Archived: Chy Byghan Residential Home

Chy Byghan Residential Home provides accommodation and personal care for up to 19 predominantly older people and had 15 people resident at the time of our inspection. The service currently does not have a registered manager in place, although the service was seeking to register a new manager. 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 carried out this unannounced inspection of Chy Byghan on 26 May 2015. At this visit we checked what action the provider had taken in relation to concerns raised at our last inspection in February 2015, when we found breaches of legal requirements related to staffing. We found the service did not have adequate arrangements for making sure there were enough staff working at the service. At this inspection we found there were still not enough staff available at the service to keep people safe and meet their needs.

There were not enough staff working during the afternoon periods to meet people’s needs. This was because one staff member was needed to prepare food for the evening meal and this left one staff member to support all the people that used the service. Also some people needed two members of staff to assist them with their mobility needs. Therefore there were times when both care staff were supporting this person and therefore were unavailable to meet the needs of anyone else in the home.

We saw some good care practices, such as the appropriate transfer of a person who required specialist equipment to help them to move. Staff were kind, patient and friendly towards the people they supported.

We found people were not always kept safe due to unsafe medication administration and recording procedures. The registered person was not ensuring people were protected against the risks of unsafe medicines administration because medicines were not always handled safely, securely and appropriately. We found the service had not made sure there was enough stock of people’s medicines. There were a number of instances of inaccurate recording of when people had taken or not taken their medicines. We observed staff were unable to give their focused attention to giving people their medicines because of numerous interruptions. This meant the service was not ensuring peoples’ safety in the way they managed, administered and recorded their medicines administration.

People’s care plans were not regularly reviewed to make sure they met people’s needs. People were not involved in making important decisions about their care. This meant there was little personal input or historical information to aid staff in understanding the life and history of the person they cared for. People were not given an opportunity to give their consent to the care planned for them. People told us they were not aware of what their care plans contained.

The service was not providing staff with effective training, supervision and appraisal in line with its own organisational policy. Staff told us they were not receiving supervision or appraisal. Staff told us they felt ‘unsupported’ and were unclear, at times, about what their responsibilities were. Staff training was out of date or not in place. There was a recognition by the management that training was an issue that required attention.

People at the service had not been assessed appropriately under the Mental Capacity Act (2005), their best interests had not been protected appropriately, and the service had not made the required Deprivation of Liberty applications. There was also a lack of stimulating activities for people to participate in and people commented that they did not have enough to do.

The service had a policy and procedure in place for dealing with complaints. However, this was not followed in practice and was not made available to people and their families. Staff told us about a recent complaint raised by a person. This had not been formally recorded, investigated or resolved.

The provider was not operating safe recruitment practices. Recruitment records showed two recent new staff members were employed before Disclosure and Barring Service (DBS) checks were received. These staff worked with the vulnerable people that live at the service before adequate checks had been made to help assure their safety.

The registered provider had failed to maintain standards of hygiene at the service. A recent Environmental Health inspection had substantially downgraded the service’s hygiene rating and issued an Improvement Notice following identified concerns with the standards of cleanliness.

Chy Byghan did not have effective governance system, including assurance and auditing systems or processes. The purpose of these systems are to assess, monitor and drive improvement in the quality and safety of the services provided, including the quality of the experience for people using the service. People, their families and other external professionals involved with the service were not asked to give structured feedback about the quality of the service. Staff told us they did not believe the service was well led. The manager told us that following the loss of the previous registered manager in January 2015, the transition to the new management arrangements had been difficult and challenging.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by 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.

We found a number of Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.