Archived: Radiant Care Home

The home is situated in the Bulwell area of Nottingham and offers accommodation for to up to 18 people who require personal care. On the day of our inspection, 13 people lived at the home, some of whom lived with dementia.

The home was last inspected on 10 January 2017 and was rated ‘requires improvement’ overall. We found two breaches of the regulations in relation to how people’s consent was sought and how the home was run. Since the previous inspection, we received information of concern from the local authority safeguarding team regarding the management of risks to people. We undertook this inspection to check whether improvements had been made since our previous visit, and to check the concerns raised by the local authority. We found some little improvement had been made and there were still some significant improvement required.

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 and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been 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.

There was a registered manager in place at the time of our inspection who was also the registered provider. 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’s governance arrangements were not effective in monitoring, assessing and improving the service for people who lived at the home to ensure they received safe, compassionate and high quality care. Where their systems had identified shortfalls in provision, these had often not been acted on, or not acted on in a timely way. Improvements made had often not been sustained and the provider has been in breach of the regulations in five of the six inspections we have undertaken at this home.

The provider did not always notify us of events they were legally obligated to do, therefore we were not always able to monitor the service provided at the home.

People were not protected from risks associated with the premises and equipment. Since our last visit the fire service found the provider had not kept the premises safe from the risk of fire and had required action from the provider to improve fire safety. Shortly following our inspection visit the fire service found that sufficient action had not been taken and people were placed at potential risk. We continued to have concerns about the provider’s response to the risks of legionella in the home.

People were not supported by enough staff to ensure they received care and support when they needed it.

People, who were able to, were supported to make decisions, however the provider did not follow the Mental Capacity Act principles when people's decision making ability was in doubt.

People were supported to maintain their nutrition and staff monitored and responded to people’s health conditions; however this was not always recorded in people's care plans. People were supported by individual staff members who had the knowledge and skills to provide safe and appropriate care and support.

People told us they lived in a home where they felt staff listened to them and knew how to complain if they were unhappy however the provider did not always take action when concerns were raised.

People’s emotional needs were recognised and responded to. People were supported to enjoy activities. However activities for people who lived with dementia required improvement.

People's privacy was not always promoted by staff, as some staff did not knock on people's bedroom doors or seek permission before entering. However people felt staff treated them with respect.

People were supported to maintain relationships with people that were important to them. Visitors were made to feel welcomed and there were no restrictions on visiting times.

The provider had displayed the rating of our last inspection within the home for people and visitors to see. They had also displayed their rating on their website.

We found five breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008. (Regulated Activities) Regulations 2014 and one breach in relation to the Registration Regulations.

The home had a registered manager (who was also the registered provider) in place at the time of our 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.

During our inspection on 7 January 2016 we identified a breach of the Regulations of the Health and Social Care Act 2008. This was in relation to keeping accurate and complete records for each person who lived at the home including a record of the care and treatment provided and decision taken in relation to their care and treatment. At this inspection, we found improvements had been made but further improvement was still needed.

People who were able to, were supported to make their own decisions about their care and support. However decision making on behalf of people who did not have capacity to make decisions for themselves was not in line with the principles of the Mental Capacity Act 2005.

Systems in place to monitor and improve the quality of the service provided were not always effective in identifying issues.

The provider had not always undertaken adequate checks and risk assessments on the premises and equipment.

People’s care records did not always provide instruction to staff on how to support them with their needs and describe what action staff would need to take to reduce risks and to keep them safe.

People were protected by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People’s nutritional needs were met and staff monitored and responded well to people’s health conditions.

People were supported by staff that had the knowledge and skills to provide safe and appropriate care and support.

People lived in a home where staff listened to them. People were involved in giving their views on how the home was run. People’s emotional needs were recognised and responded to by a staff team who cared about the individual they were supporting. People were supported to enjoy a social life.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we have told the provider to take at the end of this report.

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.

During our inspection 17 and 18 December 2014 we identified three breaches of the Regulations of the Health and Social Care Act 2008. This was in relation to the safe management of people’s medicines, care planning and reviewing of documentation and the auditing and management of the service. During this inspection we found some improvements had been made in these areas, however further improvements were still needed.

People were supported by staff who could identify the different types of abuse and knew who to report any concerns to. People told us they felt safe at the home. The risks to people’s safety were assessed but were not always reflective of people’s current needs. The registered manager investigated accidents and incidents.

People told us they felt there were enough staff to keep them safe. Improvements had been made to the way people’s medicines were managed although protocols for the safe and consistent administration of as needed medicines were needed.

The registered manager had processes in place to apply the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS); however the records used to record decisions had not always been appropriately recorded.

People spoke positively about the staff. Staff received supervision of their work. However the registered manager did not always complete the supervision documentation appropriately. The majority of the staff training was up to date; however some staff required refresher training in some areas. The majority of the people we spoke with told us they liked the food and drink provided at the home, although some felt the choice was limited. People had access to external healthcare professionals however the guidance and recommendations made by them were not always recorded within their care records.

People felt the staff were kind and caring and treated them with dignity and respect. Information for people on how to access independent advice about decisions they made was available. People’s care records did not always show how they were involved with decisions about their care. People had the privacy they needed. People were encouraged to do as much for themselves as possible and staff understood people’s likes and dislikes.

Some improvements had been made in the way people’s care records were completed. People’s care records contained an initial assessment of their needs however people’s on-going care needs were not always appropriately recorded. People’s life history was not always recorded within their care records; however staff had good knowledge of the people they cared for. Attempts had been made to provide people with access to activities; however the lack of an activities coordinator meant some people were not always able to do things that were important to them

People felt confident in raising a complaint if they needed to and the majority of people felt their complaint would be dealt with appropriately by the registered manager.

There had been some improvement in the quality monitoring processes used by the registered manager; however these processes had not identified the concerns raised within this report. People’s records were not always appropriately completed, and, although they were regularly reviewed, the registered manager had not identified that the content of these records did not always reflect people’s current care and support needs.

The majority of people and staff spoke positively about the registered manager; however some external health and social care professionals raised some concerns with the way they managed the service. The registered manager interacted with people in a positive way and welcomed people’s views on how the service could be developed and improved. The registered manager had ensured the CQC were provided with the appropriate statutory notifications. There were limited opportunities available for people to access their local community.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see the action we have told the provider to take at the back of this report.

The inspection was carried out by one inspector visiting the premises. We spoke with four people who lived at the home, the registered manager, and two other staff members.

We also spoke with other professionals as part of the inspection process, and reviewed information sent to us by other authorities. We talked with other authorities involved with the service to gain their views.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Although the service had no applications to be submitted for a DoLS order, proper policies and procedures were in place. We saw the appropriate staff understood when an application should be made, and how to submit one.

The manager explained how they would follow the policy to ensure that a person's liberty was not being restricted unlawfully.

We saw from training records that most of the staff had received training in Deprivation of Liberty Safeguards and the Mental Capacity Act 2005, which is legislation designed to help maintain the safety and rights of vulnerable people in care settings.

A relative told us, 'Now I feel my relative is safe, especially since they fitted digital code locks on the doors to prevent people wandering out.' A person living at the home told us, 'I feel safe, warm and I have nice room. I have everything I need.'

Is the service effective?

We spoke people with people who lived at the home and some of their relatives. One person told us, 'I like it here, I love it, the carers are lovely, they are proper carers, and I wouldn't go anywhere else.'

A relative told us, 'Communication between the home and relatives could be better, I would like a call if they have seen a doctor, to let me know.'

We looked at four care plans and found the service effectively identified individual needs and based care and support programmes upon those needs. The staff respected the equality and diversity of the people who used the service by making sure the care was provided individually to each person's needs.

We saw people with requirements for thickened drinks and with needs for support with eating was provided appropriately by staff.

Is the service caring?

We saw staff support people in a caring manner and respond to individual needs in a patient and dignified way. We saw members of staff talk with people and use their knowledge of each person to respond to their wishes.

One relative told us, 'Generally the care provided for my relative is good.'

Is the service responsive?

The registered manager and staff at the home met with people before they used the service to identify if the service could meet their needs. This process included consulting with family members and carers, as well as professionals such as doctors and physiotherapists to plan the best way of meeting people's needs.

However, we saw, and records confirmed there were not enough staff regularly on duty to maintain safe staffing levels of support and care to people at the home.

Is the service well-led?

Other professionals including local health service staff who supported people who used the service told us the provider had recently made positive changes, including the manager having updated staff training records.

A person who used the service told us, 'If I had problems I would go to the manager and they would sort it out for me.'

We found that where people did not have the capacity to consent, the provider did not always act in accordance with legal requirements. One person was being administered medication covertly without appropriate measures being put in place to support this.

We saw that care plans and risk assessments were in place for people, but there was often a gap of several months before these began to be reviewed.

We observed that staff were kind and patient in their interactions with the people they were supporting. However, these were usually short conversations about tasks to be undertaken as the service was short staffed. We found that due to gaps in pre-employment checks, supervision and training the provider could not be confident that people were cared for by suitable or appropriately trained staff.

People were not always protected against the risks associated with medicines because the provider did not have all of the appropriate arrangements in place to manage this. We saw that the provider did not have adequate systems in place to monitor the quality of the service. No meetings had taken place with residents or relatives this year.

We found people were treated with dignity and respect and received care that met their needs. Mental capacity assessments were taking place where appropriate.

In our tour of the premises, we saw each bedroom was personalised by the person who used the service and a number of the rooms were in the process of being redecorated to modernise the appearance of the home. We observed the environment was clean and well maintained.

We found staff were supported. One member of staff said, 'I stay working here because I feel happy and supported.' We also found the provider took steps to assess the quality of the service being provided.