28 November and 1 December 2014
During an inspection looking at part of the service
Merok Park is registered to provide care and accommodation for up to 29 adults living with dementia, an acquired brain injury or mental health disorder. On the day of our inspection 25 people were living in the home.
This inspection took place on 28 November and 1 December 2014 and was unannounced. Due to the concerns identified during the inspection we also carried out spot-checks on the home on 29 and 30 November and 5, 6 December and 7 December 2014.
The home had been without a registered manager for four months. 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 and associated Regulations about how the service is run.
The home was being managed by an interim manager who was also one of the registered nurses on duty each day.
People were not protected from abuse and avoidable harm as staff were not trained in how to recognise abuse and what they should do if they had any concerns.
The provider had not ensured there were enough staff to meet people’s needs. Staff said, “There are not enough staff. Staff are rushed and people don’t get the care they need.” We observed this during our inspection. Staff were rushing around trying to complete tasks and ignoring people calling out because they did not have time to stop.
The provider had not ensured there were the right mix of skills and competencies of staff on duty each day or the minimum number of staff. Although the provider was on the rota as the second nurse each morning, staff told us that until the middle of November 2014 the provider had not been on duty at the home which meant there had been only one nurse to look after 27 people.
There was no contingency plan for the home which meant people would not be protected in the event of an emergency.
Safe recruitment practices were not followed to help ensure only suitable people worked in the home. Not all staff had received a criminal records check and the provider could not provide us with evidence that all nurses were registered with the Nursing and Midwifery Council.
Staff did not monitor people’s risks appropriately, although we saw risk assessments in people’s care files we found staff did not always follow relevant guidance. People were left at significant risk of developing skin sores as they slept in old beds or divan beds with mattresses which were not fit for purpose. Pressure sore mattresses were not set on the correct settings for people.
The provider had failed to maintain the environment in the home. We found mould on walls, broken taps, stained carpets and only cold or tepid water coming from the taps in some people’s rooms. Furniture in people’s rooms was old and falling apart and people did not have suitable curtains at their windows. The smell of urine was overpowering in the home.
The provider and staff did not understand their responsibility in relation to infection control. The home was dirty. Some bathrooms had run out of hand wash and we saw stained toilets, toilet seats and dirty toilet brushes. The two sluice rooms (rooms where clinical equipment is washed) were not fit for purpose and the cleaner was seen to give a quick rinse to a commode in the basin of a toilet.
Staff (including the cleaner) had not had infection control training and there were no cleaning checklists. Staff had left soiled clinical waste in open bags in a bathroom and the outside clinical waste bin was unlocked which was a serious infection control risk.
The provider had not met the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People had been unable to get downstairs for approximately one month when the lift was broken, but the provider could not give us evidence they had submitted DoLS applications to the Local Authority. Although the lift had been repaired it was not used as the interim manager told us it was “Unreliable”, meaning people were restricted in accessing downstairs.
Staff did not receive an induction when they started working in the home and the provider was unable to show us any evidence of up to date training in respect of staff. Records we did read showed staff had not been provided with regular training appropriate for their role. The provider failed to support staff or ensure they did not work excessive hours. Staff regularly worked over 50 hours a week and some staff worked as much as 84 hours.
People were rushed by staff to eat and people who required encouragement were not provided this as staff were too busy. Some people did not eat their lunch at all although staff failed to notice this. Although the chef told us no one living in the home had an allergy, we read in people’s care plans this was not the case.
People did not have their health needs met. We heard from one visitor how their friend had not received the dental treatment they required despite asking staff to arrange this on numerous occasions. One person required treatment from the GP but staff had not arranged this.
We did see some examples of kind and compassionate actions from staff. However, we saw many examples of people being treated in an uncaring manner by staff. We observed staff being rough with people and ignoring people who were in distress. Staff did not treat people as though they mattered. One person said no one ever listened to them. Other people sat for long periods of time and staff did not acknowledge them. People’s dignity was not maintained as people were being washed in cold water. People’s bedrooms did not have appropriate curtains fitted which meant their privacy was not upheld.
The provider had not ensured people had the opportunity to participate in regular activities or social interests relevant to them. People had two hours of activities a week and in between were left sitting with nothing to do and no social interaction from staff.
The provider did not respond to people’s complaints. One relative told us they had given up complaining and we read a complaint from October 2014 which had not been addressed by the provider.
The provider did not have a hold on the day to day management of the home. The provider admitted to us they had not come to the home as much as they should have since the registered manager had left. They were unable to find paperwork when we requested it and did not know if any quality assurance checks had been carried out. Although the provider was the responsible person for the home, they did not delegate responsibility in an appropriate manner. Instead they left the running of the home to the interim manager, but gave them no support to do this.
We raised our concerns about what we’d seen and found during our inspection with the provider. The provider failed to take action in response. The provider did not take any action to ensure people who lived at Merok Park Nursing Home were treated with care, respect and dignity and lived in an environment that was caring, fit for purpose, free from risk and free from infection.
We found the provider had breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in 12 areas. You can see what action we took at the end of the full report.