Archived: Bindon Residential Home

Updated 23 March 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted in part by a notification of an incident following which a person using the service died unexpectedly. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls and the use of equipment to reduce risk. This inspection examined those risks.

Inspection team:

This inspection was carried out by two inspectors, a medicines inspector and an inspection manager.

Service and service type:

Bindon is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have registered manager. The previous registered manager had left the service in November 2018 and cancelled their registration with us. A new manager had been appointed in November 2018, however they had not yet registered. A registered manager is a person who has registered with the CQC to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection was unannounced on the first day. Inspection site visit activity started on 6 February 2019 and ended on 14 February 2019. On 11 February 2019 we completed a late-night unannounced inspection.

What we did:

Prior to the inspection we reviewed the information we hold about the service. This included information shared with us by the local authority, health and social care professionals, family members and whistle blowers. We reviewed notifications we had received from the service. A notification is information about important events which the service is required to send us by

law.

Some people using the service were living with dementia or illnesses that limited their ability to communicate and tell us about their experience of living there. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us and share their experience fully.

During the inspection we met with the majority of people using the service and spoke with 13 of them. We also spoke with five relatives, the company director and manager and 12 staff. We met two health professionals during the inspection. We reviewed six people’s care files; three staff recruitment files and training and supervision records; audits and policies held at the service. We looked around the premises. Following the inspection, we received feedback from one relative, six health and social care professionals as well as feedback from the whole service safeguarding meetings.

Updated 23 March 2019

About the service:

Bindon Residential Home provides accommodation for up to 42 people. The service provides care for older people; most of whom are living with dementia. The home is separated into two different areas called Bindon and Elmcroft. At the time of our visit 33 people were living at the service.

People’s experience of using this service:

• Systems and processes to monitor the service were not effective, did not drive improvement and the provider had poor oversight and had not identified this. As a result, the quality of care provided to people had deteriorated since the last inspection.

• People’s health, safety and welfare were put at risk because there were not always sufficient numbers of suitably qualified, skilled and experienced staff on duty.

• The provider had not ensured staff were suitably trained and sufficiently supervised. As a result, the staff team did not have the skills to support people effectively and people had been exposed to the risk of harm.

• The service was not safe because people were not always protected against the risks associated with medicines.

• People’s nutritional needs were not always identified and monitored. Nutritional care plans lacked detail or clear instructions for staff about how to support people in relation to eating and drinking, especially where they were at risk of weight loss. Records relating to people’s daily dietary and fluid intake were poor. This meant we could not tell in any detail what people had to eat each day

• People were at risk because accurate records were not consistently maintained. There were gaps in people’s repositioning and personal care records. We could not be assured people’s care needs were being met consistently.

• Care records did not always reflect the needs and preference of people using the service. They were contradictory in places. The lack of detailed and accurate care plans meant care and support may not be given effectively. Visiting healthcare professionals shared similar concerns.

• There was a lack of stimulation for people using the service. Several people said they would like to see improvements in this area. Very few activities were offered and those that were did not always take into account individual interests and preferences or consider individual’s abilities.

• Some equipment and aspects of the premises were not clean. Poor infection control standards were found throughout the service.

• Some environmental risk had not been identified.

• We saw positive interactions during the inspection, with staff being kind, friendly and patient when assisting people.

• People enjoyed the meals provided.

Rating at last inspection:

At the last inspection the service was rated as requires improvement (February 2018). The service had been rated as requires improvement for a third consecutive time. At this inspection we found the service had deteriorated and is rated as inadequate overall.

Following the last inspection, asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe and well-led to at least good. We also met with the provider to confirm they were following their action plan to ensure improvements were made.

Why we inspected:

We brought this comprehensive inspection forward as we had received concerns from a variety of sources that included community health and social care professionals, anonymous whistle blowers and family members. Concerns included poor staffing levels, poor standards of personal care, poor management of risks, unsafe staff recruitment practices, poor standards of cleanliness and a lack of stimulation and occupation for people. As a result of the mounting concerns, Devon County Council implemented a whole service safeguarding process in January 2019. There were also several individual safeguarding investigations in progress. Placements to the service have been suspended by Devon County Council because of the safeguarding concerns. The provider has voluntarily suspended admissions of privately paying residents. At the time of the inspection we were aware of two incidents being investigated by third parties.

Enforcement

During the inspection we identified nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk from harm because the provider’s actions did not sufficiently address the ongoing failings. There has been ongoing evidence of the provider to sustain full compliance since 2015. Our findings do not provide us with confidence in the provider’s ability to bring about lasting compliance with the requirements of the regulations.

Follow up:

During the safeguarding process the service is being monitored through a combination of visits by health and social care staff, as well as multidisciplinary safeguarding strategy meetings. Due to concerns about fire safety, we made a referral to the Devon and Somerset Fire Service.

In addition, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

The overall rating for this registered 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.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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 have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.