You are here

Archived: Cheam Cottage Nursing Home Inadequate

Reports


Inspection carried out on 30 May 2017

During a routine inspection

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 carried out on 9 November 2016

During an inspection to make sure that the improvements required had been made

This inspection took place on 9 November 2016 and was unannounced.

At our last inspection on 16 and 21 June 2016 we found continued breaches of regulations in relation to person-centred care, dignity and respect and meeting nutritional and hydration needs. We served warning notices for these three continued breaches and asked the provider to make the necessary improvements by 31 August 2016. A warning notice is a formal way of saying to the provider that they were not meeting legal requirements and they needed to make improvements by a set date. We also found continued breaches of regulations in relation to safe care and treatment and good governance. For these two continued breaches, we continued with our action where we imposed a condition on the provider to carry out monthly audits of health and safety within the service and to send the CQC a monthly report.

However, we also found the service had made sufficient improvements in each of these areas for us to improve the rating from ‘inadequate’ to ‘requires improvement’ and we removed the service from special measures. The special measures framework is designed to ensure a timely and coordinated response where we judged the standard of care to be inadequate. The purpose is to use our enforcement powers and work with or signpost to other organisations within the care system to make sure providers significantly improve the quality of service they provide within

a determined timeframe.

The purpose of this inspection was to check the improvements the provider said they would make in meeting legal requirements. We found that the provider had made all the necessary improvements to address the deficits we identified at our last inspection in relation to person-centred care and meeting nutritional and hydration needs and so had met the requirements of the warning notices. We also found that the provider had made the necessary improvements to address the deficits we found in relation to providing safe care and treatment and good governance. However, the problems we found in terms of treating people with dignity and respect required a longer period of time to address and we will look at this again at our next inspection.

Cheam Cottage Nursing Home provides residential and nursing care for up to 19 people who may be living with dementia. At the time of our visit there were 15 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.

Some staff communicated with people about what they were doing whilst carrying out care tasks but others did not, sometimes causing people to show signs of distress. Staff did not always give people who were disorientated or upset the reassurance and information they needed. When we observed staff speaking with people their conversations were task-focused and staff did not attempt to engage people in conversations about themselves or their interests. However, the provider was in the process of addressing this problem. They had arranged relevant training and had been talking to staff in team meetings about treating people with dignity and respect.

Staff used age-appropriate language when speaking to and about people. They protected people’s dignity by ensuring their clothing was appropriately arranged when using hoists to support them and they made sure people were wearing clean clothes. Staff were aware of how they should work to protect people’s privacy.

The provider had taken action to ensure the environment was safe. The home was free of visible hazards and the environment was clean. Clinical waste was stored appropriately to reduce the risk of infection spreading. The provider had updated risk management pla

Inspection carried out on 16 June 2016

During a routine inspection

This inspection took place on 16 and 21 June 2016 and was unannounced. The last Care Quality Commission (CQC) comprehensive inspection of the home was carried out on 9 December 2015 when we found that the provider was in breach of six regulations. These related to person-centred care, dignity and respect, safe care and treatment, safeguarding people from abuse, meeting nutritional and hydration needs and good governance.

We rated the service as ‘Inadequate’ and placed it in special measures. The special measures framework is designed to ensure a timely and coordinated response where we judged the standard of care to be inadequate. The purpose is to use our enforcement powers and work with or signpost to other organisations within the care system to make sure providers significantly improve the quality of service they provide within a determined timeframe.

We had serious concerns regarding the provider's failure to meet legal requirements in relation to good governance and the safe care and treatment of people and in response to this we imposed two conditions on the provider's registration that they were legally required to take into account when providing a service. The first condition requires the provider to carry out comprehensive audits of health and safety aspects within the home and the second condition requires the provider to send to the CQC reports of the audits undertaken and any action the provider was taking as a result of the findings of the audits. The provider also sent an action plan telling us they would address all of the shortfalls we identified.

As part of this inspection we checked the improvements the provider said they would make in meeting legal requirements and collected evidence to provide a rating for the service. We found that the provider has made enough improvements for none of the key questions to be rated inadequate. The service will therefore come out of special measures, however it is also rated ‘Requires Improvement’ in all key questions and overall.

Cheam Cottage Nursing Home provides residential and nursing care for up to 19 people who may be living with dementia. At the time of our visit there were 13 people using the service, 12 of whom had been diagnosed with dementia.

The service had 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.

The provider had taken action to address many of the shortfalls we found at our previous inspection in relation to the assessment and the management of risks, but we found that people were still at risk because the provider was still not carrying out comprehensive risk assessments and did not have suitable risk management processes. Some risk assessments were not sufficiently detailed or personalised to keep people safe. We also found safety hazards in the home that the provider had not identified. We found a picture frame with broken glass in one person’s bedroom that had not been noted by staff and addressed. Clinical waste was not appropriately stored prior to removal from the premises.

Although the premises were visibly clean and cleanliness checks were in place, we noted an odour throughout the ground floor of the home which made the environment where people lived unpleasant. People did not always have the support they needed to eat and drink because the provider had not arranged for people to be assessed for the use of appropriate aids. Records were not maintained accurately to identify and address the risk of people becoming malnourished. People were supported to choose from a variety of nutritious food and were offered adequate fluids.

People got on well with staff and the provider promoted positive caring relationships with the

Inspection carried out on 9 & 10 December 2015

During a routine inspection

This inspection took place on 9 and 10 December 2015 and was unannounced. At our last inspection on 25 November 2014 we found the provider was meeting the legal requirements we checked.

Cheam Cottage Nursing Home provides accommodation with personal and nursing care for up to 19 older people many of whom were living with dementia. During our inspection there were 19 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.

The provider did not have effective arrangements to manage risks to people and others. People were at risk from scalding, falling from height and entrapment in bed rails from inadequate risk management processes. In addition other risks to people such as moving and handling and choking risks were not always adequately assessed and managed.

Medicines were not always managed safely and our checks indicated people did not always receive their medicines as prescribed. Auditing systems to pick up errors and ensure people received the necessary support with their medicines were not effective.

People were at risk from poor infection control procedures such as using one electric shaver to support several men to shave and sharing slings between different people. There was also a lack of cleanliness in some areas.

The provider did not operate robust recruitment systems to make sure people were only cared for by suitable staff who have been fully vetted. They did not always check and retain documentation in relation to proof of identity, address and any health conditions which may require reasonable adjustments to be made. However, other checks of staff were carried out such as of criminal records and employment history.

People using the service and their relatives felt it was safe. However, staff had a limited understanding of how to keep people safe, particularly suitable reporting procedures of allegations of abuse or neglect.

Care staff also had a limited understanding of their responsibilities under the Mental Capacity Act 2005. Although the provider had applied for and been authorised to deprive some people of their liberty as part of keeping them safe, we found one person who might have been deprived of their liberty because there were a number of restrictions on them. The provider and staff had not recognised this and had taken no action in regards to this.

Staff did not always receive the necessary support from the provider to carry out their roles. Records relating to training were incomplete and so we were unable to confirm staff had received recent training in topics relevant to their role. In addition records showed staff did not receive regular and frequent supervision and had not received appraisal in the last year.

People were not always supported appropriately in relation to their risk of malnutrition and with eating and drinking. The provider did not always incorporate professional advice into people’s care plans. However, people received appropriate support in relation to their day to day health needs.

The provider did not always treat people with dignity or respect and we found several examples of poor practice relating to this.

The premises were not appropriately adapted for people living with dementia. We have made a recommendation for the provider to review the premises to make sure these were suitable to meet the needs of people with dementia.

Staff seldom interacted with people in a meaningful way and our observations showed they interacted with people mostly in a task-based way. People were at risk of social isolation, particularly those who spent the majority of time in their rooms. They were not supported to meet their religious and spiritual needs. There was little stimulation for people and few activities tailored to meet people’s needs. We have made a recommendation for the provider to review the provision of suitable activities for people with dementia.

A suitable complaints procedure was in place and people and their relatives told us they were aware of it and would complain if they had reason to.

The service was not well-led. Leadership across the home was lacking and the registered manager did not identify and address opportunities to improve care practices. Shifts were poorly planned and several required tasks were not always delegated or carried out. Audits for the provider to assess, monitor and improve the service were inadequate or lacking altogether for some aspects of service provision. The audits were also ineffective in that they had not identified the various areas for improvements we found during our inspection, some of which were putting people at risk of harm.

The provider had made some arrangements to support people with their end of life care needs. People and their relatives were encouraged to make plans for their end of life care and the provider liaised with the local hospice for support with this.

We found a number of breaches of regulations during this inspection relating to safe care and treatment, person-centred care, meeting nutritional and hydration needs, dignity and respect, safeguarding and good governance. You can see the action we told the provider to take at the back of the full version of this report in relation to safeguarding, dignity and respect, meeting nutritional and hydration needs and person-centred care. Because of our serious concerns in relation to the breach of regulations about the safe care and treatment of people and good governance we took enforcement action which you can also read about at the back of the full version of the report.

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.

Inspection carried out on 25 November 2014

During an inspection to make sure that the improvements required had been made

We inspected this home to check whether improvements had been made following concerns identified at our previous inspection on 26 September 2014. This summary is based on our observations during the inspection and speaking with the registered manager.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer one of the five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

The service was safe. Improvements identified as being necessary at our last inspection had been made. Previously we identified that people who required staff supervision were at risk of leaving the home alone, without staff being aware, and coming to harm through unrestricted and unalarmed fire doors. However, since our last inspection the provider had remedied this issue. They had linked all fire doors to the fire system and ensured that when a fire door was opened an alarm sounded across the home to alert staff.

In addition, we had previously identified a locked fire door which put people at risk of not being able to evacuate the home in the event of a fire. However, during this inspection this door was not locked and we saw it had been upgraded with a push-bar system, linked to the fire system. This meant that people could push the bar to open the door in the event of a fire to more easily evacuate the home.

Inspection carried out on 26 September 2014

During an inspection to make sure that the improvements required had been made

We inspected this home to check whether improvements had been made following concerns identified at our previous inspection on 13 and 17 June 2014. This summary is based on our observations during the inspection, speaking with two people who used the service, the registered manager and three members of staff. Many people using the service had complex needs, which meant that few were able to verbally communicate their views. We looked at people’s care plans and other records relevant to the management of the service.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer two of the five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

The service was not safe. A locked fire door put people at risk in the event of a fire. Other fire doors were unrestricted and unalarmed. This meant people were at risk of accessing a roof area and falling from height.

However, improvements identified at out last inspection had been made. The provider was meeting their responsibilities in relation to Deprivation of Liberty Safeguards (DoLS). Applications had been approved to deprive people of their liberty lawfully and a policy had been implemented.

Is the service effective?

The service was effective. Improvements had been made since our last inspection. People were supported appropriately with their continence needs. People were supported to transfer as per their care plans. Appropriate action had been taken when a person was identified as being at risk of malnutrition. A person was provided with appropriate nail care in line with their care plans.

Inspection carried out on 13, 17 June 2014

During a routine inspection

This summary is based on our observations during the inspection, speaking with five people who used the service, the registered manager, three members of staff and three relatives. Many people using the service had complex needs, which meant that few were able to verbally communicate their views. We looked at people’s care plans and other records relevant to the management of the service.

If you want to see the evidence supporting our summary please read the full report.

We considered our inspection findings to answer five questions we always ask:

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Is the service safe?

We found the home’s safeguarding procedures were robust and staff understood how to safeguard the people they supported. However, staff we spoke with did not have a good understanding of Deprivation of Liberty Safeguards (DoLS), and there was no policy in place regarding DoLS.

The home was well maintained, with various health and safety procedures regularly carried out. However, there was no risk assessment in place regarding Legionella, a bacteria which can grow in hot water systems and cause illness or death.

Staff recruitment was robust to ensure that only people suitable to work in a care home were recruited.

People were not always supported appropriately with their continence needs.

Is the service caring?

The feedback we received from people who used the service and their families was positive about the standards of care and support at the home. We saw that people were supported by kind, patient and compassionate staff. People were treated with respect.

Most staff we spoke with had a good understanding of the Mental Capacity Act. Staff were aware of the need to gain people’s consent, at the point of giving care.

Is the service responsive?

We saw that the home regularly sought the views of people using the service, staff and relatives. Relatives we spoke with told us they had not had cause to complain, but were confident the manager would respond positively if they did.

Is the service effective?

People’s needs were assessed regularly. People’s care plans included their likes and dislikes and covered many aspects of their life. These were reviewed regularly. However, these were not always accurate, particularly in relation to people’s moving and handling needs and care was not always delivered in line with these care plans.

Is the service well-led?

Systems were in place to effectively assess and monitor the quality of care provided at the home. The views of people and their relatives were taken into account in the way the service was provided.

Inspection carried out on 4 November 2013

During an inspection in response to concerns

At the time of our inspection there were 15 people using the service. Most people had dementia and were unable to tell us about their care and treatment. However, one person told us, “The staff are all very good; they help me if I ask. I like it here.” Another person told us, “The food is good. I always enjoy my dinner." One person said, “I like the food and the people but I don’t live here, I’m just waiting for somebody.” We also spoke to visitors. One visitor told us that the staff, “Work very hard, they never stop.”

We found that people using the service or their relatives were involved in their care and treatment and people’s diversity, values and human rights were respected. We saw that care plans were person centred and provided guidance about how people’s individual needs and preferences should be met. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We observed that staff were caring and attentive. People were provided with a choice of nutritious food and drink.

We examined equipment used to assist staff to deliver care and looked at maintenance records for equipment. Equipment was regularly maintained. We found that there were enough qualified, skilled and experienced staff to meet people’s needs. Staff were supported to provide safe care and treatment through training and regular supervision.

We noted that personal records for people using the service and members of staff were fit for purpose and records could be located promptly. Records were stored securely.

Inspection carried out on 23 May and 10 June 2013

During an inspection in response to concerns

At the time of our inspection there were 18 people using the service. Most people had dementia and were unable to tell us about their care and treatment. One person did tell us, "No troubles at the moment. It's very good."

One visiting relative said, "I am very happy with the way she is being treated here." Another relative told us, "I've seen a marked improvement in Mum since she came here." However, we were also told that relatives were not involved in planning the care and treatment provided. One person said, "There are no relative's meetings - I think they are essential."

We saw positive interactions between people using the service and staff.

We found that care plans were not personalised and did not address all the needs of people using the service.

We found that there were sufficient numbers of appropriately trained staff on duty. Staff were supported with relevant training and a programme of supervision.

Inspection carried out on 4 January 2013

During an inspection to make sure that the improvements required had been made

Following our inspection on 20 November 2012, we had issued three warning notices as we judged that the provider had failed to comply with regulations 9, 11, and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations.

We carried out this inspection to check that the provider had taken appropriate steps to comply with the warning notices. We found that there were improvements with regard to all three regulations.

At the time of our visit, there were 18 people using the service. Their level of cognitive impairment made it difficult for them to contribute to the inspection process however; we were able to observe that the majority of them showed signs of positive engagement with the staff and their environment.

We were able to speak with two relatives, the provider / manager of the service and the trained nurse and care staff on duty.

The relatives we spoke with were quite happy with the service. Both of them told us that they visited frequently and never had any concerns about the home. They said that they were involved in the care planning process and had been consulted about how the person they visited preferred to be supported.

All the staff we spoke to said they considered that people were well cared for in the home. They said that they had never observed anyone treating people unkindly and they were aware of the procedures to be followed if they had any concerns.

Inspection carried out on 17 October and 7, 20 November 2012

During an inspection in response to concerns

We made three visits to this service. The first visit was because we had received some information of concern and the following two in order to gather more evidence.

On each occasion we found the home to be clean and comfortable although it had an unpleasant odour of stale urine throughout.

People told us told us “I’m very comfortable, it’s very nice here”. However they also said “I don’t do anything all day, there’s nothing to do”.

On our first visit we observed that there was a lack of interaction between people and the staff. People’s physical needs were being met, for example they were assisted to go to the toilet and drinks were brought to them but there was there was nothing to interest or stimulate them. At our subsequent visits some people were engaged in activities with the staff.

People who were mobile were able to walk around the home and go into the garden. Concerns were raised about how these people were being supervised to ensure their safety.

Not all of the care plans we saw contained sufficient detail to tell staff exactly how people’s healthcare needs should be met.

There was limited evidence to show that the provider asked for the views of people using the service to make sure that it was meeting their needs.

During our first visit we identified concerns of a safeguarding nature. This where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect.

Inspection carried out on 17 July 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of care service.

We used the Short Observational Framework for Inspections (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. Through the use of SOFI we were able to observe that people’s experience of the service was a positive one. We saw staff support being provided in a way that protected the dignity of people and that the service was meeting the nutritional needs of people using the service.

Although we spoke with people their complex needs meant that they were not able tell us their experiences. We did speak with some relatives of a person and they told us they though people were well looked after in the home.

Inspection carried out on 17 July 2012

During an inspection to make sure that the improvements required had been made

People in this home were unable to communicate their views regarding the care that they receive due to their levels of dementia. However through our observation we saw that they displayed signs of positive wellbeing. There were several examples of positive interaction between then and the staff supporting them.

Inspection carried out on 25 July 2012

During a routine inspection

All of the people who live in this home,who are known as residents, have dementia and most are not able to contribute verbally to the review process. However, they all looked happy and well cared for and displayed positive signs of wellbeing.

Although we have raised concerns about how some of the essential standards quality and safety are being met, the atmosphere within the home was very cheerful and we saw several good examples of engagement with staff.

Reports under our old system of regulation (including those from before CQC was created)