Background to this inspection
Updated
12 December 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
This was a focussed inspection to check whether the provider had met the requirements for the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspection team
The inspection team consisted of two inspectors and two assistant inspectors.
Service and service type
St Augustine's Court Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced. We checked the COVID-19 status of people on site, when we were in the building.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and health care commissioners who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections
We used all of this information to plan our inspection.
During the inspection
In the late evening of 14 October 2020, we attended the service unannounced. We reviewed the safety of people using the service. We spoke to two people that evening about their experiences of the care provided. After our site visit, we required further information and assurances. We therefore decided to return to the service. The management team were unaware that we intended to return, therefore the second site visit on 15 October 2020 was also unannounced.
On 15 October 2020 we spoke to six people about their experiences of using the service. The inspection team also spoke to five care staff, one nurse, the registered manager and the nominated individual. An office based assistant inspector phoned seven other staff to gather their feedback. An external nurse attended the service with us, they supported the inspection team to review people’s health and medical needs.
We reviewed a range of records. This included the relevant parts of eight people's care records and multiple medicines records. We looked at incident records. We looked at three staff files in relation to their recruitment and supervision. A variety of records relating to the management of the service, including audits and policies were reviewed.
We found multiple concerns during the inspection visits on 14 and 15 October 2020. We sent a letter to the provider outlining our most serious concerns and requested a response detailing what action they would take. We were provided with assurances that these concerns would be rectified. We decided to return to the service on 27 October 2020 to review if effective changes had been made to the service. This visit was completed by two inspectors and an assistant inspector. The inspection team focused on reviewing concerns identified previously. This third day was also unannounced.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We requested further documents to support our evidence.
Updated
12 December 2020
About the service
St Augustine's Court Care Home is a nursing home providing personal and nursing care for up to 40 people. On the first two days of inspection, 36 people lived at the care home. On the third day, 33 people were living in the care home. The service provides care to people, some of which are living with dementia. The service is a purpose-built property. Accommodation is split across two floors. There are several communal living areas, an accessible sensory garden, a cinema room and a sensory room.
People's experience of using this service and what we found
People did not have good outcomes. Restrictive practice was used at the service, including locking people in rooms and physically restraining them without staff training. One person reported staff being “rough with me”. Another had bruising which supported a received allegation that the person had been restrained. These two concerns were reported to the management team, we returned 12 days later and were not provided with evidence that these allegations had been investigated. This left people at ongoing risk of neglectful care. We repeatedly observed staff not responding to people’s obvious distress and need for support.
Medicines were not managed safely. Staff had received training, however this was assessed as ineffective when observing the service. Care plans were generic and did not provide sufficient guidance for staff to provide safe and person-centred care. There were insufficient staff to respond to people in a safe way. We also observed staff not attend people who required urgent support. Lessons were not learnt when things went wrong. This meant people were at risk of incidents repeating themselves.
Poor leadership and oversight of the service had impacted on the quality of care and treatment people received. Staff reported that the management team shouted at them. There was poor morale at the service.
The service was inspected during the covid-19 pandemic. Staff were observed to wear personal protective equipment in line with government guidelines. People and staff were regularly tested for covid-19.
We communicated our concerns to the management team after the first two inspection days, they responded to our concerns stating that they would work to improve the service. We returned 12 days later and identified that minimal changes had occurred, this left people at ongoing risk of harm. We identified four breaches of regulation.
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 (Report published 23 October 2020).
Why we inspected
We last inspected this service on 8, 9, 10 and 17 September 2020. After our inspection, we received multiple concerns about the quality of care provided. This included allegations of: low staffing, poor management of incidents, the use of restraint and neglectful care.
As a result of these concerns, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
Enforcement
The previous inspection found no breaches of the Health and Social Care Act 2008 (Regulated Activities).
At this inspection we identified breaches of regulation 12 (Safe care), 13 (Safeguarding), 18 (staffing) and 17 (Governance). These are requirements for the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
After the first inspection site visit, we urgently imposed conditions on the providers registration. These conditions prevented the provider from admitting new service user's without CQC permission. They also required a review of the safety of the service. The provider did not appeal this urgent enforcement action.
When we returned to the service, we identified that improvements had not been made and people were still at risk of harm. We therefore wrote a letter to the provider, proposing that we would cancel their registration with the CQC. Cancelling a provider's registration would prevent them from legally providing personal care support from the premises. The provider informed us that they did not intend to appeal this proposal. We have therefore taken action to cancel the provider's registration.
Follow up
We have cancelled the provider's registration. This provider is therefore not legally allowed to provide personal care support from these premises. If they apply to register another service, this will go through our usual registration assessment processes.