Archived: Angelus

At the time of our visit there were 14 people living in the home and the home did not have a registered manager. The home had not had a registered manager since September 2013. The operations manager told us one of the nursing staff had agreed to assume this role while they waited a new manager to be appointed. The operations manager told us they were in the home every day currently offering support. They told us they were in charge of the home but the nurse was in charge of the shift. The agency nurse on shift confirmed this as their understanding.

We spoke with six members of staff, including the operations manager. We reviewed the care records of 10 people and attempted to speak with five people who lived in the home. However it was not always possible to establish their views due to the nature of their conditions. To help us understand the experience of people who could not talk with us we spent observing interactions between staff and people who lived in the home.

The inspection team was made up of two inspectors and a specialist advisor. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

At our inspection in May 2014 we found the system for ensuring lessons were learned from any accidents and incidents which occurred at the home was ineffective and there was a risk of harm to people as a result of this. We found care plans were not always reflective of people's current needs. We used our enforcement powers and told the provider when they must be compliant by. At this inspection we found that improvements had not been made and the provider remained non-compliant in these areas. There was no evidence of lessons learned from incidents of accidents were acted upon. Care plans did not always reflect people's current needs and we observed that care was not delivered in line with the planned support for people. Injuries to people could not be explained and no evidence of investigation into these could be provided.

Not all areas of the home were clean and hygienic. The home lacked records of cleaning which had been planned or undertaken. The home's policy for infection control referred to previous legislation that was no longer in existence. This meant people were at risk from the spread of infection because the home had not taken steps to ensure they met the requirements of the law in relation to infection control.

Is the service effective?

At our inspection in May 2014 we found that whilst people's health and care needs were assessed before they moved into the home, care plans had not always been developed and those that had did not reflect people's current needs. Observation of staff interactions with people demonstrated that did not always understand and respond to the needs of people. We used our enforcement powers and told the provider when they must be compliant by. At this inspection we found that improvements had not been made and the provider remained non-compliant in these areas. Care plans continued to not fully reflect people's needs. Not all staff who worked in the home had a good knowledge of the people who lived there or a good understanding of the needs of people within the home. The lack of knowledge and accurate, up to date plans of care meant people were at risk of receiving care and support that was inappropriate and did not meet their needs or ensure their safety.

We could not be assured consent was sought from an appropriate person. Where people lacked capacity to make decisions, the home could not demonstrate they had applied the principles of the Mental Capacity Act 2005 or had followed best interests' processes. Training for staff in this area was not sufficient and staff were not able to demonstrate a good understanding of their role within this.

Is the service caring?

We saw people were not always supported by attentive staff. We were concerned by the lack of understanding by some staff of how to meet people's needs.

On the day of our inspection we observed people sat in the lounge or their room, asleep for long periods. People were not provided with opportunities to engage in stimulating activities.

We found some evidence that people who used the service and their relatives, had been asked for their views on the service. We saw an action plan had been developed to address areas of concern that had been raised.

Is the service responsive?

We looked at people's records and attempted to speak with people who lived at the home. The home had introduced a 'This is me' document for people. The content varied from very good informative information about people's preferences, to basic statements.

Throughout the day the only activity that took place for people was when the local church visited. The activities planner on display appeared to be out of date and referred to 'Springs' activities. People were left for extended periods of time with no staff support, observation or engagement.

Is the service well-led?

The service did not have an effective quality assurance system in place. Records we viewed showed that the systems in place to monitor the quality of the service provided for people were not effective.

We will be considering our enforcement options.

This is a summary of what we found-

Is the service safe?

We found the service was not safe because people were not protected against the risks associated with medicines. The provider did not have appropriate arrangements in place to manage people's medicines safely.

Medicines were not kept safely. Supporting information for 'how a person preferred to take their medicines' or creams and ointments labelled 'to be used as directed' were not available. Documents to support 'if required' or 'variable dose' medicines were available; however a few were not consistent with the Medicines Administration Records.

Most of the administration records were complete, however for two medicines the dose and frequency of administration had changed, but we could not identify when these changes had occurred.

The inspection team was made up of two inspectors'. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found.

Is the service safe?

We found people were receiving their medicines safely and staff were following the home's medicines administration policy.

We found there was no system in place to make sure that lessons were learned from any accidents and incidents which occurred at the home. This increased the risk of harm to people. At our previous inspection in September 2013 we found the provider was not meeting these requirements. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation to learning from incidents and events that affect people's safety.

We looked at the recruitment records for staff. Some showed recruitment checks were not being followed. This meant people were at risk of being supported by staff who were not suitably qualified, skilled and safe to work with people. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff.

We found the provider had not ensured there were sufficient numbers of suitably qualified, skilled and experienced staff at the home that ensured the safety and welfare of people. In some instances we saw people had to wait until staff became available so that they could have their needs met. We found not all staff had received adequate training to be able to meet the needs of the people living in the home. We found there were areas of training with large gaps where staff had not received training, for example training in diabetes and epilepsy. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staffing.

Is the service effective?

People's health and care needs were assessed, but care plans were not reflective of people's current needs. We found care plans had not been completed for all people. We found where they had been reviewed the care plans did not reflect people's changing needs. Care plans were therefore not able to support staff consistently to meet people's needs. We found risk assessments had not been completed to ensure that any risks associated with the care and support provided to people were assessed and the necessary measures put in place to reduce these risks. At our previous inspection in September 2013 we found the provider was not meeting these requirements. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation care planning and the delivery of care to meet people's needs.

Is the service caring?

We saw people were not always supported by kind and attentive staff. We saw when visitors came to the home; people were offered the choice to see their visitors in private. However, whilst we saw some good interactions between staff members and people, we were also concerned by the lack of understanding of how to meet people's needs by some staff members. We were told by some members of staff that they did not know the needs of the people they were caring for. This was because the people were new to the home and they had not had care plans written since they came to the home.

We found some evidence that people who used the service and their relatives, had been asked for their views on the service. We saw that some concerns raised by relatives had not been addressed.

Is the service responsive?

We looked at people's records and spoke with people who lived at the home. We could not establish their preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to some activities, but these were dependent upon staff being able to organise these. People were not supported to maintain and increase their independence by staff members.

Is the service well-led?

The service did not have an effective quality assurance system in place. Records we viewed showed that the systems in place to monitor the quality of the service provided for people were not effective. At our previous inspection in September 2013 we found the provider was not meeting these requirements. We will consider our enforcement procedure and give the provider timescales to achieve compliance with the legal requirements in relation to having an effective operations system to assess and monitor the quality of service provision.

We could find no evidence the provider had sent us statutory notifications as required under the Health and Social Care Act (2008) Care Quality Commission (Registration) Regulations 2009. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to notifying us of significant incidents in the home.

We spoke with two people who used the service, two relatives, three staff and two visiting professionals.

We received mixed views about the staffing at the home. People we spoke with told us there was always plenty of staff available and they responded to the needs. Care staff told us they felt there was plenty of staff. However, registered nurses told us that at times it was difficult to perform all their duties. Visiting professionals expressed concerns about the skill mix of staff and felt the home lacked leadership. We found that there was no clarity about how staffing skill mix was assessed to meet people's needs. Staff within the home were not able to clearly tell us what the staffing ratio and skill mix should be or how this was determined. We found that the skill mix of staff fluctuated regularly and the reasons for this were not based on people's needs.

We found through our observations and the homes documentation that medicines were not administered safely, records of medicines the home held were unclear and the homes policy was not being adhered to.

Staff we spoke to told us they felt the information that was provided about people helped them to meet people's needs. Staff told us that they felt people's needs were met. We found that people were at risk of experiencing care, treatment and support that did not meet their needs and protect their rights because care records were not always clear and care was not always delivered in line with individuals' care plans. Relatives we spoke to told us most of the staff were very good. One told us 'They are brilliant, I can't fault them', another told us 'They are very caring, it doesn't feel impersonal'.

Staff we spoke with were able to describe to us what they would do if they had a safeguarding concern and who they would report this to. Staff were aware of the whistleblowing policy and told us they would feel confident using this. People we spoke with told us they felt safe in the home.

We found that the provider had effective systems in place to ensure that people were protected against the use of unsafe or unsuitable equipment.

Whilst the provider had systems in place to monitor and assess the quality of the service we found that these were not always effective.

Individualised care plans detailed the support and care each person required. People confirmed they received the support and care they needed and liked. The home ensured relevant health care professionals were contacted when needed.

We observed that members of staff spoke to people with respect and sensitivity.

People who lived at the home were protected from the risk of poor health because infection control practices were followed. The quality of the service provided was monitored by an effective quality assurance processes.