About the serviceAverlea Residential Home is a care home providing personal care for up to 14 primarily older people, some of whom may be living with dementia. At the time of the inspection, 12 people lived at the service. The home was on two floors, which were connected by a chair lift. The home had a lounge and dining room for communal use. The service is situated in the small village of Polgooth in Cornwall.
People’s experience of using this service and what we found.
The registered manager and provider did not always have clear oversight of the service. Audits, were not completed. The registered manager told us they had not completed any audits since the COVID pandemic.
Staff had not practised fire drills. There were no personal emergency evacuation procedures (PEEPs) in place to inform emergency services of people’s needs in the event of an evacuation. No maintenance checks, including checks of fire alarm systems or legionella checks, had been carried out.
No staff training matrix was available, and staff told us they had not received training. No staff supervision record was held and the registered manager informed us they had not completed any supervisions. No records of falls, injuries or accidents had been completed.
People who regularly refused food and fluids did not have appropriate monitoring charts in place. People had not been referred to appropriate professionals, for example, advice had not been sought from dieticians.
There were insufficient staff working with people. Two care staff covered each shift to care for 12 people. On the day of the inspection 1 staff member had only completed 3 shifts previously and so was unlikely to know people well. There was no staff dependency tool used to assess how many staff were needed to keep people safe.
The registered manager spent most of their time during the inspection cooking for the residential home as well as nearly 100 meals for a service they provided in the local community. The staff rotas showed the registered manager had covered 5 kitchen shifts during the week of 3 September 2023 to 9 September 2023. This meant they had not undertaken required management tasks and responsibilities.
We found the registered manager and provider had not sent death or injury notifications to the Care Quality Commission (CQC) as required.
Each person had a file holding a body map. None had been completed to show where people had marks and bruises. No accident forms had been completed.
People had little or no interaction with staff. Our observations showed there were often no staff present during the day in the main lounge area. There were no records of peoples’ individual activities and no activity coordinator employed. Staff had not had any up-to-date training in dementia care to help ensure they had the skills to enable people to pass their time in an enjoyable way. One person told us, “I’d like to go out more.” While another said, “Not much to do.”
There were two televisions in a shared lounge which were angled so people at either end of the room could see a screen. Both televisions were switched on and tuned to different channels. This meant people were unable to hear either television set.
The internal environment needed updating and attention. We had been notified by a relative of a rat infestation. On the day of our inspection, we were informed by the registered manager this infestation had been dealt with. The main area of concern, a bedroom, had been vacated and floorboards removed, and the carpet pulled up waiting for refurbishment.
Other areas of the service required work. The carpets were torn in places and heavily stained. Many areas of the service, including the main dining area and one of the bathrooms, were cluttered. The chairs and other furniture were old, dated, worn and stained.
We found chemical products left around the building which were easily accessible to people and posed a risk. A door separating the dining room and kitchen had a glass panel to allow people entering the dining room to see if there was anyone on the other side. The panel had been covered by notices obstructing the view from the kitchen. On the day of the inspection there was an accident when a member of staff opened this door and made contact with a service user they had been unable to see, who was using a walking aid on the other side, causing them some discomfort.
Medicines audits had not been completed and staff had not had checks of their competency to administer medicines safely. We could not be sure people received their medicines as prescribed as there were gaps in the MARs (Medication Administration Record). No records were available to support the safe administration of external medicines, such as creams and lotions. Some people were prescribed ‘as required’ pain relief medicines but there was no guidance or protocols in place to help staff make consistent decisions about when these medicines might be needed. Some people were receiving these ‘as required’ medicines on a regular basis and not ‘as required.’ The home held medicines that required extra security. No audits of these medicines had taken place and an error was noted on one person’s record.
People had not been given the chance to feedback on the care and support they had received. No resident meetings or quality assurance survey had been completed. We observed 1 person being given a choice of food at lunchtime. However, they commented to us that they normally were not offered a choice. One person’s records showed they had their food liquidised. There was no record of consent or rationale as to why this happened. People had bed rails and pressure mats in place without any authorisations in place or evidence they had consented to the restriction.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (report published 2 April 2020).
Why we inspected
We were prompted to carry out this inspection due to concerns we received about the service, the care provided, the premises and a vermin infestation.
A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed to inadequate.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this report.
Enforcement
At this inspection we have identified breaches in relation to risk and monitoring systems, safeguarding, medicines, infection control and good governance.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service therefore is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.