Archived: Angelus

Updated 15 April 2015

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 1 and 2 December 2014 and was unannounced. The inspection team consisted of two inspectors, a specialist nurse advisor in the care of older people and an expert by experience in dementia. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection we reviewed information we held about the service including notifications. A notification is information about important events which the service is required to send us by law.

It was not always possible to establish people’s views due to the nature of their conditions. We spoke with two people and a relative. To help us understand the experience of people who could not talk with us we spent time observing interactions between staff and people who lived in the home. We also spoke with the provider, the manager, two nurses, four care staff, the activity coordinator, two housekeeping staff, the home’s administrator, the cook and a social care professional. We looked at care plans and associated records for eight people, staff duty records, five recruitment files, records of complaints, accidents and incidents, policies and procedures and quality assurance records.

Updated 15 April 2015

This inspection took place on 1 and 2 December 2014 and was unannounced. The service provides accommodation for up to 31 people who have nursing or dementia care needs. There were 12 people living at the service when we visited.

There has been a history of non–compliance with this service since September 2013. Following an inspection on 13 May 2014, we served two warning notices and asked the provider to take action to make improvements for a further four regulations. During an inspection in July 2014 we found the provider had not taken steps to meet the requirements of the warning notices and found a breach of a further three regulations. We are currently deciding on the action we will be taking due to the level of non-compliance within the home. The provider sent us an action plan telling us the action they would take to ensure they met the requirements of the law. They told us they would achieve compliance with the regulations by the end of November 2014. At this inspection we found the provider had improved the cleanliness of the home and the management of medicines. However, they had not made the necessary improvements to the other areas of concern and were not meeting the requirements of the regulations.

At the time of our inspection the home had not had a registered manager since September 2013. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 appointed a manager who had been in post since the end of September 2014 who was not registered with CQC. This meant CQC had not had the opportunity to assess this person’s suitability and competence to manage the service.

People’s safety was being compromised in a number of areas. The arrangements that were in place to safeguard people from the risk of abuse were not adequate as not all incidents which should be reported to the local authority and CQC had been. The management of risks relating to people choking, personal emergency evacuation and people’s health conditions were inadequate. This put people at risk of serious harm.

The provider did not have a system to assess the number of staff needed and there were not enough staff at all times to meet people’s needs. Recruitment procedures did not ensure that staff employed had the necessary skills and were suitable to work with vulnerable people. Not all staff had received the necessary training and some training was out of date. There were no systems in place to support staff appropriately, identify their development needs or to check they had learnt from the training.

Mental capacity assessments were not carried out and people who knew the person well were not involved in making decisions or helping to plan the person’s care. People were not supported to eat and drink to ensure good health. People’s weight was not monitored effectively and action was not always taken when they lost weight. This put them at risk of malnutrition and dehydration.

Staff demonstrated kindness and compassion however, people’s privacy and dignity was not always maintained when receiving support in communal areas.

Care plans lacked information about people’s interests and preferences. They were not maintained and did not always reflect the needs of people. People could not rely on care being delivered in a consistent and appropriate way. Where assessments of people’s needs were required they had not always been undertaken. Activity provision was inadequate and those people who remained in their rooms had very little engagement and mental stimulation.

There was a complaints policy and a system to record and investigate complaints which we saw was being used. People were asked to confirm they were satisfied with the outcome of complaints.

The provider carried out some audits however these were not used to drive improvement. The provider had given CQC an action plan stating what they would do to meet the requirements of the law. However, this was not being followed or monitored to reach compliance with the essential standards of safety and quality. A lack of opportunities for nursing staff to meet meant there was no process to ensure any clinical issues could be discussed in a structured way to look at practice and improve standards of care being received by people. Opportunities to discuss issues relating to the home and identify areas of improvement or development were not available for people or staff.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Due to the level of concerns we served a notice of proposal to vary a condition of the providers registration and remove the location. The provider submitted representations and following the inspection in December 2014 took the decision to close the home. The providers representations were not upheld and we served a notice of decision, which the provider did not appeal against. The notice of decision came into effect on 18 March 2015.