24 February 2015
During a routine inspection
We carried out an inspection of this service on 24 February 2015. The inspection was unannounced. This means the service did not know when we would be undertaking an inspection.
The home was last inspected in January 2014 and was found compliant with the regulations at that time.
Victoria Residential Care Home is a two storey detached property in a residential area of Sale. The home provides residential care and support for up to 17 people. The home was full on the day of the inspection with one person temporarily in hospital. Most people are accommodated on the ground floor of the building with only those who are more mobile using the rooms to the first floor. The first floor is accessible by stairs with a fitted seat lift. All communal areas including two lounges and a dining room are situated on the ground floor. The kitchen is at the centre of the home with laundry facilities accessible to the rear of the property.
The home had 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The current registered manager has been in post under a year.
At this inspection we found a number of breaches to the regulations.
We looked in six people’s care plans and reviewed the information in relation to managing individuals’ risks. We looked particularly at records relating to falls. We found that information was not consistently recorded over different assessments. If information is not recorded and used consistently there is a risk of inaccurate assessments that may not meet people’s individual needs.
We found the home did not have systems in place to support people in the event of an emergency. It is the provider’s responsibility to ensure the safety of all people living at the home which includes ensuring the safe evacuation of all people in the event of the building becoming temporarily uninhabitable.
We found that ineffective assessment and a lack of information to support people in the event of an emergency were a breach of regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We saw that all equipment used in the home was serviced at regular intervals to make sure it was safe to use.
We were told by people we spoke with who lived in the home they were kept safe. One person said, “They (staff) look after us and make sure we are safe.”
On the day of the inspection we saw a number of risk assessments dated 2006 were displayed on the notice boards. The manager told us they did not have any up to date risk assessments to replace these. The lack of up to date risk assessments for the building and environment leave people who use the building at risk. This is a breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
When looking at recruitment records we found the information was not available to assure us all the staff in post were suitable for the role for which they were employed. A lack of available information to determine if people were suitable for employment is a breach of regulation 21 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.HSCA 2008
Records we reviewed for the safe administration of medicines were clear and included a care plan for medicines that were to be taken as required. Records included details of medicines to be disposed of following refusal. The medicines trolley was locked when not in use and secured to the wall.
There was not a risk assessment to manage the identified risks within the laundry room which was also used as a sluice and storage for cleaning equipment. If clinical waste and dirty cleaning equipment is not segregated from normal washing facilities there is a risk of cross contamination.
We found that a lack of clear systems to assess and manage risks associated with infection prevention control and health care associated infections left a risk to people living and working within the home. This is a breach of regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
On the day of the inspection we found little evidence to support staff had received appropriate and relevant training. We also found there was not enough staff to cover the rota. We observed a number of welfare needs were not proactively met, for example we saw people expressing pain and discomfort and no action being taken. This is a breach of regulation 22 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found staff had not received supervision for up to a year and three staff records we looked at contained no relevant training information. The lack of available supervision and support for staff did not enable them to fulfil their responsibilities of delivering care to an appropriate standard and left a risk of people not being supported effectively is a breach of regulation 23 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found applications for depriving someone of their liberty were made without appropriate assessment and decision making. Without this there is a risk of decisions and applications not being appropriate and being potentially unlawful.
The ineffective use of capacity assessments, inappropriate or lack of use of best interest decisions and the lack of consents for restrictive practice are a breach of regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
On the day of the inspection there was only one choice of meal at lunch time.
We were told if people didn’t like what was offered the chef would prepare something else. One person requested soup and this was provided. We observed people who needed support with their food who did not receive it. We saw records kept to ensure people received enough nutrition and hydration were either left blank or not reflective of the nutrition and hydration people had taken. We found a lack of appropriate support to enable people to receive enough nutrition and hydration left people at risk of malnutrition. This is a breach of regulation 14 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We spoke with people who lived in the home and their relatives about the relationships between staff and residents and their families. We were told “The people are friendly here.” And “The nurses are marvellous.”
We saw staff reassuring a person who was unsettled. It was clear the staff member knew the person well and was able to settle the person by talking to them and offering a hot drink which helped.
People living in the home did not have opportunities to feedback their thoughts on how their care was provided. People were not actively involved with developing their care plan. We found the provider had not taken steps to ensure people who lived in the home could influence the way their care was provided. The provider had not sought the views of people living in the home nor taken steps to support people with understanding their choices. This is a breach of regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The home had recently developed new care plans. We found they did not include much of the information from the ‘This is what I would like you to do’ records, which identified people’s choices and preferences; nor did they reflect a review of this information. The new care plans seemed to be stand-alone documents that were not inclusive of either pre-assessment information or needs assessments. Reviews of assessments undertaken in February had not resulted in changes to care plans even when they had identified changes in risk or support needs.
Upon reviewing the personal care records we saw that people had waited up to seven hours between visits to the toilet and support with their personal care needs. We had received information of concern around people at the home not receiving support with personal care as frequently as required. Records reviewed on the day of the inspection supported this concern.
The lack of appropriate assessment, followed by effective care planning leaves people at risk of receiving care and treatment that is inappropriate or unsafe. The planning and delivery of care was not always meeting the individual persons’ needs. This is a breach of regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The manager had told us senior carers’ meetings were held monthly and minutes were kept. We requested the last three months meeting minutes and they were not received. We also asked for training records and the contingency plan and neither were received.
The staff we spoke with were able to identify their direct line manager and knew who to go with concerns including whistleblowing. Staff we spoke with said they felt supported in their role.
During the inspection we found many monitoring systems had not been used for some time and the manager had not implemented new systems for quality assurance. There were no systems in place to monitor accidents and incidents, complaints or feedback from people living in the home.
The registered manager or area team did not audit; medication, infection control or care plans within the home. Some of these had been completed by commissioning teams in the last 12 months. Commissioning teams undertake certain inspections as part of monitoring the contract the local authority has with the home for supporting people they place there. Actions identified on these audits had not been completed sometime after the audit had taken place.
If providers do not have systems to regularly assess and monitor the quality of services provided it is a breach of regulation 10 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of the report.