. People's care records were incomplete, inaccurate and out of date, staff told us they read and followed people's plans, a staff member said, "The care plans are on the app, for each of our clients, we have the care plans on those, all clients have care plan folders in their houses." However, as assessments and care records were incomplete and out of date, this left people at significant risk of harm.

People did not receive effective and safe care as the provider had not ensured that their needs and risks had been adequately assessed. The majority of people supported by the service were receiving short term care arrangements following transitions from hospital. Most people’s records confirmed they presented with health issues conditions, often complex, and whose support needs could change quickly. When assessing people’s needs, the provider had failed to assess a number of high-risk factors, related to their health, that could potentially impact their care and support. Information relating to people’s health conditions and needs was available to the provider, but they had failed to adequately assess these and incorporate them into people's care and support plans. People’s communication care plans were not effectively completed. The registered manager confirmed that only one person they supported was identified as having communication difficulties due to their dementia diagnosis. Their communication plan was basic, cited the person had previously been assessed by SALT (Speech and Language Therapists) and that communication was though a family member. There was no guidance for staff on how they could communicate with the person directly, what signs and indicators could be used to determine the person's basic choices.

People did not receive care, treatment and support that was evidence-based and in line with good practice standards. People’s needs in relation to skin integrity risks did not utilise, or fully utilise evidence-based tools and guidance to determine level of risks. For example, the malnutrition universal screening tool (MUST) was not completed for people. The MUST tool is to determine people's risk of malnutrition and also feeds into the Waterlow tool which assesses people's risk of damage to their skin. This meant that effective care could not be fully planned or delivered and people were left at significant risk of harm.

We raised our concerns regarding the assessment of risks around people during, and following, the assessment. We also highlighted the shortfalls in the completion and lack of use of evidence-based tools, which the registered manager had available but did not utilise to assess risks. Staff told us they read people's care plans and thought they were up to date. One staff said, "For the care plans, we have an app on our phone, they (management) come out and check I think every 6 months to check on their (people's) folders that they are up to date, if they are not, I can call the office. The care plans have enough information about the clients." However, staff were unaware the records were not accurate due to assessment tools not being fully completed and integrated into people's care plans. This left people at risk of receiving inappropriate and unsafe care. Although some staff provided feedback to inspectors, we received information during the assessment process that the registered manager had told some staff not to answer their telephones from inspectors. It had been alleged that only friends and family who are employed by the registered manager were to provide feedback to CQC. We cannot be assured of the validity of this feedback.

People did not receive care and support that was evidence-based and in line with good practice standards. The provider had failed to use, or in many cases, failed to complete, care assessments tools to assess risk and to ensure people’s needs were reflected and understood. For example, the provider had failed to complete many people’s Waterlow assessments to calculate and determine the risk of skin integrity breakdown. One person, who was cared for in bed and unable to mobilise independently was not assessed using the Waterlow assessment base tool to determine the risk factors associated with their skin integrity. Assessment forms had been produced, but no assessment or calculation was completed.

The registered manager and staff did not always work together in a coordinated way to ensure essential information was shared about people's support needs. This is necessary to ensure guidance and care relating to people's care was up to date. People's care plans did not always reflect the care that was being delivered. The moving and handling risk assessments and care plans for one person indicated to staff that the person used a hospital bed and used a sara steady equipment to mobilise. The person informed us that they had not used a hospital bed for two months, that their sara steady was not used and that they mobilised using their walking frame. The person said, “They don’t use sara steady. I can walk around the bed with my frame.” Another person’s care plan stated that they used a shower chair and frame to mobilise. When the person was asked how they mobilised, they said, “I use a chair in the bath and walking stick. I don’t know why people think I've got a frame.” This information had not been shared between staff and the leadership in the service so that care plans and guidance could be updated appropriately.

While the staff we spoke with felt there was good communication, our assessment found that the registered manager and staff did not work effectively to support people. Staff spoke about team meetings where discussions around supporting people and staff practices took place. Staff gave examples of being able to contact the office staff or registered manager when required to advise of people running low on stocks such as continence aids and food. Staff spoke about working with professionals like OTs and physios in relation to people’s support.

Feedback from the professionals we contacted was poor in regard to ensuring collaborative working and information sharing. One stakeholder shared a consistent failure to inform them of concerns with one person, even when initial concerns about certain risks were discussed. When the registered manager made communication with the stakeholder, this was to discuss care hours and not the concerns that had been noted by the registered manager.

Staff did not have access to the information they need to appropriately deliver people’s care, treatment and support. Although information regarding people’s health conditions was shared and provided by professionals prior to care commencing, this information was not always shared with staff so that could provide safe and effective care. There were no effective systems in place to share information if people needed to transition to another service quickly, such as a hospital admission. The care coordinator confirmed that the service did not have hospital or care passports in place for any people they supported. These are documents, that are shared with medical staff, detailing important information about the person, their health and social care needs, preferences and communication preferences. The use of the passport is important for identifying possible problems quickly.

The registered manager had failed in their responsibility to recognise changes and deterioration in people's complex health conditions and did not consider people's needs. Some people told us they managed their healthcare needs themselves. Most people told us that either they or a family member did this. One person said, “I do that myself. They (carers) want to be in and out as soon as possible.” When asked about information in their home detailed by the service about their needs and healthcare, the person added, “There's nothing in this folder, there's no information whatsoever."

The registered manager did not support people to lead healthy lives, they had failed to assess significant risks to people, and to ensure staff were aware of risks and potential barriers to people being well, safe or healthy. Staff told us that they liaised with professionals when they were involved in people’s healthcare and support, however, professional advice was not always available to staff and included in people's care records. One staff member told us, " [Person] is bed bound, I remember the OT (occupational therapist) came and bought a hoist, but the hoist cant help him, the wife said the OT will come back." The registered manager had failed to follow this up in their professional capacity to promote a better outcome for the person to live a healthier life.

There were ineffective processes in place to adequately support people manage their health and care needs by staff. Staff were not provided with sufficient and important information regarding people’s healthcare needs to effectively understand their needs and risks within their care and support. The registered manager did not focus on identifying all the risks to people’s health and failed to provide adequate information and guidance for staff to prevent deterioration. People who lived with significant and complex healthcare needs such as paraplegia, type 2 diabetes and dementia were not supported to live healthier lives and did not achieve positive outcomes. There were no systems in place to monitor people's outcomes and ensure staff were following professional's advice which left people at significant risk of harm.

While the people we spoke to expressed that they were generally happy with their care, our assessment found care / elements of care did not meet the expected standards. Feedback focussed on the delivery of care and staff practices. Some people expressed concerns about issues that they’d raised either not being actioned or delays in achieving their requests and wishes. Other people told us their care and support was not monitored and reviewed by the registered manager.

The registered manager and staff did not adequately ensure that outcomes were effectively monitored and achieved. Assessments and care records relating to people’s health care conditions had not been completed to determine risks with plans to mitigate them. This meant that staff and management could not review, monitor or improve areas of support for people.

People using the service did not always consistently experience positive outcomes. There were ineffective approaches to monitoring people's care and treatment due to an inadequate approach to the assessment of risk. There was a failure to assess and provide guidance risks for people’s healthcare conditions. These had not been actioned following reviews of people’s care and outcomes could not be effectively monitored.

We received feedback from people in respect of difficulties they experiences with some staff due to a language barrier. Some people told us that staff communicated with them and asked for consent before supporting them. Others told us that it was often difficult to receive and provide information to staff due to communication difficulties and understanding. One person said, “Half of the carers cannot communicate with me. Some have no idea. They don’t understand what I am saying.” Another person told us, "One (staff member) came out shadowing (training), they can't speak the language or understand what i'm saying." Without clear and mutual understanding, people were at risk of experiencing support against their wishes or preferred way of receiving care.

Staff confirmed the received training in the Mental Capacity Act. Staff spoke confidently about ensuring that people were asked questions and provided them with choices and options in their daily support. One carer said, “We encourage them to make decisions. Like personal care and choosing what to wear. We can offer different meals and ask what they want.” Despite staff's feedback, people had told us they were not consistently communicated with, therefore were not consistently asked for consent.

People were not always supported in accordance with the Mental Capacity Act. When applicable, information around people’s capacity was provided by local authorities when the service commenced care. Although records showed that the provider conducted mental capacity assessments to determine people’s capacity to consent to making specific decisions, these were not being completed fully and appropriately. This meant people were not informed of their fundamental human rights to refuse care and support. For example, a person was assessed to determine their capacity to make a decision around their personal care needs. The person's communication plan was basic, cited the person had previously been assessed by SALT (Speech and Language Therapists) and that communication was though a family member. The assessment was completed by the registered manager and did not include information as to whether family members, who it was stated understood the person communication, were involved. There was no guidance for staff on how they could communicate with the person directly, what signs and indicators could be used to determine the person's basic choices, highlighting the inaccuracy and ineffectiveness of the assessment. Another person had been assessed as lacking capacity, their capacity assessment had been completed by the registered manager in July 2022 but had not been reviewed. This person's capacity assessment contained contradicting information which did not evidence the registered manager understood how to complete mental capacity assessments appropriately.