Archived: Ismeer

Updated 1 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 7 June 2016 and was unannounced. The inspection was carried out by two adult social care inspectors.

Before the inspection we reviewed previous inspection reports and other information we held about the service including any notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we looked at seven people’s care plans, Medicine Administration Records (MAR), three staff records and other records in relation to the running of the home. We spoke with the agent acting on behalf of the provider’s representative, the two acting managers and three other members of staff. We also spoke with six people who were living at Ismeer.

Due to people’s health needs we were not able to communicate verbally with everyone to find out their experience of the service. We spent some time observing people at lunch time using the Short Observational Framework Inspection (SOFI) tool. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We also observed staff interactions with people.

Updated 1 July 2016

We inspected Ismeer on 07 June 2016, the inspection was unannounced. Ismeer was last inspected in January 2016 when we identified breaches of the regulations. These were in respect of: Care plans being out of date with no evidence people had consented to their plan of care. Monitoring records not being in place or not consistently completed. Issues regarding the environment. A lack of effective oversight of the service. At this inspection we checked to see if improvements had been made and found the service remained in breach of these regulations.

Ismeer is a residential home for up to 27 older people. At the time of the inspection 17 people were living at the service, some of whom were living with dementia.

Ismeer is required to have 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. There had been no registered manager in post since January 2015.

The provider had passed away in April 2016 and the service was being overseen by the provider's representative who was one of two executors of the estate. The provider's representative lived overseas and was unable to monitor the service on a day to day basis. The provider's representative had appointed an agent who was based at the service two or three days a week and they communicated regularly. There were also two full time acting managers in post who had responsibility for the day to day running of the service.

There was a lack of risk management for people living at Ismeer. Risk assessments were either out of date or had not been put in place despite people being identified as at risk. Systems to ensure staff were aware of people's changing needs were not robust. For example, the day before the inspection a visiting GP had identified one person was dehydrated and had associated low blood pressure. They had advised the person be encouraged to drink six glasses of water a day. This had been recorded in the person's notes by the GP but staff on duty were unaware and were therefore not acting on this advice.

Recruitment processes were not robust, one new member of staff was working unsupervised. They had not had a completed Disclosure and Barring check and only one telephone reference had been received. This was contrary to the service policy.

Records showed shortfalls in staff training identified as necessary for the service. For example, no staff had undertaken recent refresher safeguarding training. There had not been any training to meet people's specific needs.

The provider was not working in accordance with the processes set out in the Mental Capacity Act (2005) or associated Deprivation of Liberty Safeguards (DoLS). Only one DoLS application had been made to the local authority. The local management team acknowledged several people were not free to leave and therefore should have had DoLS authorisations should have been applied for. There was no evidence of any mental capacity assessments or best interest meetings taking place. One person with capacity was being kept from going out of the home, which was against their legal rights.

The service was based in an old property and there were structural problems with the building which had resulted in considerable damp forming. Bedrooms showed signs of damp and mould, the décor was in need of updating and furnishings were of a poor quality. There was a general air of neglect throughout the property. Systems for reporting faults and defects were not robust and repairs were not always happening.

Information in care plans was out of date and was at times inaccurate. There was no evidence of regular reviews taking place. People and/or their representatives had not signed to indicate they were in agreement with their plan of care.

There was a lack of organised activities taking place and one person told us they were bored. On the day of the inspection we did not observe anyone being supported to take part in activities. One person we met chose to stay in their room but only had access to one channel on the television. They were unable to operate the radio.

There was a lack of oversight of the service from the provider's representatives. There was no effective leadership to support the prioritisation of tasks necessary to make improvements to the service. There were no systems in place to help ensure stakeholders opinions were sought to help drive improvement. For example, no staff meetings were taking place, there were no residents meetings or ways of gathering their views and families were not asked for their experiences of the service.

There was no system to ensure regular audits took place in order to monitor the quality of the service. For example, while falls were recorded as required they were not audited in order to highlight any patterns or trends.

We identified several breaches of the regulations. You can see these listed at the back of the full version of the report.