Archived: Four Winds Residential Home

We carried out an unannounced comprehensive inspection of this service on 3 and 5 February 2015. Breaches of legal requirements were found.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others. People were not protected against the risks of receiving care that was inappropriate or unsafe. Assessments of the needs of people were not current so did not meet individual needs or ensure the welfare and safety of people. People were not protected against the risk of the unsafe use and management of medicines. There was no safe system in place for the recording and administration of medicines. The provider did not have suitable arrangements in place for obtaining and acting in accordance with, the consent of service users in relation to the care provided for them in accordance with the Mental Capacity Act 2005. People were cared for by staff who were not always supported or trained to deliver care safely and to an appropriate standard.

After the comprehensive inspection on 3 and 5 February 2015 we received concerns in relation to the safety of the electrical installation.

As a result we undertook this unannounced focused inspection on 21 April 2015 to monitor improvement and assess current risk.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Four Winds Residential Home on our website at www.cqc.org.uk.

Four Winds is a residential care home registered to provide care for up to 26 people some of whom were living with dementia. At the time of the focused inspection 19 people were living at Four Winds Residential Home.

Two registered managers were in post and had been registered since June 2014. 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.

We found that the provider had put documentation in place with regard to a summary of people’s capacity but this was not in line with the MCA (2005) as it was not decision specific. Care plans were written from the perspective of the person and stated, ‘I would like…, I agree to…’ but there was no recorded signature or record of how people had consented to this decision.

Staff were asked about Deprivation of Liberty Safeguards (DoLS) and how this impacted on people’s care. Staff knew that many of the people cared for had a DoLs authorisation in place but could not describe the impact this had on their care.

Assessments of the needs of people were not current so did not meet individual needs or ensure the welfare and safety of people. We found there was a brief consideration of risk recorded on care plans but risks had not been assessed in a robust and effective manner. Control measures to manage risks had not been assessed and recorded. We saw that one person needed to be transferred using a hoist and sling but this had not been risk assessed.

There continued to be no risk assessment or audit of people’s moneys that were managed and stored by the home.

Improvements were needed as people were not protected against the risk of the unsafe use and management of medicines. There was no safe system in place for the recording and administration of medicines. We found that medicines continued to be managed in an unsafe manner. We saw that one person had not been receiving one of their routinely prescribed medicines. We asked about this and were told, “Oh, I think it’s because they take another medicine for the same thing.” There had been no medical advice sought about this decision. Another person had attended a medicine review and the dosage of one of their medicines had been reduced. It had taken the provider over seven weeks to reduce this medicine.

We saw four bottles of medicine which had no opened date recorded on them, so people were at risk of receiving medicines that had passed their shelf lives.

Recording of the administration of as and when required medicines (PRN) was inconsistent and there were no protocols in place for the administration of this medicine.

We found improvements were needed to support and train staff to deliver care safely and to an appropriate standard. We found that the provider had a comprehensive training programme in place and a lot of training had been delivered to staff. All staff who had been in post for over a year had received an annual appraisal although supervisions had not been completed since February so were due for April.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others and improvements were required in this area. The provider had introduced a medicine audit which was going to be completed on a monthly basis. We saw that this had been completed once and had identified actions in relation to medicine management. As this had only been completed once we were unable to assess its effectiveness.

A manager’s checklist had been introduced but we found the policy instructions on how to use this were confusing in terms of time frames for completion. Registered managers had completed this and had identified some actions but there was no standardisation in the area’s that needed to be audited or the quality they were expected to achieve.

Prior to the focused inspection we also received concerns in relation to the electrical safety of the building. We found that there were two major concerns that were defined as dangerous and required immediate action. We also found the list of potentially dangerous work requiring urgent action had increased.

The emergency lighting was tested and we found that 50% of the fittings failed within half an hour. We also found that one of the fire alarm detectors was not working. This left people at risk of significant harm.

You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 3 and 5 February 2015. This was an unannounced inspection. This means the provider did not know we would be visiting. We last inspected Four Winds Residential Home on 12 June 2014 where we found the provider to be meeting all the standards we inspected.

Four Winds is a residential care home registered to provide care for up to 26 people some of whom were living with dementia. At the time of the inspection 22 people were living at Four Winds Residential Home.

Two registered managers were in post at the time of the inspection and had been registered since June 2014. 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.

We found the provider had breached Regulations 9, 10, 13, 18 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People were not protected against the risks of receiving care that was inappropriate or unsafe. There was no effective system in place to regularly asses and monitor the quality of the services provided. The identification, assessment and management of risks in relation to the health, welfare and safety of people was not being managed appropriately. Senior care staff were completing some audits of records, including care plans but these were not effective in identifying area’s for improvement and action needed to maintain a high quality of service provision. We saw no evidence of registered managers quality assurance systems or oversight of senior care audits. One registered manager told us that they did not complete audits or improvement plans.

People’s individual needs had not been robustly assessed and care plans and risk assessments were not appropriate to meet people’s needs. Care plans had been evaluated on a monthly basis but any changes to level of need or circumstance had not led to a new care plan being developed. We saw that some care plans contained contradictory and confusing information.

Risk assessments for the use of specialised equipment such as walking aids and wheelchairs were not always in place. This meant people were not receiving care that met their needs.

We saw that medicines were stored safely and in a temperature controlled environment. However people were not protected from the risks of unsafe administration and recording. We saw that medicines were signed as having been administered before they were given to people. We also saw gaps in recording on Medicine Administration Records. There were no audit systems in place to monitor medicines management.

The registered managers’ understanding of The Mental Capacity Act 2005 (MCA) was limited in terms of supporting people to make day to day decisions with regard to capacity to consent to care. The registered managers explained that they would not complete any capacity assessments and best interest decisions without the involvement of a best interest assessor and a doctor if they felt the person lacked capacity. The mental capacity act code of practice is clear that for day to day decisions such as bathing it would be the people closest to the person, for example care staff, who would be best placed to support with this decision making.

Staff told us they received an annual appraisal but records showed gaps. Not all staff had received an annual appraisal. We reviewed training records and saw gaps in the delivery and attendance of refresher training for safeguarding, mental capacity, moving and handling and medicines. This meant people were at risk of receiving care from staff who did not have the skills and knowledge to consistently meet their needs.

Accidents and incidents were recorded however there was no analysis of these incidents which meant people who had regular falls had not been referred to the falls clinic or other appropriate professionals for assessment. There was no effective means to identify areas for improvement or lessons learnt.

An emergency plan was in place and had been signed as reviewed on an annual basis. However it had not been kept up to date as staffing levels did not reflect the current situation. Therefore people were at risk as the emergency plan may not have been effective with reduced staff.

We saw staff had positive and caring relationships with people but noted that people’s dignity and respect was not always maintained to a high standard.

The registered managers understood the process for Deprivation of Liberty Safeguards (DoLS) and we saw that authorisations were in place.

People confirmed there were enough staff employed at Four Winds Residential Home and we saw that a dependency tool was used to identify people’s needs and the staffing levels required. We noted that the hours provided were often in excess of the hours identified as needed on the staffing tool.

Staff told us they felt supported by the registered manager and they had an open door policy. Staff explained they received supervision which was completed by either the senior care staff or the registered managers.

Appropriate recruitment practices were in place.

Staff had a good understanding of safeguarding and told us they felt confident to report any concerns.

The home had good links with the infection and prevention nurse and staff attended an annual programme of training with the nurse. The nurse confirmed that the home had an infection control champion who attended study days and acted as a liaison between the nurse and the care staff at the home.

Staff had some knowledge about challenging behaviour and used distraction techniques to support people who were anxious however it was noted that no training had been provided in the management of challenging behaviour.

There were mixed comments about the food. Some people told us the food was “alright.” Others had complained that it was often cold and had raised this during residents meetings. We saw that mealtimes were sociable events and people were supported as needed.

The home employed an activities coordinator who engaged many of the people with activities such as chair exercises, bingo, cooking and knitting. People told us they thought the activities were good and the coordinator had ideas for improving things further.

Complaints were recorded but there was no effective system in place for analysing trends and developing improvements across the home.