27 August, 28 August and 1 September 2015
During a routine inspection
The inspection took place on 27 August, 28 August and 1 September 2015. This was an unannounced inspection. On day three of our inspection the registered provider decided to close the home with immediate effect.
We last inspected the service in November 2014. We found the registered provider had breached regulations 13, 15, 18 and 21 of the Health and Social Care Act 2014. In particular: medicines were not managed appropriately; people’s consent to their care was not obtained in line with the Mental Capacity Act 2005; recruitment checks were not always undertaken; servicing and checks of certain areas of the home had not been carried out as planned.
At this inspection we found sufficient improvements had not been made to meet the requirements of regulations 15. The registered provider had also breached regulations 9, 12, 13 and 17.
The home provided accommodation for up to 29 people, some of whom were living with dementia. There were eight people living at the home at the time of our inspection.
The home did not have a registered manager. The registered provider had been unable to recruit a permanent manager. There had not been a registered manager since February 2015. A registered manager is a person who has registered with the Care Quality Commission 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 assurances the provider gave in the action plan had not been met. We found the registered provider was still not carrying out health and safety checks consistently. This included some fire safety and electrical safety checks. The Legionella Risk Assessment had not been updated since our last inspection. The registered provider was unable to provide assurances the home’s electrical installation was safe.
The registered provider did not have an effective risk management process in place. Risk assessments were either out of date or only partially completed. This included assessments to protect people from the risks associated with poor nutrition and skin damage. Risk assessments were not done for four out of eight people. This included personal emergency evacuation plans (PEEPs) and medicines risk assessments.
Referrals were not being made to the local authority following incidents to ensure people were protected from abuse. One incident resulting in a person briefly losing consciousness had not been reported. The registered provider confirmed there had been no contact with the local authority about the incidents.
Initial assessments and care plans had not been completed for four out of eight people. Some of whom had lived in the home since January and March 2015. The other four people did not have up to date care plans which matched their needs. One family member said, “[Staff member’s name] is sorting care plans out because they are disgraceful.” Health and social care professionals had also documented their concerns about out of date or missing care plans. A senior care worker said these care plans were, “Not in place, due to the manager situation.” Regular audits of people’s care to ensure their safety and well-being were not carried out.
One person gave positive feedback about their care. They told us they were supported to be as independent as possible through making their own choices. They said, “I loved it that much I wanted to stop.” Family members said their relatives were safe. They also said staff were considerate. One family member commented, “100% safe, no concerns at all. We have had no problems here.” Another family member said, “Very safe, [I am] over the moon. [My relative] loves it, [my relative] is so happy.”
Accurate records were kept for all medicines received, administered and returned. Medicines were stored securely and trained staff administered them. One person said, “There was no problem with meds.”
During our last inspection we found recruitment checks were ineffective. The registered provider told us no new staff had been employed since then.
People, family members and staff gave us mixed views about whether there were enough staff. One person said, “I don’t have to wait long for the girls.” One family member said, “[Staffing levels] not always enough. There is a trainee on a morning but not on an afternoon. Some require two to one care so people are left unsupervised every day.” Another family member said staffing levels were, “Fine for the amount of people.” One staff member said, “Staffing levels were very low, we could do with more staff, mainly on an afternoon. We need two [staff] to see to [person’s name], so other residents are left.” They then said, “[People were] not at risk but more staff would help.”
Staff supervisions were not taking place. One staff member said, “We don’t have supervision.” One staff member told us they felt well supported. They said, “We work as a team. Management are quite good.” Training records showed essential staff training was up to date.
We observed people received support from kind and caring staff to meet their nutritional needs. At lunchtime staff ensured people had a drink of their choice and received their meal quickly. One person received consistent, un-interrupted support from a patient staff member. People commented positively about their experience. One person commented, “I enjoyed that dinner.” Another person said, “It was nice that.”
Family members told us their relative had access to health care when required. They also said they received regular updates. One family member said, “They keep us informed if [my relative] is not well. They phone and let you know about hospital appointments. [Staff name] took [my relative] to hospital.” Another family member said the district nurse visited their relative regularly.
One person told us they chose whether to take part in activities. They said, “When I am well, I help them [staff] do the washing up.” They went on to say they could, “Crochet and play the guitar.” Activities available to people included entertainment and raffles. We observed staff sat and chatted with people and family members.
People and family members knew how to complain if they were unhappy with their care. One person said, “I would talk to the senior if I was not happy or [staff member’s name]. [Staff member] is lovely.” One family member said, “I would speak up If I was unhappy.” The registered provider did not provide regular opportunities for people or family members to give their views about the service.
Family members and staff said the home had a welcoming atmosphere. One family member said they felt, “Welcomed, staff see you in and see you out. I am always offered a cup of tea.” They went on to say, “Lovely atmosphere, I have never felt anything wrong.” The staff member we spoke with described the home as having, “A lovely atmosphere, it is a lovely home.”