Archived: Neilston Residential Care Home

Updated 19 July 2017

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 was 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 inspection was brought forward because we had received concerns.

This inspection took place on 1 and 2 February 2017. The first day was unannounced. The second day was announced. The inspection team included two inspectors over the two days and a specialist advisor, on the first day, who was a nurse with experience of working with older people and people living with dementia.

Before the inspection we had received concerns relating to the health and welfare of people using the service. We reviewed information we held about the registered provider. This included information from previous inspections and notifications (about events and incidents in the home) sent to us by the provider. The provider completed a Provider Information Return (PIR) before the

inspection. The PIR is a form that asks the provider to give some information about the service, what the service does well and improvements they plan to make.

We met all of the people who lived in the service; most of them were living with dementia and were unable to communicate their experience of living at the home in detail. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We spoke with one relative.

We went into all rooms and areas in the home. We spoke with the registered provider, the manager, the deputy manager, six staff, and one visiting health care professional.

We observed the interactions between staff and people living at the home and reviewed a number of records. The records we looked at included eight people's care plans, the provider's quality assurance system, policies and procedures, three staff files, training files, accident and incident reports, records relating to medicine administration and staffing rota.

Updated 19 July 2017

This inspection took place on 1 and 2 February 2017 and was unannounced. We brought the inspection forward due to concerns raised in relation to people's care and welfare. In April 2015, the service was rated "inadequate" and the local authority quality monitoring team worked with the provider and staff to support them to bring about improvements. In January 2016 the home was rated as "requires improvement" after improvements were made. Evidence gathered during this inspection showed the service had not been able to maintain these improvements as nine breaches of regulations were found.

We have shared our concerns with commissioners and the safeguarding team. Following this, with the agreement of the provider, health professionals visited the home to assess people's safety and wellbeing. Some people's care needs are currently being reviewed by the local authority commissioners. In addition, the local authority quality monitoring team are working with the provider and staff to support them to bring about improvements.

Neilston Residential Care Home is registered to provide personal care and support to 22 people who may be living with dementia. The registered manager was also the provider of the service but they did not have day to day responsibility for the running of the service. They are referred to in this report as the registered provider. The registered manager who did have day to day responsibility for the service left in January 2017. Another manager had been appointed and had been working at the home for four weeks at the time of our 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.

People were not safe and were placed at risk of harm. Risks to people's physical health were not identified and managed. The management of falls, choking, skin and pressure area care, medicines, and moving and handling was unsafe. Poor monitoring and management of people's eating and drinking put some people at risk. Care plans were not clear and up-to-date, which meant staff did not have current information on how to meet people's needs. This meant people were at risk of receiving inconsistent care and not receiving the care and support they needed. Staff did not always make referrals to other healthcare professionals to ensure people's care and treatment remained safe.

The provider did not operate safe and robust recruitment procedures. Checks required by law had not been carried out before staff started work at the home. This exposed people to unnecessary risk.

People did not benefit from enough staff to give them the care they needed. At various times throughout the inspection, we observed people sitting in the lounge with no staff present. Some of these people were unable to mobilise independently and had no way of calling for assistance if they needed it. The care and support we saw staff giving in the lounge was largely task based. For example, supporting people with moving and handling transfers and offering drinks or food. There was little meaningful communication between staff and people in the lounge area throughout the inspection. This meant people's social needs were not being met and there was a lack of consideration for their wellbeing.

People did not receive support from staff who had appropriate training and supervision to ensure they had the skills and knowledge to meet their needs. Although some dementia training had been completed, we observed not all staff understood how to meet the needs of people living with dementia. Most interactions between staff and people were poor. We observed staff did not always listen to people or support them to express their views. For example, one person asked to go to the toilet and was ignored, despite there being a strong smell of urine. People were not treated with respect at all times. For example, we observed staff telling one person they were a ‘good girl’ and another person was told they were ‘being naughty’.

People did not benefit from meaningful activities. People had not been supported to follow their individual interests. We saw people who sat in the main lounge spent most of the time dozing or looking round the room. The television was on but not many people were watching it. The manager told us organised activities took place for two hours on a Tuesday and Friday. There was little attempt to engage any of the people with any form of activity or conversation.

There were restrictions to people’s movements around the home and these had not been assessed as being the least restrictive option to keep people safe. For example, people’s bedroom doors were alarmed and stairgates were in place. The environment was not suitably adapted to meet the needs of people living with dementia. We had made a recommendation at our inspection in April 2015 in relation to the environment but there had been little progress since then in meeting people’s needs.

Risks to people within the environment were not assessed or managed. In people’s bedrooms and communal areas we observed items that people living with dementia may misuse or swallow. People were not protected by the prevention and control of infection. The environment was dirty and dusty. The premises were not free from offensive odours. Odours of urine were noted at different places and different points of the inspection. Infection control practices were poor. We identified concerns in relation to the safety of the electrical installation and hot water temperatures. We asked the provider for more evidence so that we could judge whether people were safe but we did not receive this.

Weak leadership and a lack of oversight of the service had allowed poor practice and inconsistent care to be delivered. When the registered manager who had day to day responsibility for the service left in January 2017, another manager was appointed. Following our inspection, we were informed this manager had resigned from their post. The previous manager then returned to cover three hours a day each afternoon, from Monday to Friday. The provider told us they were unaware of events relating to the care of people living in the home. The provider had not developed the staff team to ensure they displayed the right values and behaviours towards people. At times, this resulted in poor outcomes for people who lived in the home.

Management systems were not effective as they had not identified and addressed the risks and issues we found during our inspection. There had not been any recent audits at the time of our inspection. Where the registered manager had identified issues previously, these had not been actioned within the timescale given. The local authority quality monitoring team had completed a report with recommendations, following a visit to the home in October 2016. We identified the same issues during this inspection. Records relating to the care and treatment for each person were not accurate, up-to-date or easily accessible. This showed the provider had not taken action to ensure improvements were made.

During the inspection, we identified a number of concerns about the care, safety and welfare of people who lived at Neilston Residential Care Home. We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.