2 April 2015
During a routine inspection
This inspection took place on 2 April 2015 and was unannounced. The service provides accommodation for up to 18 older people who have age and health related care needs. There were 11 people living at the service when we visited.
At an inspection in June 2014, we highlighted concerns that the service had not been well led, with a lack of effective management. Quality monitoring of service delivery was not well developed to provide assurance that the operational management of the home and the delivery of care and support to people was safe and to a good standard. We asked the provider to take action to make improvements. The provider did not send us an action plan to tell us how they were going to make improvements. At this inspection we found that improvements had not been made, and we identified further breaches of regulations.
The Provider is also the registered 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.
The registered manager had a limited presence in the home. There was a lack of management structure. Much of the decision making and operation of the service hinged on the presence of the deputy manager who was the most experienced member of staff. Her time was spent mainly working on shift alongside a workforce that was mostly comprised of new and inexperienced staff. Important documentation to inform staff about people’s needs was not always completed. Some procedures, for example recruitment, were not appropriately monitored to ensure that all required checks had been made and all necessary information gathered before staff commenced work.
People’s safety was being compromised in a number of areas. Some people told us they felt safe but others felt their health care needs were not being met and this placed them at risk of becoming unwell. People’s needs were not adequately assessed when they moved into the service. This placed people at risk of harm as the support people needed to manage their health needs were not known by the staff caring for them.
People’s care records had not been updated to reflect important changes to people’s care and support needs. Two people did not have care plans and staff did not know their support needs. This put people at risk of serious harm as their health needs were not being monitored appropriately
Staff were friendly to people, but were not always respectful when writing about people in their care records. Staff were discreet when offering personal care support so as to maintain people’s privacy and dignity. Activity provision was inadequate and no provision had been made for people who chose to stay in their rooms and could become socially isolated.
The provider did not have a system to assess the number of staff needed. There were not always enough staff to meet people’s needs and many staff were new and a number were new to caring. Staff induction was inadequate and did not ensure they had the basic skills needed to support people safely. The quality of staff training was not sufficient to ensure staff had the necessary competencies to support people correctly, and use equipment appropriately to ensure they did not place themselves or people in the home at risk of harm. The management of individual risks was inadequate in respect of people’s health conditions and procedures for the emergency evacuation of individuals from the premises had not been developed, so that staff knew what support each person would need.
Two out of four staff spoken with, who had received safeguarding training, were unable to explain what this was, or their role and responsibilities around this or that of other agencies. There was a risk therefore that some staff may not recognise abuse if it occurred.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Whilst no-one living at the home was currently subject to a DoLS, conversations with staff and a review of records showed that the deputy manager and staff were not familiar with this legislation. No action had been taken to assess people within the home to ensure they did not meet the criteria for a DoLS authorisation referral. In addition, staff did not demonstrate a good understanding of the Mental Capacity Act 2005, and only two staff working in the home had received this training. There was a lack of capacity assessments within people’s care records to ensure they were able to make every day and important decisions about their care and support.
Medicines were not managed safely and some staff administering had received minimal to do so. There were large numbers of gaps in medicine administration records and medicines prescribed by the GP to prevent recurring conditions were kept without appropriate care plans in place for their use.
People said they enjoyed the lunchtime meals they received but the quality of tea time meals was variable and for some people this was given too early. People felt confident that they would tell a staff member if they had concerns or wanted to complain but there was no complaints procedure displayed, to inform them about how their concerns should be dealt with, and a complaints log was not maintained to demonstrate how complaints and concerns were being addressed.
The Care Quality Commission had not been notified as required of deaths that had occurred in the home. The provider carried out some audits however these were not used to drive improvement, and the frequencies of audits was not made clear. Where audits had identified shortfalls there was a lack of timescales or evidence that these had been addressed. Audits were not effective and failed to identify the concerns we found.
Although the deputy manager told us people were consulted about the service, there were no records to evidence this. When we asked people if they had been asked about their views they could not recall when this had happened. Visitors to the service and people’s families were asked for their views in annual questionnaires. These views were not always acted upon. For example, the most recent survey analysis completed in February 2015 showed that a lack of activities for people had been raised, but despite this we found there was a continued lack of activities for people at the service.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
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.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.