We inspected this service on 22, 28 March and 5 April 2018. Wheathills House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Wheathills House accommodates up to 30 people in one building.
The service was last inspected in 7 September 2016. There were two breaches of regulation at that inspection. At this inspection the provider continued to be in breach of these regulations as they had not taken action to respond to the breaches.
On the first day of our inspection 28 people were using the service and this was reduced to 26 on the 5 April 2018. The service is required to have a registered manager. 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 provider is the registered manager.
During this inspection we found the service was unsafe as there were no systems in place to manage the service, identify and mitigate risk and therefore ensure people’s safety.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice
There were no systems in place to deploy staff to ensure people were supervised at all times. The provider was unable to show the staff had trained in and understood how to protect people’s rights under the Mental Capacity Act (MCA) and Deprivation of Liberty (DoLS).
Not everybody had a care plan that detailed their care needs and wishes. The care plans that existed were not inclusive and the information was inaccurate or was out of date. Some care plans consisted of data from various agencies. This information was not analysed and a plan of care written. There was no assessment process in place to re-admit people who had been in hospital. Daily notes were written in diary form. They were not referred to nor were they filed in a manner that supported the care of people.
On the first inspection visit the provider was unable to show us care plans for seven people who were using the service. Risk was not effectively assessed and put in an up to date care plan for staff to follow. Some accidents and incidents were recorded, however they were not reviewed to ensure the cause of accidents was recognised and, where appropriate, acted upon to prevent other accidents happening.
There was no process in place to identify people who were at risk of choking. People were left alone during breakfast without means of communication or calling for assistance.
There were not enough staff to meet people’s needs in a timely manner. People were left unattended for long periods of time. Staff were not up to date on the training the provider considered necessary to care for people safely and effectively.
Some medicine was stored and administered as prescribed. There were no systems in place to store medicines for people who were using the service for respite care.
There were no communication systems in place to ensure all staff were aware of the current needs and welfare of people. The provider was unaware of the number and gravity of the falls people had and was unable to supply us with accurate and up to date information when asked for.
Staff were not supported, trained or supervised. There were no systems in place to recognise and put best practice in place.
Menus were planned in advance taking in people needs wants and wishes.
There were no systems in place to recognise signs that the service may no longer be able to meet people’s needs.
People were not always referred for health assistance in a timely manner.
People’s dignity was not always promoted. People were not involved in the planning or delivery of their care. Staff were kind in their interactions with people. However they did not always knock before they entered a person’s room. Independence was not always promoted.
Care was not person centred and reviews did not reflect the condition of people. People were not supported to pursue their hobbies and interests. They were bored. Choice was not promoted.
There was no easily assessable complaints process in place. People did not have the opportunity to join in community based activities. There was an activity co-ordinator in place but they didn’t have a budget to arrange entertainment or activities.
The provider did not ensure the service was managed effectively and in the best interests of people. There were no systems in place to review the quality of the service. The provider did not ensure there was a system in place to inform CQC of incidents. Therefore there were incidents we were not informed about. Record keeping was poor and ineffective. There was no system in place to keep staff updated on people’s changing needs and wishes. Some records were missing and others were not dated appropriately.
Staff were not recruited in a manner that promoted the safety of people.
There was no quality assurance process in place. No audits were completed, which meant the provider could not be assured they knew how the service was recognising and meeting people’s needs and wishes. It also meant there was no process to learn from mistakes to ensure they were not repeated.
We identified the provider was in breach of eight of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.
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.
You can see what action we told the provider to take at the back of the full version of the report.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.
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.