Background to this inspection
Updated
26 September 2019
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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The comprehensive inspection was brought forward in response to information of concern that we received from a number of stakeholders.
Inspection team
The inspection site visit was completed over two days. On the first day two inspectors, a medicines inspector, an assistant inspector and an expert by experience was in attendance. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service, specifically for older people. The second day of the inspection was completed by one inspector and an inspection manager.
Service and service type:
Felmingham Old Rectory is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to 41 people in one adapted period building. At the time of this inspection, 28 people were receiving care and support. Two of those people were in hospital. Most people residing in the service were living with dementia.
The service did not have a manager registered with the Care Quality Commission in place at the time of the inspection. This means the provider alone is legally responsible for how the service is run and for the quality and safety of the care provided.
An interim manager was in post at the time of this inspection. They had started three days prior to our inspection visit. We refer to them as the manager throughout this report. A senior management team of three others had been brought in from another of the provider’s services to assist the interim manager. They had been in the home approximately four weeks.
Notice of inspection
This was an unannounced inspection and the provider was not aware of our inspection prior to our visit on 1 May 2019. The provider was aware we needed to return for a second day but was not made aware of when this would take place.
What we did
Prior to our inspection we reviewed and analysed the information we held about this service. This included reviewing statutory notifications the service had sent us. A notification is information about important events which the provider is required to send us by law. We also viewed the information sent to us by stakeholders including the commissioning body.
A Provider Information Return (PIR) is key information providers are requested to send us on their service, what they do well and improvements they plan to make. The information helps support our inspections. We reviewed the PIR we had requested, and received from the provider, in August 2018.
We spoke with ten people who used the service and briefly with one relative. We also spoke with two visiting professionals. In addition, we spoke with the regional manager, interim manager, two staff from the management team brought in from one of the provider’s other locations, two senior care assistants, one care assistant, a chef and two domestic assistants.
We reviewed the medicines administration record (MAR) charts for 15 people and spoke with five members of staff about these. We also reviewed the care planning documents for eight people who used the service. Documents associated with the management of the service were also viewed.
After our inspection, we asked the provider for further information and this was received within the requested timescale. These were reviewed and included as part of this inspection.
Updated
26 September 2019
About the service
Felmingham Old Rectory is a residential care home that was providing personal care to 16 people aged 65 and over, and younger people, at the time of the inspection. The service can support up to 41 people. The home is an adapted period building set in its own grounds. Accommodation is over two floors.
People’s experience of using this service and what we found
People remained at risk of avoidable harm through the provider’s failure to consistently identify, assess, manage and mitigate risk. This included putting people at risk of abuse and receiving unsafe care. People did not receive their medicines as prescribed and this had resulted in harm.
The governance of the service remained ineffective. This was due to inconsistent and changing management and failure to promptly act on identified concerns. There was a lack of accountability on behalf of the provider and a failure to act promptly on long identified concerns. This had resulted in people receiving unsafe care that exposed them to the risk of avoidable harm.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was inadequate (report published 6 June 2019) where nine breaches to regulations were found.
Shortly following our last comprehensive inspection in May 2019, the local authority terminated their contract with the service. This resulted in nine people being moved out of the service. At the time of this inspection in June 2019, urgent reviews were being undertaken of all other local authority placed people with the view of finding alternative placements for them.
Why we inspected
We received concerns in relation to the management of risk and the governance arrangements. As a result, 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 since our last inspection in May 2019 which indicated we did not need to reinspect the other Key Questions of Effective, Caring and Responsive. Ratings from the previous comprehensive inspection for those Key Questions were used in calculating the overall rating at this inspection.
The overall rating for the service remains inadequate. This is based on the findings at this inspection. We found evidence that people were at risk of harm from these concerns. Please see the Safe and Well-led sections of this full report.
Following our inspection, the provider took some action to mitigate the risks found.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Felmingham Old Rectory on our website at www.cqc.org.uk.
Enforcement
At this inspection, we have identified breaches in relation to the safe care and treatment of people, the governance of the service and the provider’s regulatory responsibilities.
Our findings at this inspection confirmed the actions we took following the comprehensive inspection completed in May 2019 where serious and widespread concerns were found. Following that inspection, we took urgent enforcement action to restrict admissions into the service. Further enforcement action was taken which cannot be reported on at this time.
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
We will continue to closely monitor information we receive about the service, and work with partner agencies, until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service remains 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.