This inspection took place on the 10 and 11 October 2018 and was unannounced on the first day.

Catherine 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.

Catherine Court accommodates 60 people across two floors each of which have separate adapted facilities. One of the floors specialises in providing care to people living with dementia. The other floor supports people with nursing needs. At the time of our inspection there were 50 people using the service.

The service is required to have a registered manager to manage the service. 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.

At our last inspection in 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated concerns.

People and relatives gave positive feedback about the caring nature of staff, comments included “Yes I feel [my relative] is safe and well looked after”, “The staff are very approachable”, I am looked after here”. People told us staff treated them respectfully and in a caring manner.

People told us they felt safe living at Catherine Court and we saw that appropriate referrals were made to the local authority when required.

Staff we spoke with understood the importance of treating people as individuals, irrespective of their preferred lifestyle or physical and mental abilities. During our observations of one person’s support we saw the service respected their chosen lifestyle. The service had policies and procedures in place to guide staff.

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.

Care needs were assessed and reviewed at regular intervals.

Robust recruitment procedures meant that only suitable staff were appointed. People were supported by suitable numbers of staff who had received training to enable them to provide high quality care.

Medicines were mainly managed effectively. Where issues were raised appropriate intervention was carried out.

People told us there was a choice of meals and said they had plenty to eat of good quality food. Staff knew about people’s dietary needs and preferences. Snacks and drinks were available throughout the day.

Activities and social events were available for people to avoid social isolation. Relatives and friends could visit without restriction.

There was a procedure in place for anyone to make comments or raise any issues. Relatives and people told us they knew how to make a complaint if the need arose.

The provider had systems in place to ensure the service offered quality care and support. Where issues were identified the provider took action to enable improvements to be made.

The provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

People were able to attend external healthcare visits to ensure their healthcare needs were met.

Catherine Court is a nursing home located in High Wycombe. It provides care for up to 56 people with nursing needs and dementia. At the time of our inspection 55 people were living at the service.

This inspection was undertaken on the 1 & 2 March 2016 and was unannounced.

Catherine Court had 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.

Catherine Court is a purpose built nursing home divided over two floors. People were supported to maintain their physical and emotional well-being through both care staff and nursing staff. Clear plans were in place on how people wished to be supported and associated risks were assessed and managed.

People were supported by staff who were kind, caring and respectful. People and relatives we spoke with were complimentary about the staff who worked at Catherine Court and how they were looked after. We made good observations of how people were supported in a person centred way.

A range of activities were provided to people living at Catherine Court. People and relatives were involved in the running of the service including areas such as regular reviews of care needs and activities and food committees.

Staff were supported and developed through effective supervisions and training. Management undertook regular auditing to identify where improvements could be made to the service and the way people were cared for. We found the management team were actively striving to improve the service.

People were supported by staff who knew them well to remain safe and well. Recruitment checks were in place to ensure staff suitability to work with people living at Catherine Court. People were supported to maintain their health through good management of medicines.

A single inspector carried out this inspection. When we visited the service 27 May 2014 we had concerns how three standards were managed. We set a compliance action for the provider to improve practice.

The provider sent us an action plan which outlined how they intended to become compliant.

We returned to the service on the 8 September 2014 to check if improvements had been made.

Below is a summary of what we found. The summary describes what we observed and the records we looked at .

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were protected from the risk of potential neglect as the provider had addressed our previous concerns around people’s call bells. We found people were individually assessed and risk assessed where it was deemed they could not use their call bell to call for attention. We found where people lacked capacity to use their call bell, the provider worked within the Mental Capacity Act 2005 to ensure alternative arrangements were in people’s best interests.

This meant the service was safe.

Is the service effective?

We found the provider had addressed concerns raised during our visits on the 27 May 2014. The provider now undertook daily ‘floor walks’ to observe staff practice. We found an effective complaints system was now in place to ensure people’s complaints and concerns were responded to appropriately. Daily call bell checks were now undertaken by the maintenance manager to ensure people's call bells were working effectively.

This meant the service was effective.

We looked at the personal care or treatment records of people who use the service, carried out a visit on 27 May 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and reviewed information sent to us by commissioners of services. We talked with commissioners of services.

What people told us and what we found

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? During the time of this visit, the named manager was not in post. We saw evidence a new manager in post had made an application to the Commission.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were protected against the risk of harm in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Where people were assessed as lacking capacity, appropriate procedures were followed to ensure arrangements were in people’s best interests and in line with the correct legal framework.

During our observations we found examples of poor practice relating to people’s care. We found people were unable to access their call bells as they were placed out of reach. We were not provided with a reasonable explanation as to why this was. Care plans and risk assessments did not clearly outline why people’s call bells were out of reach. We found one person’s call bell had not been reported as not working for a period of seven days. We observed poor practice at lunch time where staff had inappropriately handled people using the service. We observed a hazardous substances cupboard left unlocked with the keys in the door for over an hour.

Is the service effective?

We spoke with the manager who was in the process of implementing changes within the service to improve the quality and care. We found although regular audits and checks were undertaken within the service, this did not feed down into practice which was observed during our visit. We found complaints were not always responded to appropriately and in line with the provider’s policy and people were not always sure who they could speak with in regards to concerns or complaints. We found there to be adequate numbers of staff.

Is the service caring?

One person told us “It’s very nice here.” We saw staff actively engaged with people who used the service and provided a range of activities for people to participate in. During the lunch period we found a lack of person centred practice. We regularly saw people were in their rooms with no one to speak to. One person told us “It’s so lovely to have someone to talk to.” We spoke with one person who was very upset about their breakfast. They told us they wanted something warm. We asked a staff member if they could provide them with a warm breakfast and if they were offered a choice. The staff member told us “Tthey always have cornflakes”. This did not demonstrate person centred practice. We observed the manager entering people’s rooms without knocking. This did not preserve people’s dignity or respect.

Is the service responsive?

We saw one person was assisted to attend regular hospital appointments. Arrangements were in place to deal with foreseeable emergencies. During observations we found people’s call bells were placed out of reach. This meant people could not be sure their needs would be met in a responsive and timely manner as they had no alternative to gain staff member’s attention. We were told observations were undertaken. We could find no evidence of observations being undertaken or how often these were being undertaken.

Is the service well-led?

Regular quality monitoring visits where undertaken by the provider which fed into audits completed by management. We were advised annual surveys were sent to service users and relatives to gain feedback on the service. Although audits were undertaken regularly, we could see that checks and audits did not always reflect front line practice which we observed during our visit.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

One person told us, ''I'm well looked after here.''

A visitor told us, ''We are very happy with this home. We went to three homes and this one is like one big happy family - we have even visited at midnight.'' Another visitor said, ''Most of the time it is good in here. They could do with more chairs, we have to search for a chair to sit on sometimes.''

Another visitor said their relative's care was better when they were in another part of the building. They added, ''Today he has not been shaved, he does not have any socks on.''

One person we spoke with told us they got enough to eat. They added, ''They know I love chocolate and they are very good - they always bring me some.'' Other comments made by residents included ''nice meal,'' ''the food is good'' and a nod and ''yes'' when we asked someone if they enjoyed lunch.

A visitor told us, ‘'As an ex-catering officer the food is excellent, smells good, looks good and it is all eaten.'' Another visitor said, ''I come in most days to feed my husband. Some of the staff are brilliant, some are not, they just say 'you are not hungry today' if the food is left. It takes time to feed and some carers don’t bother.''

Three people told us if they had a complaint they would complain to the nurse in charge of their floor, who they knew by name. They all said they did not have any complaints. One person told us, '‘I feel very safe here.''

A visitor told us, ''They could do with more staff.'' Another visitor said they had trouble understanding some of the staff. They added, ''I wish they had a 'Rogues Gallery' on the wall so I could work out who is who.''

One person said, ''You get used to the care here. Some of the carers are better than others. Sometimes I get a man. I didn’t like it at first.''

Another person told us, '‘It is mostly OK. Sometimes I have to wait but they come eventually.’'

People told us that some of the staff were good. One person said 'others haven't got time, they make you feel like a nuisance'. Some people said that call bells were answered in a reasonable time, others said they had to wait. One person told us that staff repositioned her regularly to keep pressure areas intact. A relative told us they were very pleased with standards of care and added 'they understand my husband's needs'.

We saw that people who were being cared for in their rooms had call bells close to hand. We noticed information in one person's room, outlining who the named nurse and key worker were for that person. We observed a carer bring in the person's lunch on a tray and ask her how she would like to be positioned to have her meal.

We spoke with six people who used the service, four relatives and a visiting healthcare professional. We heard that most people were satisfied with the service and care they received. The healthcare professional told us he thought the care was very good, adding that the dementia care in particular was to be commended.

Some relatives told us of concerns they had had, and how they had been addressed. We heard that one person had been offered the wrong medication. The home showed us the steps they had put in place to ensure this could not happen again. We were told that the home had had a recent change of manager and that "Things seem to be more organised now."

We observed many individual episodes of care throughout our two day visit. We saw that the care given on the dementia unit was of a high standard, with the staff taking time to ensure the most effective care was delivered. We also spent time on the nursing floor. The care given there was generally of a good standard, although we observed some variability of practice.

The home was clean with good infection control practices in place. The standard of the food was very high, and we heard many positive comments about it.

The medication policy was now robust, and carried out appropriately.

Staff recruitment and training policies ensured that appropriate staff were in post, and they were well-trained for their posts.

The new manager used regular quality checks to ensure the safe running of the home.