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Archived: High Dene Inadequate

Reports


Inspection carried out on 23 July 2015

During an inspection looking at part of the service

We carried out unannounced comprehensive inspections of this service on 26 January 2015 and 2 June 2015. Both found the service to have serious shortfalls and ongoing breaches of legal requirements including Regulation 12 (care and welfare), Regulation 17 (good governance), Regulation 18 (staffing), Regulation 19 (fit and proper persons employed), Regulation 14 (meeting nutritional and hydration needs) and Regulation 15 (premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We carried out an unannounced comprehensive inspection of this service on 26 January 2015 and 2 June 2015. After that inspection we continued to receive further information of concern relating to staffing, people’s safety and how the service was being managed. We requested information from the provider to assure us of what action was being taken to safeguard people from harm. The provider was unable to provide us with all of the information requested within the timeframe we set, and this meant we needed to undertake an inspection of the service to look into the concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk

The service is registered to provide care for up to 15 people. On the day of our inspection there were 9 people living in the service, some of whom were vulnerable because of their circumstances.

On the day of our inspection the service did not have a registered manager in place. 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.

There were insufficient staff on duty to meet people’s needs effectively. This meant people had to wait extended periods of time for support from staff, and did not have their social and emotional needs met by staff. Staff did not have the time to complete care records and documentation appropriately.

New members of care staff had started work without having completed the appropriate training. The staff on shift during our inspection did not have the appropriate knowledge, skills and experience to deliver safe care that met people’s needs.

Risks to people were not being appropriately managed. Where risks had been identified by the service, there was no clear guidance for staff on how to minimise the risks and keep people safe.

Care planning for people remained ineffective and did not accurately reflect people’s current needs in sufficient detail.

People were not supported to eat and drink sufficient amounts. Care plans did not set out people’s specific needs in relation to eating and drinking, and records of what people ate and drank were not being completed properly.

People’s health, safety and welfare were compromised because the provider did not have in place a robust quality assurance process to identify issues that presented a potential risk to people. The provider did not have a system in place to ensure that improvements were made in area’s that had been previously highlighted to them.

During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 2 June 2015

During an inspection looking at part of the service

This inspection took place on 2 June 2015 and was unannounced.

At our last inspection we found that the service had breached Regulations 10, 17, 18,19, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service was not carrying out appropriate background checks on staff, had not provided staff with training relevant to their role and the tasks they were to perform and did not provide care for people in a manner that promoted their dignity and respect. The provider had failed to carry out effective quality and safety monitoring of the service. They also failed to listen and respond to the complaints or concerns that people had expressed.

The service is registered to provide care for up to 15 people. On the day of our inspection there were 14 people living in the service, some of whom were vulnerable because of their situation.

On the day of our inspection the service did not have a registered manager in place. 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.

There were insufficient staff on duty to provide people with the care they required. This meant that people were left for long period without personal interactions and staff did not complete required documentation appropriately. Staff had not received appropriate training. On the day of our inspection we observed inappropriate and incorrect practice taking place. Appropriate background checks were not always carried out before staff commenced employment.

Risks to people were not managed. Risk assessments had been carried out but where a risk had been identified no actions had been taken to mitigate the risk.

The building was found to be dirty and poorly maintained. Corridors and communal areas were cluttered with odd pieces of furniture which presented a hazard to people with reduced mobility.

Medicines were not managed safely. Training for staff who administered medicines was not up to date and medicines administration was not recorded accurately.

Care plans were generic and did not demonstrate that the person or their representative had been involved. They did not contain information about people’s likes and dislikes to enable staff to meet their needs. Where people were unable to make decisions staff were not aware of the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards which ensures that decisions are made appropriately. This put people at risk of having their liberties unlawfully restricted and physical harm.

Care plans had not been reviewed and updated regularly to ensure that they reflected a person’s current care needs.

People were not supported to maintain a nutritious diet. Care plans did not identify people’s nutritional needs and records of what people had eaten or drunk were not completed appropriately. Where people required support to eat or drink this was not always provided in a dignified manner whilst ensuring people ate and drank a sufficient amount.

Mostly care staff demonstrated a caring attitude. However, this was mostly instinctive and was not supported by the provision of training or procedures in the service. The care provision was task led and we saw that the task sometimes took precedence over the care.

People were not supported to carry on activities they had engaged in before moving into the service. Social engagement between people living in the service was minimal.

People’s health, welfare and safety was compromised because the provider did not have in place a robust quality assurance process that identified issues in service provision and potential risk to people. The provider’s quality and safety monitoring had failed to identify the shortfalls we found at this inspection.

The service did not have an effective complaints procedure to monitor and investigate complaints.

Open communication was not encouraged by the service. No recent residents meetings, staff meetings, or quality assurance surveys had taken place.

The service did not have links with local or national organisations to ensure that the care provided reflected up to date practices and guidance.

Inspection carried out on 26 January 2015

During a routine inspection

We inspected on 26 January 2015. High Dene provides accommodation and personal care for up to 15 older people who require 24 hour support and care. Most people using the service were living with dementia. There were 14 people using the service when we visited. At our last inspection on 12 June 2014, we asked the provider to take action to make improvements in protecting the care and welfare of people, respecting and involving people, records and assessing and monitoring the quality of the service. The provider wrote to us to tell us how they had implemented these improvements. During this inspection we found that there was need for further improvement and we had identified further issues which needed action.

The service is not required to have a registered manager in post. 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. Overall responsibility and accountability for the service lies with the provider, who owns the service.

The provider did not have in place a robust system to ensure that the staffing level was appropriate to the needs of people using the service. People, their relatives and health professionals raised concerns about low staffing levels and how this impacted on people’s needs being met.

The provider did not have in place a robust system to ensure that new care staff were of suitable background and character for the role. Appropriate checks had not been made before staff started work to ensure that they were safe to work with vulnerable people, and this put people at risk of harm.

People were put at risk because staff had not received sufficient training to carry out their caring duties safely. Staff were unable to explain how they would safely reposition someone, and were unaware of their responsibilities with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). This put peope at risk of physical harm and at risk of having their liberties unlawfully restricted.

People’s welfare was compromised because staff did not demonstrate a good knowledge of the people they were caring for and interactions observed between staff and people using the service were not always caring and caused distress to people. Staff did not know enough about people to engage them in appropriate meaningful activity, and this led to some people to become bored and distressed.

People were put at the potential risk of receiving unsafe or inappropriate care because their care plans did not contain specific and individualised information about how their needs should be met.

People’s health, welfare and safety were compromised because the provider did not have in place a robust quality assurance process that independently identified issues in service provision and potential risks to people. People did not feel listened to because views they expressed did not lead to the provider implementing changes.

People and their relatives told us they felt safe living at the service and staff were aware of their responsibilities with regard to protecting people from abuse. The provider carried out appropriate investigations when concerns were raised.

People received their medications when they needed them and medications were stored and administered safely.

People and their relatives were involved in the planning of their care, and signed their care documents to indicate their involvement.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 12 June 2014

During a routine inspection

Prior to our inspection we received information from the local authority safeguarding team, who are responsible for investigating safeguarding concerns. This information told us that there were concerns regarding the care that people received relating to their continence care and moving and handling. As part of this scheduled inspection we looked at how people were provided with the care and support that they required to meet their needs.

We spoke with six people who used the service. We also spoke with one person's relative, two staff members and the manager. We looked at three people's care records. Other records viewed included staff training and supervision records, quality assurance and records relating to the safety of the environment. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a staff member asked to see our identification and asked us to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns. One person said, "I feel safe here."

There were enough staff on duty to meet the needs of the people living in the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Records showed that an application had appropriately been made where a person lacked the capacity to make their own decisions about the care they were provided with. Staff had been trained to understand when an application should be made, and how to submit one. We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Is the service effective?

People told us that they were happy living in the service. One person said, "This is like heaven." Another person said, "It is lovely."

Whilst people told us that they were happy living in the service, we found shortfalls which required improvement.

There were shortfalls in the care records of people who used the service. People's care records showed that care and treatment was not planned and delivered in a way that was intended to ensure people's safety and welfare. The records did not sufficiently explain how people's needs were met and how their preferences were considered when planning their care. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People's care records did not show how people were involved in the planning of their care and how their diverse needs were met. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with kindness and respect. One person said, "They (staff) are so attentive, they cannot do enough for you."

Staff offered people choices throughout our inspection, including what they ate and drank and what they did during the day. We saw that the staff listened and acted on what people said.

Is the service responsive?

People's care records showed that where concerns about their wellbeing had been identified, the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse. However, there had been an incident where staff had not contacted the appropriate professionals to ensure that a person was safe. The service had taken steps to ensure that a similar incident did not happen again. People's care records had not been updated to reflect the advice received and the changes in people's needs.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that identified shortfalls were addressed. We found that the service was taking action following recent safeguarding concerns. However, improvements were needed in the way the service recognised risks and took action to reduce them before being told that there were shortfalls by other professionals. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Inspection carried out on 9 April 2013

During a routine inspection

We spoke with five people who used the service. Not all people spoken with could communicate their views of the service they were provided with to us. However, they were able to tell us about their lives and what they enjoyed doing. We also spent some time sitting in the lounge and dining room to observe the care and support provided to people. We saw that staff were attentive to people's needs and they interacted with people in a caring, respectful and professional manner.

People told us that they were happy with the care and support they were provided with and they were complimentary about the approach of the staff. One person said, "It is nice here, I am quite happy." Another person told us that they liked the food they were provided with and said, "I had a lovely breakfast." Another said, "The staff are kind, all smile and are cheerful." Another person said, "They (staff) are nice people."

We looked at the care records of three people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

We saw that staff were trained and supported to meet the needs of the people who used the service.

During a check to make sure that the improvements required had been made

We did not visit the service or speak with people who used the service.

We found that the provider had taken actions to ensure that people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Inspection carried out on 1 November 2012

During an inspection looking at part of the service

We spoke with three people who used the service. They told us that they were provided with a choice of meal and that they had enjoyed their lunch. One person answered, "Yes thank you" when we asked if they had enjoyed their meal.

We observed the support that people were provided with during lunch time. We found that the staff interacted with people in a caring and respectful manner. They responded to people's requests and need for assistance promptly.

Inspection carried out on 3 July 2012

During an inspection looking at part of the service

We spoke with three of the ten people who used the service. They said that they were happy with the service that they were provided with. One person said "All is well."

One person said that they were provided with enough to eat and drink. We asked another person if they had enjoyed their breakfast and they said "Yes." We asked them if they had chosen what they wanted to eat and they said "Yes, I chose it."

We asked two people if they were comfortable in the service and they both said that they were.

Inspection carried out on 2 April 2012

During a routine inspection

We spoke with six people who used the service. Two people were able to tell us about their views about the service that they were provided with, others answered yes or no to our questions and talked with us about their lives and memories. We also observed the care and support that people were provided with during our visit.

All six people spoken with told us that the home was clean and that they were comfortable in their bedrooms.

People spoken with told us that the staff assisted them when they needed help. One person said 'They (staff) are very kind', another person said 'They (staff) are very good to me' and another three people said that the staff respected their privacy and treated them with respect.

Two people told us that they had enjoyed their meals, that there were choices of meals and that they were provided with enough to eat and drink.

One person told us that a representative from their local church visited them regularly.

Inspection carried out on 12 January 2012

During an inspection in response to concerns

We spoke with three people who used the service. We asked one person if they were well and happy. One person smiled and nodded and another said 'yes thank you'.

One person said that they were not happy and they gave us a cushion from a chair. We were not sure what they wanted to do with the cushion and we asked a staff member if they could help. They took the cushion out of our hand and replaced in on the chair, they did not ask the person what they wanted.

Upon our arrival several people were sitting in the lounge area and the television was on. Later during our visit we saw staff talking with people and one staff member read a book with a person.

Inspection carried out on 22 September 2011

During an inspection looking at part of the service

We spoke with three people who used the service. One person told us that they were happy with the changes in location of the lounge and dining room. They told us that they were comfortable living in the home. Another person told us that they had enjoyed their lunch and they got enough to eat and drink. Another person told us that the staff smiled at them and treated them with kindness.

Inspection carried out on 24 March 2011

During a routine inspection

One person who uses the service, and their visitor, told us that the staff were caring and treated them with respect, listened and acted on what they said. They told us that the food was of good quality and they were always offered a choice of meals.

During our inspection of the service on 17 May 2010, we received surveys from six people who lived in the home. All six told us that they were always provided with the medical support that they needed, that they knew who to speak with informally if they were not happy, that the staff were available when they needed them and that the staff always listened and acted on what they said. The survey asked if there were activities that they could participate in, two answered always, one answered usually and three answered sometimes. The survey asked if they were provided with the care and support that they needed, three answered always and three answered usually. Five said that they knew how to make a formal complaint and one said that they did not.

Reports under our old system of regulation (including those from before CQC was created)