Serene Residential Care Limited

Serene Residential Home is registered to provide accommodation for up to 35 people aged 65 and over who require personal care, some of whom live with dementia. At the time of our inspection there were 13 people living at the home.

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

The service had significantly improved since the last inspection. People, their families, staff, stakeholders and health professionals all recognised the improvements. Feedback was positive about the care and support people received.

The premises were clean and there was improved infection control practice consistently in place. All individual risks for each person had been reviewed and were understood by staff. Care plans and risk assessments had been updated and there were clear systems to communicate new risks to staff. Where we saw one potential hazard, this was addressed immediately. Records were up to date and senior care staff had been given time to check and update these throughout the day. Work was in progress to further enhance care plans with personalised information about people’s individual needs and wishes.

There was significant improvement in people’s dietary needs and risks. The cook worked with people and families, menus had been updated and there was clear risk information around modified diets, thickeners, choke risks and diabetes. 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.

Staffing levels supported people’s needs well. An activities coordinator was in post and people were engaged in a wide range of activities as well as having individual time in conversation. Recruitment processes were robust, staff induction, supervision and training was updated. The provider had strengthened the management team, with the appointment of an operations director to complement the registered manager’s skills and abilities. New governance systems were put in place as well as robust checks for health and safety, staff practice and overview of risk. Audits were regular and thorough and a resident risk meeting was held weekly, with an overview of all risks updated and shared with staff. Records had vastly improved and were still being updated with person-centred language and involvement from families and people who used the service. The environment had been refurbished and there was a wide range of resources and activity areas, as well as private visiting space and relatives’ lounges for social visits. Signage was clear and rooms were very personalised with people’s belongings and photographs.

There was clear evidence to show the service had worked hard to address the breaches found at the last inspection and was continuing to drive improvement.

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 and there were multiple breaches of regulation (published 25 November 2021). The provider completed an action plan after the last inspection to show what they would do, and by when, to improve.

This service has been in Special Measures since November 2021. 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.

The overall rating for the service has changed from Inadequate to Requires improvement. This is based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Serene Residential Care Limited is a residential care home providing accommodation for people who required nursing or residential care for up to 35 people aged 65 and over. At the time of the inspection the service was supporting 21 people.

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

Risks were not safely managed in relation to people’s care. Where risks were identified, such as for infection prevention, pressure care, choking, moving and handling, there were inadequate processes in place to ensure people’s safety.

Records of people’s care and support were not adequately kept. Care plans did not sufficiently reflect people’s needs and were not up to date. Daily records were not kept accurately.

Fire safety procedures were not adequate and staff did not all know how to support people in the event of a fire.

Safe recruitment procedures were not followed. DBS checks and references were not always sought before staff began work, and agency staff were deployed without identity checks verified. There were concerns with staffing rotas, which showed some staff worked excessive hours without rest days. There were weaknesses in staff training to ensure they had the skills to support people safely.

Feedback received from people and relatives was largely positive, and they said they felt safe and supported. However, this inspection identified a continued lack of person-centred care and there were no meaningful activities for people to engage in. Staff worked with patience and care, although they had little opportunity to engage with people, other than when supporting them with care tasks.

The registered manager was enthusiastic and expressed the will to make changes when these were identified. However, there was insufficient evidence of driving improvement or overview of the risks in the service, both to individual people and within the environment. There was poor quality auditing in place; matters identified at the last inspection and raised by the local authority partners had not been addressed and there was a deterioration in the standard of care.

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 Requires Improvement (published 20 July 2021).

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 not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We received concerns about lack of staffing, people’s dietary needs not being met, lack of recording and poor management of the service. 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. No areas of concerns were found in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection of 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.

We have found evidence the provider needs to make improvements. Please see the Safe and Well-led sections of this report.

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

Following this inspection the provider has told us some improvements have been made to ensure care plans are accurate and people are safely supported

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 person-centred care, safe care and treatment, staffing and recruitment, and safe management of the home.

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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and 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 six months to check for significant improvements.

If the provider has not made enough improvement in this timeframe and if 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 means 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 of 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

Serene Residential Care Limited is a residential care home providing accommodation for people who required nursing or residential care for 15 people aged 65 and over at the time of the inspection. The service can support up to 35 people.

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

Records concerning the management of people’s medicines were not sufficiently robust. On the day of inspection, medicine records were completed two hours after administration and medicine storage temperatures were not always recorded. However, people told us they received their medicines as prescribed.

Infection control was not well managed. Staff were not always wearing masks correctly in the home and social distancing was not maintained.

Safe recruitment procedures were not followed for two individuals working in the service. There were sufficient numbers of staff available, although at lunchtime, people had to wait to leave the dining room due to staff pressures.

Activities were not taking place during the inspection. Activity records showed meaningful activities were not taking place.

Systems to ensure oversight of the service had not identified most of the issues found at this inspection. However, feedback from people, relatives and staff about the registered manager was very positive.

People had been moved on to one floor due to the occupancy levels at the time of inspection. The living environment was not dementia friendly and provided limited space for people using mobility aids.

People and relatives spoke positively about the care provided by staff, although we identified some concerns around maintaining people’s dignity.

People felt safe and protected from harm at this service. Relatives shared this view. Safeguarding incidents and complaints had been investigated and responded to.

People received timely access to healthcare when they needed it. Records for people who needed to be weighed weekly showed gaps.

Most staff received an induction and ongoing support through training and supervision.

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

Risks to people had been assessed and reviewed. Care plans were sufficiently detailed and person-centred.

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

Rating at last inspection

This service was registered with us on 29 April 2020 and this is the first inspection.

Why we inspected

Prior to this inspection, we received information reporting concerns about people’s dietary requirements not being met, unsafe medicines management, a lack of food and missing furnishings in people’s bedrooms.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. Following our inspection, action has been taken by the provider to reduce risks to people and this has been effective.

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

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.

Follow up

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.