Background to this inspection
Updated
10 August 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 unannounced focused inspection took place on 25 February 2016 to follow up on concerns from the previous inspection on 8 July 2015 which were related to people not having enough to drink, placing them at risk of dehydration. We found the rating was not displayed for members of the public to see and this was brought to the attention of the provider. Due to the level of concerns on the first day of our inspection we then proceeded with a full comprehensive inspection on 26 February 2016 and a follow up visit on 2 March 2016.
The inspection team consisted of an adult social care inspector and a specialist nurse advisor.
We gathered information prior to our inspection and requested a Provider Information Return form be returned to us to provide us with information about the service. We did not receive a PIR form. We received concerns about the standard of care at the care home and there had been a number of safeguarding's over the past 12 months and a high number of complaints. We spoke to the safeguarding in the Local Authority, Health Watch and Continuing Health Care as part of our information gathering.
During the inspection we spoke with five residents and observed the care of 10 people who were unable to converse with us. We spoke with six relatives.
We looked at documentation such as care plans and fluid balance charts for 10 people. We case tracked high risk people who were unable to communicate or where concerns had been found on day one of our inspection. This involves undertaking a detailed check of information available for us to view from admission and other information pertaining to the person encompassing all aspects of their care.
We viewed six staff recruitment files to check the appropriate checks were being undertaken prior to staff working at the care home. We spoke with a rage of staff of varying roles such as a cleaner, the cook, carers, qualified nurses, the manager and provider.
Updated
10 August 2016
An unannounced focused inspection took place on 25 February 2016 to follow up on concerns from the previous inspection on 8 July 2015 which were related to people not having enough to drink, placing them at risk of dehydration. We found the rating was not displayed for members of the public to see and this was brought to the attention of the provider. Due to the level of concerns on the first day of our inspection we then proceeded with a full comprehensive inspection on 26 February 2016 and a follow up visit on 2 March 2016.
At the previous inspection there were breaches of Regulation 14 Hydration and 15 Premises and equipment identified and the service was rated as requires improvement. We found on inspection the service remained in breach of these regulations in addition to further breaches of regulation.
The service had also been previously rated Inadequate for two breaches of Regulation 12 Safe Care and Treatment and also Regulation 17 Governance in December 2014.
The service was a 33 bedded nursing care home. One of the stipulations of their registration was that they were required to have a Registered Manager to lead the service. The manager was in the process of registering at the time of our inspection to become the 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.’
Due to the level of concerns and the immediate breaches of Regulation 14 and 15 found on the first day of our inspection, we undertook a full comprehensive inspection.
We found the service was not keeping people safe from harm or abuse. One resident who was unable to communicate their needs requiring 24 hour nursing care was observed to have marks/bruises to their arms which had not been documented or investigated and there was no body map to illustrate where and when the mark/bruise was first seen. We were shown photographs taken by a family member of marks/bruises which had appeared since October 2015. We also found evidence the relative had made several complaints but the service failed to send a safeguarding to the Local Authority and failed to investigate all the complaints with an outcome.
There were not enough staff to meet the needs of the residents. We observed people who required assistance to eat and drink were not having adequate amounts of food and fluids. This was observed from the fluid balance charts and also by our observations of individual residents. For example, one resident's plate of food was cold as there were not enough staff to provide them with the support they needed to eat. We also observed one resident's water jug and beaker in their bedroom was dry to touch.
We were concerned the service did not have empathetic or skilled qualified staff to care for people with complex health needs such as dementia. One qualified nurse was observed to have retrospectively completed care records. Another nurse spoke disrespectfully about one resident and were not knowledgeable in the care of people with dementia despite there being a high number of residents suffering with dementia. We found the service did not offer staff dementia training. The manager was not skilled in implementing effective systems according to risks. We were also concerned that the manager was being restricted in their role by the owners who specified how many staff could be deployed despite them not being aware of all the complexities of the needs of the residents.
The residents care records were incomplete with risk assessments missing and also no Mental Capacity Assessments/Deprivation of Liberty Authorisations in place for people who were lacking in mental capacity. We questioned the practices of administering medication to people who lack mental capacity in the absence of a Best Interests Process being followed. One resident who lacked mental capacity was being administered medication by the nurse placing the medication on the person's tongue whilst the person opened their mouth to drink their thickened fluids. We discussed this with the nurse who had not considered their practice may be classed as covert administration of medication.
The Fire Service had inspected the premises a few weeks prior our inspection and rated the service as inadequate with an action plan to mitigate risks.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘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.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
Following the second day of our inspection we asked the service for an urgent action plan given the seriousness of the concerns we found. We followed this up on the third day of our inspection and found sufficient improvements had not been made. On 3 March 2016, the provider informed us of their decision to close the home voluntarily and cancel their registration. We worked closely with other stakeholders and all people who used the service were moved to other care homes within 7 days of the provider informing us of their intention. The registration of the provider is in the process of being cancelled.