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Archived: Cheam Cottage Nursing Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

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

Inspection areas

Safe

Inadequate

Updated 26 March 2018

The service was not safe.

The provider did not take appropriate steps to safeguard people from abuse.

Risks to people's safety, particularly the risk of developing pressure ulcers, were not properly assessed and managed.

The provider did not always take appropriate steps to protect people from the risks of being cared for by unsuitable staff.

Effective

Requires improvement

Updated 26 March 2018

The service was not consistently effective.

Although staff received support in other areas, they did not always have the training they needed to care for people effectively.

People only received care they consented to or, if they did not have capacity to consent, this was agreed in line with the requirements of the Mental Capacity Act (2005).

People received enough food and drinks to meet their needs and had support to attend healthcare appointments.

Caring

Requires improvement

Updated 26 March 2018

The service was not consistently caring.

The care provided did not always show due regard for people's privacy and dignity.

Staff did not always give people the support they needed to understand and make choices about their care.

Staff took time to get to know people and build relationships with them.

Responsive

Inadequate

Updated 26 March 2018

The service was not responsive.

Care was not planned in a person-centred way and staff did not always support people in line with their care plans. Care plans were not always completed and did not always contain the up-to-date information staff required to support people in line with their needs and preferences.

There were activities on offer but these were not person-centred and did not suit everyone who used the service, meaning some people did not have enough to do.

People's cultural and religious needs were met.

Well-led

Inadequate

Updated 26 March 2018

The service was not well-led.

The provider did not have an effective system for assessing, monitoring and improving the quality of the service. They did not identify any of the concerns we found at this inspection.

Where the provider made improvements, these were not sustained and did not address shortfalls in a proactive way before they became concerns.

The provider did not use effective methods of gathering people's views about the service they received.