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Archived: The Cottage Residential Home Inadequate

Reports


Inspection carried out on 27, 28, 29 July and 07 August 2015

During an inspection to make sure that the improvements required had been made

We undertook this unannounced inspection on 27, 28, 29 July and 7 August 2015. The last inspection was undertaken in December 2014 when the service was found to be non-compliant with two of the regulations looked at.

Part of this inspection was to see if the registered provider had complied with the actions we asked them to take following the last inspection. We also received information from the local authority safeguarding team which raised concerns about the standard of care and attention the people who used the service received.

The Cottage is registered with the Care Quality Commission [CQC] to provide care and accommodation for 30 older people who may be living with dementia. Accommodation is provided in a mixture of shared and single rooms, with some having en-suite facilities. There is a large dining room and two lounges.

The Cottage is on the outskirts of Hull and has good access to public transport routes.

At the time of the inspection there was a registered manager in post. A registered manager is a person who has registered with the CQC 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 registered provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 following the last comprehensive inspection in December 2014. The breaches included safe care, the environment, how people were supported to make informed choices and decisions, gaining people’s consent to care and treatment, staff training, people’s privacy and dignity, person centred care and monitoring and governance. You can see what actions we have told the provider to take at the end of this report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the CQC. The purpose of special measures is to:

  • Ensure that providers found to be providing inadequate care significantly improve.

  • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

  • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

People were not consulted with regard to the care and treatment they received and decisions were made which were not in the best interest of the person or the least restrictive option available. For example, the registered manager had been using a covert camera in two people’s bedrooms and had not gained their permission or consulted with any other stake holders. People were receiving medicines covertly and no assessment had been undertaken as to their capacity or if this was the least restrictive practise.

The environment was dirty and at the time of the inspection smelt of urine. Bedrooms were dirty and bedding was stained as were the beds. The bathroom was dirty and in need of redecoration, the bath sides had mould growing on them. Since the inspection in July we have revisited and found the registered provider has cleaned the service and addressed some of the infection control issues and has made us aware of plans to re-site the bathroom and make it fit for purpose.

Staff knew how to identify and report abuse they may become aware of but their training needed updating and renewing in line with current good practise guidelines.

Staff had been provided in enough numbers to meet the needs of the people who used the service and had been recruited safely. However, as a result of the findings of this inspection with regard to the environment the registered provider is increasing the domestic staff.

The City Health Care Partnership [CHCP] pharmacist had recently undertaken an audit of the medicines systems due to concerns raised and had recommended areas for improvement. When we looked at the medicines we found the registered provider had complied with what the CHCP had recommended. Discussions with the CHCP pharmacist confirmed they were working closely with the staff at the service to implement changes and improvements. We found the registered provider had improved the way the medicines were stored and administered and how the staff recorded this. The registered provider had developed protocols for the use of medicines which were administered as and when the person required [PRN]. This meant people received their medicines as prescribed by their GP. The main outstanding recommendation made by the CHCP pharmacist was with regard to the temperature of the room the medicines was stored in, however the registered provider told us they had plans to relocate this to another room so the temperature could be better regulated.

We found staff training had not been updated and some staff had not completed training identified as mandatory by the registered provider and part of their development. Staff supervision had not been carried out for over 12 months and staff had not had the opportunity to undertake any further qualifications and development. We found the staff induction was basic and did not follow current good practise guidelines with regard to staff skills and development. This meant people may have been cared for by staff who did not have the training, support and experience to meet their needs.

People were not protected by legislation or assessment to make informed decisions about their care and treatment practises were not always the least restrictive or in the person’s best interest. The principles of the MCA 2005 were not being followed and deprivation of liberty safeguards [DoLS] were not being used to protect people.

At the time of the inspection we found the environment to be in need of refurbishment and redecoration. Double glazed window seals had ‘blown’ and this made it difficult for people to see through the windows and they appeared murky. Windows frames were rotten and need of replacement. The bathroom was not fit for purpose and was dirty and need of upgrading, the bath sides had mould growing on them. We have revisited the service since the inspection in July and found the registered provider had replaced the double glazing and was systemically replacing the rotten windows. They told us they had plans to relocate the bathroom making it fit for purpose and meet the needs of the people who used the service better; this was to commence week commencing 24 August 2015. We will check this has been done.

At the time of the inspection there were no locks fitted to the doors of either the bathrooms or the toilets. Some of the door handles on people’s bedrooms and toilets did not work properly therefore making it difficult to keep the door closed. This meant people’s privacy and dignity was compromised. We have revisited the service since the inspection in July and found the registered provider had fitted locks to the bathroom and toilet doors and replaced the defective door handles on the bedrooms.

People were provided with food which was wholesome and nutritious and of their choosing. Staff monitored people’s daily food and fluid intake and involved health care professionals when required.

People had good relationships with the staff and staff respected their privacy and dignity, however, people did not receive person centred care and their needs were not always met by the staff. People’s care plans were not followed and staff did not always understand people’s needs, especially with regard to behaviours which could challenge the service and put the person and others at risk.

There was a lack of meaningful activities provided at the service and there were no specific activities to support those people who were living with dementia. This meant people could go for long times unstimulated and became bored and restless.

There were no management systems in place to ensure the service was safe, effective, caring, responsive and well led. There were on monitoring systems which audited the service and made sure it was safe for people to live in. There were no systems in place which audited the environment to ensure it was clean and free from the risk of cross contamination. There were no systems in place which systematically gathered the views of the people who use the service and other stakeholders about the running of the service. There were no systems in place which ensured the staff had the right skill to meet the needs of the people who used the service. The management style was not inclusive and did not motivate staff to achieve excellence and ensure the service moved forward.

You can what actions we have told the registered provider to take at the end of this report.

Inspection carried out on 15 and 16 December

During an inspection to make sure that the improvements required had been made

The Cottage is registered with the CQC to provide care and accommodation for 30 older people who may be living with dementia.

It is on the outskirts of Hull and has good access to public transport routes.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a 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 there was a lack of auditing of the cleanliness, infection control and safety of the environment which meant people were un-necessarily exposed to the risk of cross infection and lived in an environment which was not well maintained, safe and clean. People were at risk of cross infection because staff had not been provided with appropriate hand washing facilities.

People’s medication was not handled safely. This meant potentially people may be at risk of not receiving medication as prescribed by their GP.

People were not supported effectively to make informed decisions or protected by systems which were intended to safeguard their best interest. This meant people were potentially at risk of receiving inappropriate care and support.

People’s care plans described the person, their likes and dislikes and how they would like to be cared for. However, there was a lack of organised activities on a daily basis for people to participate in, this meant people were unstimulated for long periods of time. This had the potential to exacerbate behaviours which may challenge the service and put people at risk; especially with regard to people who lived with dementia. We have made a recommendation about the subject of dementia.

Staff were able to describe to us how they would keep people safe and how they would report any abuse they may witness; they had received training about this which was updated regularly.

Staff were provided in enough numbers and with the right skills to meet the needs of the people who used the service. The registered provider’s recruitment procedures ensured, as far as practicable, people were not exposed to staff who had been barred from working with vulnerable adults.

Staff received training and support which enabled them to meet the needs of the people who used the service and this was updated as required.

People were provided with a nutritionally well balanced diet, their food and fluid intake was monitored and referrals were made to health care professionals when required. This ensured people were not at risk of receiving a poor nutrition and were supported by health care professionals when needed.

People were cared for by staff who were caring and sensitive. They had good relationships with the staff and staff understood their needs and how these should be met. People were involved with their care and attended reviews on a regular basis. This ensured people received the care and attention of their choosing.

The registered provider had a complaints procedure in place and people knew they had the right to make complaints and expect these to be investigated.

People could have a say about how the service was run and the registered provider consulted with them.

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

Inspection carried out on 12 August 2013

During a routine inspection

We found that people were involved with their care and the running of the home. People told us they could live their life as they pleased. One person said, “I pretty much do as I please really.” Another person told us, “I can go to my room and watch the TV in the evenings, I like doing that.”

People were provided with a varied and nutritional diet. People told us they enjoyed the food. Comments included, “The food is superb you just can’t fault it” and “There is always plenty of choice.” People’s dietary needs were assessed and health care professionals were involved if they experienced any problems or difficulties with eating or swallowing.

The home was clean, tidy and well maintained. People were happy with the level of cleanliness. One person said, “I have a really nice room and it’s kept lovely and clean.” Equipment was provided for staff to assist people with mobility problems.

There was enough staff on duty to meet people’s needs and staff had received training to help them carry out their roles. People who used the service told us “The girls are marvellous, they will do anything for you, you just have to ask” and “The staff are really kind and helpful.”

During a check to make sure that the improvements required had been made

We found that the provider was meeting the standards we inspected.

Inspection carried out on 17 September 2012

During a routine inspection

People told us they could come and go as they pleased. One person told us they could spend time in their room if they wished. Another person told us they knew they had a care plan and what was recorded in it. People were complimentary about the food and told us there was plenty of choice and it was always nicely prepared.

People told us there had not been any residents meetings held for along time. Some people we spoke with told us they wished they could have a shower instead of a bath.

People who used the service were happy with the care they received and told us the staff were very kind and caring. They also told us they would speak to the manager if they had any concerns and one relative told us their relative felt safe at the home.

Inspection carried out on 15 March 2012

During an inspection to make sure that the improvements required had been made

There was no requirement to interview people as part of this follow up inspection.

Inspection carried out on 14 November 2011

During a routine inspection

People told us they were able to come and go as they pleased and were supported to lead lifestyles of their own choosing. One person said, “It’s as good as being at home to me.” People also told us the care they received was very good; one person said, “The girls are very kind and helpful.” Another person told us, “We are all very well cared for.”

People told us they would speak to their key worker or the manager if they had any concerns and that they were able to air their views about how the home was run. They also told us they had been involved in meetings and they found the manager approachable.

Reports under our old system of regulation (including those from before CQC was created)