Background to this inspection
Updated
5 February 2019
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 registered 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 over three days, the first day was unannounced. An adult social care inspector and a pharmacist inspector carried out the inspection on the first day; the second and third days of the inspection were carried out by one adult social care inspector.
We observed the interaction between people who lived at the service and staff and we spoke with seven people and two family members. We spoke with the registered provider, registered manager, general manager and staff who held various roles including, care staff, kitchen staff and domestic staff.
We looked at areas of the service including the communal lounge and dining room, bathrooms, bedrooms, the kitchen, laundry and outside areas,
We reviewed a number of records, including care records for six people who lived at the service and three staff files. Other records we looked at which related to the management of the service included quality monitoring audits and safety certificates for equipment and systems in use at the service.
Before our inspection we reviewed the information we held about the service including notifications that the registered provider had sent us. We also looked at information we received from the local authority and members of the public. This included concerns which they raised with us about the service. We looked at those concerns as part of this inspection.
Updated
5 February 2019
The inspection took place on 23, 26 & 28 June 2017. This first day of the inspection was unannounced.
Haven Lea Residential Care Home is registered to provide accommodation and personal care for up to 26 adults. The service is located in the Whiston area of Merseyside and is close to local public transport routes. Accommodation is provided over two floors. These floors can be accessed via a stair case or passenger lift. There were 20 people using the service at the time of our inspection.
A registered manager was in post at the time of the inspection visit. They were registered with the Care Quality Commission in October 2016. 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 last inspection of the service was carried out in December 2016 and we found that the service was meeting all regulations. However at this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
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 management of medication was unsafe. People did not receive their prescribed medication at the right times. Medication administration records (MARs) for some people had been signed to indicate they had received prescribed medication which was not given. Handwritten MARs had not been signed by two staff to ensure the accuracy of the information recorded and some MARs did not provide instructions about the use of medication. This put people’s health safety and wellbeing at risk. Immediate action was taken on the first day of inspection to improve the management of medication.
The premises were unsafe. There were hazards both inside and outside of the premises which had the potential to cause people harm. This included the unsafe storage of harmful substances and obstructions which placed people at risk of slips, trips and falls. External doors, including a fire door, were left open and the areas were unsupervised. This placed people’s safety at risk. Action was taken on the first day of inspection to improve the safety of the environment.
The cleanliness and hygiene of the service was not maintained and clinical waste was not secured. This placed people at risk of acquired infection. Areas of the service, including the kitchen, food stores and floorings on corridors and people’s bedrooms were unclean. The clinical waste storage container kept at the front of the building on a space open to the public not secure. The lid on the container was open and there was no lock fitted to it. This increased the risk of the spread of infection. The Euro bin was secured by the second day of inspection.
The recruitment of staff was not always safe. Recruitment records for nine members of staff working at the service did not evidence that checks required by law were carried out on their criminal record.
New staff had not received a thorough induction into their roles and there was a lack of initial and ongoing training for all staff. Staff had not received an appropriate level of support to enable them to discuss their performance, training and development needs. Staff were given the responsibility to carry out tasks without being provided with the relevant training and support. This meant that people were not supported by staff that had received the right training and support
People who lacked capacity were not fully protected because staff lacked an understanding of the Mental Capacity Act 2005 and the associated deprivation of liberty safeguards (DoLS). Staff were unsure which people had an authorised DoLS in place and what is meant for people.
There was a lack of stimulation for people and opportunities for them to engage in things of interest. People spent most of their time sat in the lounge either watching the television or sleeping. The environment lacked items of interaction and stimulus to help engage people.
Personal records belonging to people were left unsupervised on a table in the communal lounge areas which were accessed by visitors to the service. Items belonging to people who no longer lived at the service were left in bedrooms which other people now occupied. People’s clothing was not stored in a dignified way; laundered clothing was left in an unoccupied bedroom which smelt strongly of urine. This meant that people’s confidentiality, dignity and privacy were not respected
Pre-admission assessments did not contain sufficient information about people’s needs and care plans were not in place for people’s needs which were identified. Aspects of people’s care were not monitored in line with their care need requirements. This included fluid intake, weight, positional changes and skin integrity. This meant that there was a risk that people’s needs were not assessed and planned for
There was a lack of management oversight at the service. The registered manager delegated the task of carrying out audits and checks across the service to staff that were not appropriately skilled and qualified. The checks were not carried out as required which meant risks to people’s health and safety were not identified and mitigated. Records were not maintained securely, accurate and complete.
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.