Archived: Knotty Ash Residential Home

Updated 23 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection which took place on 10, 11 and 14 January 2019 and was unannounced. The inspection team included an adult social care inspector, inspection manager and an expert by experience. An expert-by experience is a person who has personal experience of using or caring for someone who uses this type of care service. In this instance, care of people living with dementia.

Before the inspection we reviewed information relating to the service including notifications sent to us by the provider. A notification is information about important events which the provider is required to tell us about by law. We contacted the local authority quality assurance team, to ask their views about the quality of the service provided.

During the inspection we spoke to the registered provider, the home manager, deputy manager, the assistant support officer, activities coordinator, and five members of care staff on duty. We were also able to speak with four visiting relatives and five people living in the home.

We spent time observing care and used the short observational framework for inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us. We spent time looking at records, including four people's care records, one staff file and other records relating to the management of the service, such as policies and procedures, medication records, training records and audit documentation.

Updated 23 February 2019

This inspection took place on 10, 11 and 14 January 2019. The first day was unannounced; the provider knew we were returning on the other days.

Knotty Ash 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. The service provides support to up to 35 people and there were 32 people living in the home on the day of the inspection, many of whom were living with dementia.

The service did not have a registered manager in post at the time of the inspection. 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 left the service in November 2018. A new manager had been recruited and started in post a few days before this inspection.

At the last inspection in June 2018, the registered provider was found to be in breach of Regulations 11, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because consent was not always gained in line with the Mental Capacity Act 2005, people's records were not always accurate or up to date, the environment was not always safely maintained and systems in place to monitor the quality and safety of the service were not effective. We asked the provider to complete an action plan to show what they would do to improve the key questions of safe and well-led to at least good. During this inspection, we looked to see if they had made the necessary improvements. On this inspection we found some small improvements had been made regarding the Mental Capacity Act 2005, but the provider remained in breach of some legal requirements.

At the last inspection the provider was in breach of regulations as the systems in place to monitor the quality and safety of the service were not effective. We found during this inspection, that they were still not effective. Quality assurance processes were not in place to review all areas of the service and those that had been completed did not always reflect what actions had been taken to address the issues. If more robust quality assurance processes had been in place and were being monitored closely, then the serious issues that were found during the inspection would have been identified earlier by the registered manager or the provider and dealt with.

The management team completed various quality audits including care plans, medicines, cleaning and health and safety. However, these audits had not proved effective at identifying issues and were not reviewed to ensure issues had been resolved.

Medicines were not always managed safely within the home, as they were not booked in and counted accurately, there were no guidelines in place for staff to administer medicines that were prescribed ‘as needed’, and there were no times recorded for the administration of medicines that needed to be given at specific times.

There was no clear system in place to oversee accidents and incidents. Although a log was maintained, no information was analysed to establish potential themes or trends. This meant it would be difficult for lessons to be learnt or for actions to be taken to prevent recurrence of some incidents.

Small improvements had been made in relation to the homes compliance with the Mental Capacity Act 2005 (MCA). We saw a care file which had appropriate mental capacity assessments completed, and evidence of best interest decisions being made. However, we found that staff had not been trained in MCA, and had limited knowledge of how this related to peoples care. We have made a recommendation about staff training on the Mental Capacity Act 2005.

Some peoples care records lacked detail. We saw some care files that contained detailed information, including peoples likes, dislikes and preferences regarding personal care and food. However, some care files contained very limited information. and had limited personal details in there. A lack of personal information makes it harder for staff to tailor care to suit that persons preferences and needs. We spoke to the manager and director about this and we were told that care files were currently being updated to make them more person centred.

People told us that staff treated them in a caring way and respected their privacy and supported them to maintain their dignity.

People told us they felt safe with the care provided by staff. Staff we spoke with understood their responsibility in relation to protecting people from the risk of harm. Staff told us they had received training that had helped them to understand and support people.

The home appeared clean and well maintained during the inspection. Staff had access to personal protective equipment such as gloves and aprons and bathrooms contained paper towels and liquid hand soap to help prevent the spread of infection.

Activities were available and we saw people joining in and enjoying singing and dancing during the inspection. We also observed lots of warm and caring interactions between staff and people who lived at the home throughout the inspection.

Our observations throughout the day showed that people were treated with dignity and respect. People received comfort when needed. Staff used their knowledge of people to engage them and help build positive relationships.

Policies set out that when a safeguarding incident occurred management needed to take appropriate action by referring to the relevant safeguarding agency. However, we found an incident had not been reported to us, as legally required.

Safe staff recruitment procedures were in place to protect people from receiving personal care from unsuitable staff.

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.

The provider was in breach of the regulations surrounding safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.