About the service
Smithy Bridge Court is a newly built residential care home providing personal and nursing care to working-aged and older adults with complex care and mental health needs. The home is registered to support up to 51 people and was supporting 28 people at the time of the inspection. Care is provided over three units on separate floors, which have communal living areas and single occupancy en-suite bedrooms.
People’s experience of using this service and what we found
People did not have their risks and needs accurately assessed and there was not always a detailed and personalised plan of support in place to ensure people received the support they needed. There was not always enough staff on duty to support people and recruitment processes were not robust. People were not protected from avoidable risk and restricted areas were not always secure. People’s medicines were not safely managed, and we identified shortfalls in the storage of medicine and the administration and recording practices. The service was not clean, and staff were not consistently wearing personal protective equipment in line with the government guidance for care homes.
People were not protected from potential harm through good oversight and effective action by staff and the provider. Systems for audits and checks were not being effectively used to monitor the service and drive improvement. Feedback from people and families had not yet been formally obtained, although structures were in place to do this once the service was more established. The service worked in partnership with internal and external services as needed.
People’s assessments and care plans were not always accurate and detailed. People had limited choices for meals and at the time of inspection there was no chef in post. We have made a recommendation that the service review the menu to ensure it is suitable for the needs and preferences of the people living at the service. The building was new but was not suitable for the needs of everyone living at the service. We have made a recommendation that the provider review good practice guidance when considering the adaptations required to meet the needs of the people living at Smithy Bridge Court.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were in place but had not been effective in ensuring good practice. We have made a recommendation that the service ensure staff are knowledgeable in this area and that assessment and consent documentation is accurately recorded in people’s records.
People’s privacy and dignity was not always maintained when being supported by staff and not all staff had completed training in this area. People were not always encouraged to make choices and remain independent and care plans did not always contain enough detail about people’s abilities. People and families spoke highly of the care staff and although staff were busy and task focused, they generally spoke kindly with people. People with specific cultural or religious needs were supported and care plans reflected these needs.
People’s care plans did not contain enough detail about likes and preferences to ensure that people were supported in a person-centred way. The service was not currently supporting anybody who was at end of life, but the care plans were not always detailed and accurate in this area. The service could provide information in a variety of formats and used technology to support different communication methods. People were not always supported to engage in a varied and meaningful program of activities, but families spoke positively of their experiences of contacting and visiting people living at the service.
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 23 February 2021 and this is the first inspection.
Why we inspected
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.
The inspection was prompted in part due to concerns received about staffing levels, management of medicines, safeguarding concerns and management of individual risk. A decision was made for us to inspect and examine those risks.
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.
You can see what action we have asked the provider to take at the end of this full report.
The provider took steps to address some of the concerns we found during the inspection including focusing on ensuring sufficient staffing levels are in place and recognising situations where they were not able to meet a person’s needs.
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 individualised care planning; managing individual and environmental risk and people’s medicine; ensuring there were enough staff to support people and that these staff were safely recruited and trained, supported and competent to perform their role; and ensuring that the service had enough oversight to address shortfalls and concerns and improve the service in a timely way at this inspection.
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.
We will request an action plan from 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 program. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review, and 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 of 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.