Archived: Cheam Cottage Nursing Home

Updated 26 March 2018

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 inspection took place on 30 May and 1 June 2017 and was unannounced. It was carried out by an inspector and a specialist advisor, who was a tissue viability nurse.

Before the inspection we reviewed the information we held about the service. This included previous inspection reports, notifications the provider is required to send to us about events that take place within the service, information received from commissioners and a provider information return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with three people who used the service, four members of staff and the registered manager. We looked at nine people’s care plans, three staff files and other records such as maintenance checks, audits and staff rotas. After the inspection we spoke with commissioners, social workers and healthcare providers who were involved in the care of people who used the service.

Updated 26 March 2018

This inspection took place on 30 May and 1 June 2017 and was unannounced. At our last inspection on 9 November 2016 we found the provider had taken action to address two continued breaches of regulations that we found in June 2016. However, they remained in breach of the regulation in relation to dignity and respect. We judged that the provider required more time to fully meet this regulation, which we looked at during the current inspection.

Cheam Cottage Nursing Home is registered to provide nursing and personal care for up to 19 people. At the time of our inspection there were 13 people using the service. There was 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.

At this inspection we found a number of risks to people’s safety. The provider did not record or appropriately respond to allegations of abuse, which meant people were not adequately protected from abuse and ill-treatment. Staff did not always follow risk management plans to protect people from the risk of developing pressure ulcers. Equipment used for the same purpose was worn out or not being used correctly and was not providing effective pressure relief. Pressure ulcers and wounds were not appropriately recorded or risk assessed and people did not have wound management care plans. This meant people were at unnecessarily high risk of developing pressure ulcers or of existing wounds deteriorating further. We also found other risks were not properly assessed and managed, such as risks associated with people using bed rails. Equipment used for assisting people with moving and handling was not always checked and serviced regularly to ensure it was safe to use.

Staff were not always recruited safely. The provider did not obtain all of the documents and information the law requires them to have for all new staff, to help ensure those recruited are suitable to care for people.

Medicines were generally managed safely, although information in care plans about medicines people were taking was not always up to date. This increased the risk of errors or of miscommunication with healthcare professionals.

Although the provider demonstrated at our last inspection that they had made improvements to the service, we found at this inspection that they had not been able to maintain these. As a result, people were and remained at risk of experiencing poor care and treatment that compromised their rights and failed to meet their needs. The provider’s audits and checks did not contain sufficient detail to be effective in identifying and addressing shortfalls in the quality of the service. Consequently, they had failed to identify the areas of concern we found at this inspection. Where concerns were identified, these were not addressed in a timely manner.

The provider carried out surveys to obtain the views of people who used the service, but these were not effective or reliable because they were completed by staff and did not necessarily reflect people’s own views. The provider did not attempt to make the process more accessible for people with complex communication needs.

Staff did not have the training they needed to provide effective care to people with pressure ulcers and wounds or to people living with dementia, although staff were satisfied with the support they received in other areas. The provider sought advice about good practice from reputable sources.

Staff did not always give people the support they needed to understand and make choices about their care. Staff did not always support people in a way that promoted their privacy and dignity as they were sometimes left with food on their hands or wearing stained clothing and staff did not always knock on people’s doors before going in.

People’s care plans were not always sufficiently personalised to give staff the information they needed to meet people’s individual needs. The care plans contained generic information that did not necessarily apply to everyone. Although some also contained personalised information about people’s personal care needs and preferences, others did not. People sometimes did not have care plans for certain aspects of their care such as wound care or diabetes management. Information about the care people required was often out of date or had not been included. Staff did not in practice always give people the support that was indicated by their care plans.

Some people were satisfied with the activities on offer but others were not. Activities were not person-centred and people often did not get anything to do if they did not want to take part in what was being offered to everyone.

Staff made an effort to keep people informed about what they were doing while carrying out care related tasks. They took time to get to know people and learn about their life histories and showed an understanding of how to meet people’s emotional and cultural needs.

People had enough to eat and drink and received support to attend healthcare appointments.

We found the provider was meeting their legal requirements in terms of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were enough staff to care for people safely and staff were able to respond appropriately to behaviour that challenged the service.

In total, we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection, we have imposed a condition on the provider’s registration, which states that they may not admit people to this home without prior written permission from CQC. We are also taking further action against the provider for repeated and serious failures to meet eight regulations. 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.

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.