Archived: Dunedin Residential Home

At this inspection we found that whilst the manager had made some improvements to the service, they were not adequately supported by the provider. There was a lack of oversight, resources and infrastructure to ensure that the service provided consistent safe and good quality care. It therefore remains in special measures and the Care Quality Commission is taking further action. We will report on this once it is concluded.

Dunedin Residential Home is registered with the commission to provide care to up to 21 people over the age of 65, who may or may not be living with dementia. At the time of this inspection there were nine people living at the service.

The service is operated as a partnership, with three people registered as making up this partnership, within the report they will be referred to as the provider.

The manager had been in place for a number of months, they had yet to register with the commission at the time of inspection. 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 or meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people were not always kept safe as there were insufficient staff deployed on shifts and whilst staff knew people well and were kind, they were not able to meet their care needs as they did not have sufficient time.

Risk assessments were in place and mitigations were reflective of people’s needs, however staff were unable to ensure people were safe as they did not have the time to ensure risks were mitigated appropriately.

People told us that staff were kind and caring but they often had to wait for care to be delivered.

Staff had completed training required to enable them to meet people’s needs and the manager was trying to implement a series of supervision and appraisals although these had not been effectively implemented. Recruitment processes were robust and staff had relevant checks in pace to ensure people were safe.

Care plans were reviewed monthly and were person centred and the documents were in place to support people to remain as independent as possible. A lack of staff meant that these were not implemented effectively.

Whilst improvements had been made by the manager, there remained a lack of strong infrastructure to support them to ensure improvements were sustained, built on and fed into continued development plans for the service. Following the inspection the provider reported to us that they were unable to continue running the service due to a lack of staff and because the manager had resigned. They were unable to provide staff until people using the service had been supported to find alternative homes. Therefore the local authority provided staff and oversight to ensure this was done in a safe and planned way. No people currently live in the service.

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We returned to the service on the 20 and 21 February 2017 to carry out a comprehensive ratings inspection to assess whether the service had improved. Whilst some improvements were made, the service continues to be inadequate in providing safe care and treatment to people. You can see what measures we took at the end of the report.

Dunedin Residential Home is registered with the commission to provide care to up to 21 people over the age of 65, who may or may not be living with dementia. At the time of this inspection, only 11 people were living at the service.

The service is operated as a partnership, with three people registered as making up this partnership, within the report they will be referred to as the provider.

The registered manager had left the service and a new manager was in place. They had yet to register with the commission at the time of inspection

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.

The provider had not routinely maintained the environment and there were significant risks to people’s health and safety. The provider did not take action to reduce these risks; they did not introduce action plans and did not specify how or when improvements would be made to make sure people were safe.

Sufficient recruitment checks had not been carried out before staff started work to ensure that they were suitable to work in a care setting. The registered provider had failed to ensure a risk assessment was in place to mitigate risks regarding employing a person with recent criminal convictions or document the reason for their employment. This exposed people who used the service to the risk of being supported by staff who may not be suitable to work with vulnerable adults.

Whilst the monitoring of medicines had improved, when errors had been identified action had not been taken to make sure future practices were safe.

Infection control practices were poor and cleaning staff did not have access to appropriate equipment.

Induction practices for care staff and training of staff had improved and we saw a variety of training opportunities that staff were now being invited to attend.

People's nutritional needs were being met and appropriate referrals had been made to the dietician and speech and language services.

A new staff team had been employed and we saw some caring responses to people. However, there continued to be little engagement with people, particularly for those who were less able to join in with group activities.

Staff did not understand what protected characteristics were. Confidentiality of people's information was poor and staffs understanding of capacity and consent remained poor.

Care plans, did not provide staff with information about how to meet people's health needs. Some systems had been improved and people and their relatives were now asked to give their views about the care they received.

The provider continued to have very poor oversight of the service. They did not have clear governance system or audits in place. Those employed to by the provider to manage some of the issues identified, had not taken appropriate steps to ensure that actions were being implemented effectively.

New managers had been recruited, but the provider did not provide them with an induction and did not support them to carry out their role.

However, we received additional information on the 10th November and returned to the service unannounced. At which time we found additional evidence about the lack of managerial oversight at the service and the safety of people living there. On the 16th of November 2016, an inspector and inspection manager met with the providers at the service to discuss on-going concerns.

Dunedin residential home is registered to take up to 23 people requiring accommodation and personal care. At the time of inspection there were 16 people residing at the home. On the day of inspection, the local authority had placed restrictions on the service admitting local authority funded people to the service.

On the 26 October 2016 the registered manager was absent and an acting manager was in place to ensure the continued running of the home. During the duration of the inspection period the registered manager was removed from the service. 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.’ In the absence of the registered manage the provider had promoted a senior carer into the role of manager.

We found a number of significant concerns relating the safety and managerial oversight at the service. The environment and equipment at the home was not safely maintained and there was a lack of good infection control practices.

Cleaners found it difficult to maintain the cleanliness of the environment due to its age and run down state. We had to request environmental health inspectors to come to the home to check the safety of the kitchen area due to the lack of cleanliness in the storage of food. Whilst no risk to people was found, it was agreed that the home needed to improve its cleanliness and rotation of food, some that had passed the best before dates.

When incidents of behaviour that challenged occurred, staff did not appropriately record and investigate to discover the cause of the behaviour, and whether they could have prevented the incident. Consequently, there was a culture of not learning from incidents. External professionals did not always receive referrals from the home to support people with complex needs, for example the speech and language therapists and falls team. There were no systems in place to chase up referrals when these were made, such as repair of people’s hearing aids, without which left people unnecessary isolated from the environment.

Staff had received training, which appeared to be in date; however, training certificate dates did not match management audits of training undertaken. Only one member of staff had in date manual handling training. Witness statements of staff written following the management of behaviours that challenged demonstrated a lack of knowledge in how to engage with people who were confused and de-escalate potentially unsafe behaviours during incidents of distress.

The dining experience was poor and few people were moved from their seats to enjoy a meal together, often not moving for very extensive periods of time.

Staff demonstrated kindness in their interactions with people and people told us that staff were very kind to them. However, staff used old stained and misshapen bedding for people that they would not use for themselves and supported people to use a toilet / shower area that was dirty. Staff told us when questioned that they would not be prepared to use these themselves.

People who had capacity and were able to vocalise were observed to have positive interactions with staff. People with cognitive impairment, and more difficulty in communication were left for long periods without any interaction or engagement. There was a lack of stimulating activities on offer at the home.

Care plans were not person centred. As a result, people who presented with high-risk behaviours or physical health needs did not have in place interventions that would instruct staff how to be response to their needs, preferences, and wishes.

There was a significant lack of leadership and management across the service, with little effective governance systems in place to monitor the quality and safety of the service provided. The providers had trusted all the running and oversight of the home to a manager who was now absent. They had not assured themselves that the registered manager had been running the service safely. In the place of the registered manager was a senior carer acting up into the role without being given any guidance on how to run the service and what their roles and responsibilities were. This lack of oversight had resulted in significant failings at the service, which had previously been rated as “good” in January 2014.

Consequently, the overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ Services in special measures will be kept under review. If we have not taken immediate action to propose to cancel the provider’s registration of the service, they will be inspected again within six months. You can see what action we told the provider to take at the back of the full version of the report.

The expectation is that providers found to be providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We checked that people had given their consent before receiving care or support. We saw that staff spoke respectfully to people living at the home and there was a calm, happy and relaxed atmosphere throughout the home.

A relative we spoke with told us: 'We come unannounced when we visit and we always find X well cared for and happy.'

We found safeguarding procedures were in place to ensure people were safe. Staff members were supported in their roles to provide appropriate and safe care for people.

We saw effective recruitment processes had been undertaken before staff began working at the home.

We found records were appropriate, accurate and maintained to protect people from the risks associated from unsafe care.

We spoke to relatives of the people living at Dunedin. They told us 'It always smells nice here, and the staff members always make sure the people living here look nice and are clean' another relative told us 'They always ask in a caring way if they can help people'.

We found evidence within peoples care plans that the service was providing good, person-centred care to people, which met their individual and specific needs.

Staff members were found to be experienced in their roles and had taken time to acquaint themselves with people's preferences and requirements ensuring they remained as active as they wanted to be and were supportive of those not so able.