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Inspection Summary


Overall summary & rating

Inadequate

Updated 7 October 2017

The inspection took place on 14 and 15 August 2017 and was unannounced.

Woolston Mead Care Home registered to provide accommodation and personal care for up to 28 people. Accommodation is provided on four floors with two lounges on the ground floor and a dining room in the basement. A passenger lift and stair lift provide full access to all areas of the home. The home is situated in a quiet residential area and is located close to all amenities and transport links. At the time of the inspection 15 people were living at the service.

There was a registered manager. 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.

We completed a comprehensive inspection of Woolston Mead in January 2017. We found that the provider was in breach of regulations with regard to safe care and treatment, meeting nutritional and hydration needs, staffing, premises and equipment and good governance. The service was rated as ‘’inadequate’ and was placed in ‘special measures’.

We issued two warning notices to the provider which required the service to be compliant with regulations. We received assurances from the registered manager that the actions required by the warning notices had been completed. As part of this inspection we checked to see if the necessary improvements had been made and sustained.

We found that although some improvements had been made, breaches of regulations previously identified had not been met.

A warning notice was issued following the last inspection with requirements related to medicines, which were not safely stored or monitored. During this inspection we found continued concerns regarding the storage of medicines as well as errors in the administration of controlled drugs. We also found errors in the recording of some people’s medicines on medicine administration records.

A further requirement of the warning notice related to the lack of audits competed to help ensure safe administration and storage of medicines. At this inspection we found that audits were completed regularly. However the errors found on this inspection had not been identified because checks of all medication stock were not carried out. The breach had not been met.

A second warning notice had also been issued following the last inspection in relation to the lack of any quality audit processes to monitor and improve the safety and quality of the service. On this inspection we saw that improvement had been made. Audits were now in place to check for common themes or trends for accidents and incidents which had occurred. During this inspection we found evidence that risk had been reviewed as required. Audits were now completed to help ensure the home was kept clean. Audits of the care files had not identified the inaccurate risk assessments because staff responsible for the check were absent from work and this role had not been given to another staff member. The breach had not been met.

A further requirement of the warning notice related to staff recruitment files and staff training. At the last inspection we found that files were not kept in an ordered way for individual staff members so we were unable to determine if proper recruitment had taken place and staff did not receive training, professional development, supervision and appraisal. On this inspection we saw that improvement had been made. The registered manager now had a system in place to ensure staff were regularly supervised and received mandatory training on a regular basis. However we did see that the registered manager had accepted two character references for two members of staff. It is a requirement that employers should request a reference from a person’s last employer. The breach had not been met.

At the last inspection we found that people were not routinely offered a choice of meals. At this inspection we found whilst the menus had been changed to offer an alternative meal, for their main meal the alternative offered was always a jacket potato. This meant that some people did not receive a balanced meal to meet their dietary preferences. The breach had not been met.

At the last inspection we found that any repairs that were discovered were not always attended to in a timely way. Despite the absence of a maintenance person the provider now had a system in place to help ensure repairs were completed until the post was filled. The breach was now met.

At the last inspection we found that people's personal records were not stored securely. The medicine and care records for people were now stored in locked cabinets to ensure the contents remained private. The breach was now met.

On this inspection we found that medicines were not always managed safely in the home. We found errors had occurred when administering medication to some people, which meant they did not receive the correct dose prescribed by their GP. Records could not be found to demonstrate staff had applied barrier creams and antibiotic creams regularly.

We found the premises were not checked regularly to ensure they were safe. Checks of fire alarms, emergency lights and window restrictors were not completed. The fire service had visited in July 2017 and issued an enforcement notice requiring urgent repairs and actions were undertaken to ensure the building was safe and equipment and procedures were in place to evacuate people in an emergency.

There were enough staff on duty to provide care and support to people living in the home. The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported. Staff were trained to ensure that they had the appropriate skills and knowledge to meet people’s needs. They were well supported by the registered manager.

Staff were received support to undertake their roles effectively. They received regular training, supervision and appraisal. Staff meetings took place regularly.

The home was clean and tidy with no odours. Staff wore protective clothing (aprons and gloves) whist they worked. We observed staff use sanitising gel. Disposable aprons and gloves plus hand sanitisers were available on all floors for staff to use.

Equipment was in place in the bathrooms to assist people with bathing.

Staff sought the consent of people before providing care and support. The home followed the principles of the Mental Capacity Act (2005) for people who lacked mental capacity to make their own decisions.

People had access to a range of health care professionals to maintain their health and wellbeing.

We observed positive interaction between the staff and people they supported. People at the home had their views taken into account when deciding how to spend their day.

Care plans were completed which provided information to inform staff about people's support needs, routines and preferences. Risk assessments had been undertaken to support people safely and in accordance with their individual needs. However we found risk assessments for two people had not identified their recent weight loss.

A limited programme of activities was available for people living at the home to participate in. People told us they were bored. People were supported to access the community for pre-arranged visits.

People living in the home and relatives were able to share their views and were able to provide feedback about the service in monthly ‘residents and relatives’ meetings.

People knew how to raise a concern or make a complaint. A process for managing complaints was in place. No complaints had been received.

Systems and processes were in place to assess, monitor and improve the safety and quality of the service. However some checks completed by the senior staff and registered manager were not robust to find the issues we found during the inspection. The audit completed by the provider each month failed to address the issues relating to medication addressed by the CCG in their audit to ensure changes were implemented. The lack of fire safety checks was not addressed to ensure the work was carried out to ensure the safety of people living in the home. The provider had failed to notify CQC of a recent fire safety Enforcement notice that had been issued despite having the opportunity to do so.

The service had a registered manager. Feedback from people, relatives about the manager and staff was complimentary.

The overall rating for this provider is 'Inadequate'. This means that it remains in 'Special measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The concerns we identified are being followed up and we will report on any action when it is complete.

Inspection areas

Safe

Inadequate

Updated 7 October 2017

The service was not safe.

Medicines were not managed safely in the home.

Safety checks of the environment and equipment were not completed regularly.

The provider had recruitment procedures in place. However references from previous employers had not been requested for two staff to ensure they were suitable to work with vulnerable adults.

The staff we spoke with described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported.

There were enough staff on duty to provide care and support to people living in the home.

Effective

Requires improvement

Updated 7 October 2017

The service was not always effective.

People did not have sufficient choice regarding meals and a varied diet was not provided to all people living at the home.

Staff were trained to ensure that they had the appropriate skills and knowledge to meet people’s needs. They were well supported by the registered manager.

Staff sought the consent of people before providing care and support. The home followed the principles of the Mental Capacity Act (2005) for people who lacked mental capacity to make their own decisions.

People had access to a range of health care professionals to maintain their health and wellbeing.

Caring

Requires improvement

Updated 7 October 2017

The service was not always caring.

Although staff were caring in their approach given our observations, the findings associated with safety, meeting nutritional needs and the lack of an environment to support people with dementia did not always demonstrate the service adopted a caring approach

We observed positive interaction between the staff and people they supported.

People at the home had their views taken into account when deciding how to spend their day.

Responsive

Requires improvement

Updated 7 October 2017

The service was not always responsive.

A limited programme of activities was available for people living at the home to participate in. People were supported to access the community for pre-arranged visits.

Care plans provided information to inform staff about people's support needs, routines and preferences.

A process for managing complaints was in place. People we spoke with knew how to raise a concern or make a complaint.

Well-led

Inadequate

Updated 7 October 2017

The service was not well led.

Systems and processes were in place to assess, monitor and improve the safety and quality of the service. However checks were not robust enough to identify the issues we found during the inspection. The provider also failed to tell us about an enforcement notice that was served by the fire service as legally required.

There were continued breaches of regulations and a failure to meet safe standards of care.

The service had a registered manager.

People living in the home and relatives were able to share their views and were able to provide feedback about the service.