Mother Red Caps Home

Mother Red Caps Home is a care home providing nursing and personal care for up to 51 people, some of whom are living with dementia. There were 47 people living in the home at the time of the inspection.

People's experience of using this service and what we found

The provider had implemented some refurbishment such as the development of newly refurbished bathrooms. However, we noted a high volume of repairs needed for the environment such as scraped doors, windows, door frames, scraped worn flooring, repairs throughout the building including faults to some radiators. The registered manager was responsive in her actions and by day two of this inspection had taken appropriate actions for auditing and improving cleaning schedules and repairs. The refurbishment and development of the home needs confirmed timescales to improve and enhance the service.

Systems to monitor the quality and safety of the service were in place but needed further review to identify issues raised during the inspection around maintenance, repair and cleaning of the service. The registered manager was open to improvement and listened and acted on feedback and demonstrated a commitment to keep improving the service.

Staffing levels were appropriately managed by senior staff. However due to current difficulties recruiting new staff, the home had regularly used agency staff. Staff showed us they were taking action to recruit more permanent staff and were in the process of arranging inductions.

People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. Staff were knowledgeable and shared lessons learnt from seeking training and sought support from other health professionals as appropriate to support people's needs. People told us they felt safe and their relatives also found the service safe.

Care records were individualised and reflected each person's needs and preferences. Risk assessments had been updated and staff had guidance to help them support people to reduce the risk of avoidable harm. Medicines were administered safely and actions had been taken to train staff and audit improved practices at the service.

People, relatives and staff spoke positively about the management of the service who they felt were approachable and listened to their views.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had the necessary capacity assessments and legal processes in place to ensure their rights were fully respected.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was rated requires improvement (published 02/09/2022). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvement had been made however, at this inspection, we found that the provider had failed to make sufficient improvements within the service. This meant the service was in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Mother Red Caps Home on our website at www.cqc.org.uk

Enforcement

We have identified a breach of the regulations in relation to lack of effective governance of the service.

Please see the action we have told the provider to take at the end of this report.

Follow up

Will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mother Red Caps Home is a care home providing nursing and personal care for up to 51 people, some of whom are living with dementia. There were 43 people living in the home at the time of the inspection.

People's experience of using this service and what we found

We identified issues of concern with COVID 19 weekly testing regimes that did not fall in line with government guidance.

People and relatives were not always invited to attend resident and relative meetings to discuss any updates or changes in the home.

People were protected from abuse because staff understood the correct procedure to follow if they had any concerns. Staff were knowledgeable about people's health needs and the provider had sought support from other health professionals as appropriate to support people's needs.

Care records were individualised and reflected each person's needs and preferences. Risks were assessed and identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. We did however see missing entries in daily records and some key information missing in people's care records that we looked at.

Staffing levels were appropriate. However due to current difficulties recruiting new staff, the home used a high volume of agency staff. The provider did show us that they were taking action to recruit more permanent staff.

The provider had addressed issues identified from the last inspection and internal quality assurance audits relating to the environment. Changes had been implemented to the building that made it safer. On the day of inspection, we identified concerns regarding doors that would not fully close and beds not having their brakes engaged appropriately.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People had the necessary capacity assessments and legal processes in place to ensure their rights were fully respected.

People received their medicines as prescribed. These were stored and disposed of safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires Improvement (published 26 August 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remains requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last inspection, by selecting the 'all reports' link for Mother Red Caps Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

At this inspection we have identified breaches in relation to safe care. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Mother Red Caps Home is a care home providing nursing and personal care for up to 51 people, some of whom are living with dementia. There were 31 people living in the home at the time of the inspection.

People's experience of using this service and what we found

The systems in place to monitor the quality and safety of the service had improved since the last inspection. However, further developments regarding improvements with cleaning schedules, maintenance and refurbishment of the environment had been identified and a plan was in place to ensure these were managed.

We made a recommendation that the service's development plan was shared with people within the service.

People told us that staff were caring and they liked them. There were enough safely recruited staff on duty to meet people's care needs. However, some relatives felt the service needed more staff at times within the day. The manager advised they would review how they shared information with staffing levels, so this information was easily accessible to everyone.

Management of medicines had improved. Medicines were safely managed.

People's dietary needs had been assessed and were appropriately managed. Some records needed updating to ensure complete recording of fluid intake for some people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff felt well supported and trained with topics necessary for their work. Staff were positive about the changes to the service and felt the manager was bringing lots of positive improvements to the care and records within the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was inadequate (published 23 December 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvement had been made.

This service has been in Special Measures since December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe, Effective and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mother Red Caps Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

Follow up

The overall rating for this service is requires improvement. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mother Red Caps Home is a care home providing nursing and personal care for up to 51 people, some of whom are living with dementia. There were 50 people living in the home at the time of the inspection.

People’s experience of using this service and what we found

People’s safety was not maintained as safeguarding procedures were not always followed to protect people from the risk of harm and potential risks were not always assessed robustly or mitigated. Medicines were not always managed safely and records regarding administration were not completed accurately. These issues are breaches in regulation.

The systems in place to monitor the quality and safety of the service were not effective. They had not identified the issues we highlighted during the inspection and when actions were identified, it was not always clear if they had been addressed. The Commission had not been informed of all reportable incidents and events providers are required to inform us about. This is a breach in regulation.

People’s consent was not always sought and recorded in line with the principles of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This is a breach in regulation.

Records showed that not all staff had completed training relevant to their role. Staff felt well supported in their roles and felt comfortable raising any issues they may have. They received regular supervisions and new staff completed an induction when they commenced in post.

People’s dietary needs had been assessed, however identified risks were not always managed and kitchen staff did not have access to information regarding all people’s dietary needs. People and their relatives told us GP’s were contacted quickly when people were unwell.

There were enough safely recruited staff on duty to meet people’s care needs. The home was clean and infection prevention and control procedures were in place, including those relating to COVID-19. Staff told us they enjoyed their jobs and were well supported in their roles and feedback from people regarding the service they received was positive. Quality assurance surveys had recently been completed by staff and people living in the home and the registered manager had developed an action plan based on this feedback.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 June 2018).

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to consent, medicines management, safeguarding and the governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The home 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. The home had a registered manager.

At our last inspection of the home in March 2017 we found that the service overall required improvement, however there were no breaches of Regulations of the Health and Social Care Act 2008.

People we spoke with during the inspection believed the home was safe. Maintenance records showed that regular checks of services and equipment were carried out by the home’s maintenance person and testing, servicing and maintenance of utilities and equipment was carried out as required by external contractors.

There were enough qualified and experienced staff to meet people’s care and support needs. Recruitment records showed that robust procedures had been followed to ensure new staff were of good character.

Risk assessments were recorded in people’s care notes and plans put in place to reduce the risks identified. A log of accidents and incidents was maintained and the records showed that appropriate action had been taken when accidents occurred.

Staff received training about safeguarding as part of their induction, with updates periodically. The manager had reported safeguarding incidents as required and full records were kept of safeguarding referrals that had been made.

The service complied with the requirements of the Mental Capacity Act and appropriate Deprivation of Liberty Safeguard applications had been made to the local authority.

People told us they enjoyed their meals and had plenty to eat and drink.

There was a comprehensive programme of training for all staff to ensure that they knew how to support people safely.

People who lived at the home told us that the staff provided them with good care and support and we observed that staff treated people with kindness and respect. Everyone had their own bedroom and personal care was provided in a discreet way in the privacy of the person’s room.

The care files we looked at showed that people’s care and support needs were assessed covering all aspects of their health and personal care needs and personalised plans were written for the care and support people needed. These were kept up to date with monthly reviews.

There was a planned programme of regular social activities, including trips out.

Regular meetings were held for staff and for people living at the home and their families. The staff we spoke with told us they enjoyed working at the home and found the management very supportive.

People spoke highly of the home manager and described him as approachable and supportive.

There was a schedule of quality audits for the year and these had all been completed to date. They were accompanied by action plans for improvement as needed.

At our last inspection on 26 March 2015, we had found that there were breaches of regulations 11 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the need for consent and inadequate staffing levels.

At this inspection we found that the provider had made improvements in these areas.

Mother Redcaps Home is in a residential area of Wallasey, in Wirral, overlooking the Mersey estuary. The home has capacity for and is registered to provide accommodation and nursing for up to 51 people. At the time of our inspection, there were 49 people living in the home.

The home is a large building over three floors and all rooms are for single occupancy. There are communal lounge areas on each floor. The home was divided into three units. The lower floor accommodated 12 people who were living with dementia but did not require nursing care. The middle floor accommodated 16 people who required nursing care. The top floor accommodated 21 people who required personal care.

The home requires 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. The previous registered manager had left the home several months prior to our inspection. The current home manager at the time of our inspection had been in post for four months and had applied for registration with the Care Quality Commission.

We looked at records relating to the safety of the premises and its equipment, which were correctly recorded. Records we looked at showed that the required safety checks for gas, electric and fire safety were carried out.

The home used safe systems for recruiting new staff. When we looked at staff recruitment files and we saw that staff had been recruited using safe recruitment methods. There had been appropriate application and interview process and before any staff member had started in employment there has been checks made on their previous employment history and any criminal records. These included using Disclosure and Barring Service (DBS) checks. References were available from at least two sources including applicants last employer.

A new training provider had been sourced who provided face to face training which staff enjoyed. Staff told us they felt supported by the deputy manager and the home manager.

Food menus were flexible and alternatives were provided for anyone who didn’t want to have the meal on the menu for that day. People we spoke with said they always had plenty to eat. However, some people complained about the quality of the food. We observed the lunch time meal where staff were observed to support people to eat and drink with dignity. However, some people who needed support were not given help due to a shortage of staff. People and some staff told us there were not enough staff, especially at peak times such as the morning or at mealtimes.

The provider had complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the care plans, risk assessments, staff files and other records were in the process of being reviewed and updated.

People told us they felt safe with staff and this was confirmed by people’s relatives who we spoke with. The home manager had a good understanding of safeguarding. The home manager had responded appropriately to allegations of abuse and had ensured reporting to the local authority and the CQC as required

Medication administration was correct. However we saw that some fluid charts were not completed properly which meant that there was no record of people getting sufficient to drink to prevent risk of poor hydration or urinary tract infections.

People were able to have person centred, one to one activities provided, to promote their wellbeing. Group activities were provided, such as reminiscences with music and we experienced a happy atmosphere in the home as people were happy and engaged in the activities. People told us they enjoyed them and looked forward to more.

There were staff meetings and resident’s meetings seeking the feedback of the attendees and we saw that actions had been taken as a result, such as the purchase and installation of a darts board.

Is the service safe?

The service was safe. At this inspection we found that people were protected from harm as appropriate arrangements were in place for obtaining, recording, storing and handling medicines.

Is the service effective?

The service was effective. Where people did not have the capacity to consent, the provider acted in accordance with legal requirements in respect of medicines that were to be given covertly.

Is the service responsive?

The service was responsive. We saw that people's medication was now obtained in a timely manner and adequate supplies were kept in the home.

Is the service well led?

The service was well-led. A new manager was now in place having been appointed following our last inspection. An application to register with the Commission was on-going during this inspection process.

We found that the manager carried out frequent medicine audits and monitored staff practice related to medicines in the home.

We spent time observing staff interactions with people using the service. We saw that staff explained what they were doing, didn't rush people and were reassuring.

The manager (not yet registered) had been in post for four months and had begun to implement systems to seek the views who used the service and identify and manage risks. Staff expressed confidence in the manager and felt that standards had improved since her appointment.

However, we found that people's safety was still at risk because there was inadequate control of hot water temperatures. We have referred this matter to the Health and Safety Executive.

We also found continued concerns with the management of medicines and are considering taking further action.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and there were enough staff to meet people's needs. Required recruitment checks into character, qualifications and experience were carried out to make sure that staff were suitable.

The arrangements for the management of medicines did not ensure that people were given their medicines at the times they needed them, which may have put them at risk of harm.

Is the service effective?

People's care needs were assessed with them, and they were consulted about their care plans in relation to personal care. However, some people's medication was being disguised in food without their knowledge or consent. The provider did not have proper systems in place to ensure that this was in the best interests of the people concerned and that their rights were upheld.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us staff were polite and had always treated them well. Comments included: "The girls are great'; "The staff are very kind"; "They have a good attitude".

Is the service responsive?

Relatives of people who used the service told us they were involved in their relative's care and support. One person commented; 'I'm very happy with my father's care, I'm kept involved and informed and there are no restrictions on visiting".

People were referred to relevant health care professionals such as their GP, a dietician or nurse specialist when necessary. However, changes to medication were not implemented in a timely manner.

Is the service well-led?

The home did not have a registered manager who had been assessed by the Care Quality Commission as fit to manage the service.

The service had a quality assurance system. People using the service and their relatives completed an annual satisfaction survey and were invited to meetings to discuss the care provision. There were checks in place to identify risks but these were not always managed effectively. Medicine audits seen by us showed that shortfalls identified had not been addressed.

We spoke to the relatives of three people residing in the home, who were also happy with the care provided. Comments from relatives included: "The care is outstanding"; "We honestly couldn't ask for anything more"; "My mother is really settled here".

We spent time observing staff interactions with people using the service. We saw that staff explained what they were doing, didn't rush people and were reassuring.

We examined the home's recruitment processes and found that the registered manager carried out the necessary checks to ensure that staff were appropriately qualified and physically and mentally fit for the job.

At previous inspections we had found that appropriate arrangements for safely handling medicines were not in place. At this inspection we found significant improvements had been made and overall we found medicines were being safely and appropriately managed.

At previous inspections we had found that there was inadequate control of water temperatures to reduce the risk of scalding. Since then the provider had made improvements to the heating and water systems and regular checks were carried out on the water temperatures to ensure they were not too hot.

The home was clean, warm and well furnished.

People told us that, on the whole, they enjoyed the food provided and they were offered choices. Comments included: "The food's not bad"; 'The food's very good'; "I can choose what I have and some days it's very nice'.

We spent time observing staff interactions with people using the service. We saw that staff explained what they were doing, didn't rush people and were reassuring. However we did find that, for two people, not all staff were aware of their current needs. Also people were not encouraged to eat at a dining table.

Since the last inspection there had been another change in manager. This was the fifth manager in two years.

Staff we spoke with said they were provided with training in how to carry out their role and that the current acting manager was supportive.

We found continued concerns with the management of medicines and are considering taking further action.

In addition we found that the registered provider did not have adequate systems in place to seek the views of people using the service or identify and manage risks.

We carried out this inspection on the 14 September 2012 and also during the late evening of 17 September to check whether improvements had been made.

Some of the people at Mother Red Caps Home could not communicate verbally and we spent time observing the support they received. We found that staff were aware of the needs of the people who used the service. However, there were concerns identified during our visits regarding the lack of bathing opportunities and social activities.

At the last inspection we found continuing non compliance with the management of medicines and as a result we issued a warning notice. We found the provider had not complied with all aspects of the warning notice and as a result we are considering taking further action.

Satisfactory recruitment processes were in place but there were insufficient staff to meet people's needs, in particular at night. We also identified safety concerns with fire doors and bed rails and we informed the Fire Safety Officer and Health and Safety Executive of our findings.