Archived: Curzon Park Residential Home

Curzon Park is situated in a residential part of Chester. It is registered to provide personal care for up to 25 older people and people living with dementia. At the time of the visit there were 20 people living at the service.

There was no registered manager in post, and the service was without a manager. There had been four managers employed by the registered provider over the last 12 months, and following the visit a new manager started. 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.

In January 2016 the service was rated as ‘requires improvement’ and we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were no systems in place to monitor the quality of the service. At this inspection we found that the required improvements had not been made. We also identified a number of new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Prior to our inspection, the fire service had identified a number of concerns relating to the premises. As a result an enforcement notice has been issued with a compliance date of 9 February 2017.

Parts of the environment were not safe and placed people at risk of harm. In two examples we required the registered provider to take immediate action to keep people safe. There were no audits of the environment to ensure that it was safe, and therefore the registered provider had failed to identify issues that needed rectifying.

Action was not taken to ensure people’s physical health was maintained. There was no system in place to ensure that pressure relieving mattresses were on the correct settings, and in one example we found the setting was far too high. This increased the risk of people developing pressure sores. Risk assessments were not always accurate and action had not been taken to keep people safe. For example, the malnutrition risk assessment for one person had failed to identify that they were at high risk of malnutrition.

There had been a high proportion of accidents and incidents within the service since September 2016 in relation to the number of people using the service. On multiple occasions during the visit we saw that staff had left people unobserved in communal areas, which increased the risk of incidents occurring.

People were not protected from the risk of infection. An up-to-date legionella check had not been completed to ensure that bacteria levels in the water were safe and water temperatures were not being monitored. Laundry processes were not sufficient to prevent cross contamination and parts of the environment were dirty.

Recruitment processes were not robust. Staff had not been required to provide references from previous employers. This meant that the registered provider had not had access to important information needed to make judgements about their suitability to work with vulnerable people. A check by the disclosure and barring service (DBS) had been completed.

Staff had not received training in key areas such as safeguarding, infection control and moving and handling. This meant that the registered provider had failed fulfil their duty to ensure that staff knowledge and skills were up-to-date.

People were not always treated with dignity and respect and their confidentiality was not protected. For example staff spoke sharply to people at times and one person’s care record described them as “demanding” and was not strengths based. Letters labelled as ‘private and confidential’ were not kept securely and were left in a tray near the entrance to the building.

There were limited activities available for people. People’s relatives told us that staff did nail care and baking activities, however during the visit there was no entertainment for people. One relative told us that there had previously been an activities co-ordinator, however this post had been cut to save money.

Leadership within the service was poor. Staff did not have a management structure to refer to and we saw examples where they did not receive the support they needed from the registered provider. There were no audit systems in place to monitor the quality of the service, and the registered provider had not completed quality monitoring checks. This meant that the registered provider had failed to identify and act upon serious issues that we identified.

Following the visit CQC took urgent action and placed a condition on the registration of the provider to ensure that the service had sufficient staff working in the home to maintain people’s safety in the event of a fire.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

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.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Curzon Park is located in Chester and is registered to provide personal care and accommodation for up to 25 older people and people living with dementia. At the time of the inspection there were 15 people living within the service.

At the time of the inspection visit there had not been a registered manager in post since June 2016 and the current manager had not yet submitted their application to become registered with the CQC. 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 overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that registered providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Whilst the safety and security of the premises had been improved in some areas, there remained some aspects of the service that required further improvement. An enforcement notice had been issued by the fire service which required the registered to provider to make the required improvements by the 22 June 2017. At this inspection some actions remained outstanding and following the inspection visit we received information from the manager that it was unlikely that the requirements would be completed within the timescale required by the fire service. This placed people at on going risk of harm in the event of a fire.

Improvements had been made with regards to infection control in some areas, however not others. Parts of the kitchen needed cleaning and action had not been taken to address an infection control risk in the laundry room. One room which we identified at the last inspection had retained a strong malodour. This placed people at continued risk of infection.

At the last inspection we identified issues relating to the suitability of the premises. At this inspection we identified that improvements had been made in some areas but not others. People did not have the option of having a bath because the facilities were not adequate. This placed people at risk of a deterioration in their health.

At the last inspection we identified that quality monitoring processes were not in place which had led to a deterioration in the service being provided. At this inspection the manager had introduced audit systems to monitor the quality of the service. However, the registered provider did not have any systems in place to monitor the service being provided and surveys had still not been completed to ascertain the views of people using the service or their family members. This meant that the registered provider would remain unaware of any deterioration, and showed a lack of learning from previous issues.

The registered provider had failed to ensure there were sufficient funds available to buy food, which had resulted in the manager having to use their own money to do this. Following the inspection visit the manager told us a system had since been put in place to prevent this from occurring again. This showed poor co-ordination by the registered provider and a lack of care for the people using the service.

Adaptations had not been made to the environment to promote the wellbeing of people living with dementia, despite the service being a dementia specialist service. This meant that aspects of the service did not meet the needs of the service being provided. We have made a recommendation to the registered provider on seeking advice and guidance regarding adaptations to the environment for people living with dementia.

People’s rights and liberties were being protected. People were being supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We identified that mental capacity assessments were not always being completed as required, however following the inspection the manager confirmed that this had been addressed.

At the last inspection we identified issues with the safe administration and storage of medication. At this inspection we found that people were receiving their medication as prescribed by staff who had been trained in the safe administration of medication. Staff competencies to carry out this role had also been reviewed. This helped ensure that people’s health and wellbeing was maintained.

At the last inspection we identified issues around staff training. Staff had now received training in a majority of areas needed to carry out their role effectively, and were booked to complete training in first aid, which remained outstanding. Staff presented as knowledgeable around preventing pressure sores and weight-loss and were taking appropriate action to monitor and prevent any deterioration.

Care records had been improved since the previous inspection and were accurate, up-to-date and personalised. These included important information for staff around the support they should provide to people using the service.

Staff morale had improved since the last inspection and this was reflected in the more positive interactions with people using the service. It was apparent from these interactions that positive relations had been developed between people and staff, and that people felt at ease in the company of staff. Staff commented that they felt well supported by the manager, whereas previously there had been no management support in place.

Curzon Park had been without a registered manager since May 2016. Whilst there was a manager in post, they were not registered with the CQC. 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.

Curzon Park is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate up to 25 people in one building. At the time of the inspection there were 14 people using the service. The service is registered to support older people living with dementia. The service is situated close to Chester in Cheshire West. It is situated over two floors and has access to gardens.

People were at risk because parts of the service were not safe. Wardrobes in some of the bedrooms were unsteady and not fixed to the walls. Window restrictors in some bedrooms were broken, and one window at the top of the stairs was not restricted and would not close. This provided access to the roof. In the upstairs toilet we also found the boiler was accessible and that the exposed pipework around this was very hot to the touch. We asked that the registered provider take immediate action to address these issues and received confirmation that this had been done.

The fire service had an enforcement notice in place which had required the registered provider to ensure the premises were meeting standards required by fire safety regulations. The enforcement notice had required works to be completed by the 22 June 2017. The registered provider had failed to meet this deadline, and had commenced works on part of the requirements on or around the 28 August 2017. These works were still on going, whilst other works had yet to be commenced. Some of the work being completed had not been carried out to a high standard. For example, some fire doors did not fully close, and others had gaps between their base and the floor. We asked that action be taken around this, and following the inspection received confirmation from the manager that this had been done.

Infection control processes were not robust and posed a risk to people’s health. The laundry was located in an outhouse that was dirty and ill maintained. There were cobwebs around the ceiling, dirt under the shelves and a piece of tarpaulin covering part of the roof. There were no hand washing facilities for staff to use after handling dirty laundry, and there was a large crack in the floor.

Pest control records showed that there was rodent activity in the garden which posed a ‘risk to the site’. Actions to address this had not been acted upon, despite these recommendations having been made following three visits carried out in August 2017 and September 2017. During the inspection we observed the back door to the kitchen being left open which made this area susceptible to pests.

The environment was poorly maintained. It was identified that a number of downstairs bedrooms, the downstairs toilet and bathroom were without hot water. Staff and the manager confirmed that issues with the boiler had been ongoing for at least eight months, however the past two weeks this had become worse. Two radiators were found to be leaking with plastic containers placed underneath, collecting dirty water. The inside and outside of the building contained areas of disrepair and no adaptations had been made to meet the needs of people living with dementia, in line with best practice.

Staff had received training, however a majority of this had been provided through DVDs that dated back to 2010. This meant these may not be up-to-date with best practice or current legislation. There was no formal process of assessing whether staff were competent following training sessions, however the manager told us they carried out observations but did not document these.

Whilst we found evidence of people being supported to have maximum choice and control of their lives and staff supporting them in the least restrictive way possible; the policies and systems in the service were not always supportive of this practice. Mental capacity assessments were not always completed in line with the requirements of the Mental Capacity Act 2005, and there was no centralised record kept of those people who were subject to a Deprivation of Liberty Safeguards (DoLS), which meant the manager could not be sure when these needed to be reapplied for.

During the inspection we identified examples where people’s dignity had not been upheld. Some people appeared unkempt whilst others appeared well groomed. Following the inspection a member of staff contacted us with concerns that one person had not been appropriately washed after an episode of incontinence due to hot water not being readily available.

At the last inspection in May 2017 we found ongoing issues relating to audit and quality monitoring systems. During this inspection we identified that the registered provider had employed an external quality monitoring company to assess the service. Whilst actions had been identified as part of this process, not all of these had been acted upon.

Audit systems remained ineffective and were not robust. For example, Infection control audits had not considered issues relating to pest control or the availability of functioning hand washing facilities. In one instance an issue had been identified on a monthly basis since December 2016, however action had not been taken to address this.

Health and Safety audits were not being completed and had failed to identify or act upon issues that we found during the inspection.

There was no support in place for the registered manager. No supervisions were held with the manager and the registered provider communicated primarily via text. This meant they were not readily available to support with making decisions that needed their input.

Staff had a good knowledge of safeguarding procedures and processes and knew how to report any concerns they may have. The manager had previously reported issues to the local authority in line with the local authority’s safeguarding policy. This helped ensure people were protected from the risk of abuse.

People were supported to take their medication as prescribed. Medication administration records (MARs) were signed by staff which showed this had been given as required. We identified that protocols were not in place to inform staff when to ‘as and when’ (PRN) medication. We asked the manager to ensure this was addressed.

People were supported to have a diet that was appropriate to meet their needs. Meals were well presented and looked appetising. Staff were aware of those people who needed encouragement and ensure this was given in a respectful manner. This helped protect people from the risk of malnutrition.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

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.

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.

Curzon Park Residential Home is registered to provide accommodation with personal care for up to twenty five people living with dementia. It is a large detached property set in its own grounds consisting of twenty three single rooms and one double room. At the time of this inspection there were 23 people living at the home.

There is a registered manager in place at this service. 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.

A previous inspection undertaken in June 2013 found breaches of legal requirements around the maintenance of the environment and security of records. An action plan was received and further inspection in November 2013 found that the service met the regulations.

On this inspection we identified a number of concerns and a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we told the provider to taken at the back of the full version of the report.

We found the registered provider had no quality assurance system in place and therefore many of the issues identified during the inspection had not been highlighted by the service. Medication audits were not robust and failed to highlight discrepancies in medicines management. There were no audits completed in regards to infection control, the environment or documentation relating to people who used the service.

People told us they were supported with their medication and commented that staff were “good with her tablets” and “on the ball with medication”. The administration of medication was carried out safely however, there were concerns regarding some aspects of the recording of medication.

People told us that they felt safe at the service and that the staff understood their care needs. People commented “The staff are lovely”, “The staff are very friendly and caring”, “The home is small and homely” and “People here are happy and safe.”

The staff team understood people’s care and support needs, and we observed people were treated with kindness and respect. We looked at the care records of people who lived at the service and found information was person-centred, reflected people’s needs and wishes and was up to date.

People told us the food was good. We observed the lunch time meal being served and saw that sufficient staff were available to help people as required throughout the mealtime.

The registered provider had policies and procedures in place to guide staff in their day to day work, We looked at staff training and we saw that staff undertook a range of training in line with their identified roles. Staff had up to date supervision and appraisals and had the opportunity to attend relevant meetings. Good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people could be confident that they were protected from staff that were known to be unsuitable and that staff were competent in their roles.

The registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Staff had received training in safeguarding adults and during discussions said they would report any suspected allegations of abuse to the person in charge. Policies and procedures related to safeguarding adults from abuse were available to the staff team. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at the service.

People lived in an environment that was clean and hygienic. However, parts of the building were tired and we considered that it would benefit from redecoration and refurbishment.

There was enough staff working to meet the needs of people. People who lived at the service said that staff were available when they needed them. We noted that an activities coordinator was employed at the service and that a range of activities were available to people to encourage social contact and stimulation.

People told us they would approach the staff on duty or the management team if they had a concern or complaint. The registered provider had not received any complaints over the last year, however, processes were in place should a complaint be raised and these showed they would be dealt with in a timely manner.

We found that some maintenance had been carried out to improve the environment.

We also found that people's confidentiality was being maintained because people's personal records were being stored securely.

People told us that they were consulted about the care provided to see whether it was meeting their needs.

People told us the food was good, that they were offered choices and they got enough to eat. A visitor said that the person they visited had put on weight since admission and seemed "much better".

People we spoke with were complimentary about the staff. One person said "The staff are very nice" and another said "The staff are lovely, they're ever so kind".

Staff received appropriate training and supervision.

However, records containing personal information were not all stored securely, which posed a risk to confidentiality.

Also, more attention to the maintenance of the premises was required.

"It's very good'

'Staff are kind and look after us"

As the people who lived at the home had limited mental capacity to consent or make informed decisions, the home kept in regular contact with relatives and involved them in any decision making.

Care records were simple, concise and personalised to the individual. Care plans contained relevant information in relation to individual needs and preferences and were regularly reviewed.

Staff treated people with dignity and respect and were knowledgeable about a person's care. People's needs were tended to in a timely, responsive manner.

There was a lack of arrangements for the appraisal, training and supervision of staff and no staff meetings had taken place since December 2011. This meant staff, were not properly supported in their day to day duties.

The home was in need of some improvement to ensure it was suitable for the people who lived there. There was a leak in the ceiling in the main corridor, a fault on the alarm panel and one bedroom smelled of urine.

Staff records, the service user guide and complaints policy were out of date. This meant there was a lack of proper information about staff and the home. Care records were not stored securely and were kept in the manager's unlocked office posing a risk to confidentiality.