Archived: St Helena's

Updated 15 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.

We visited the service unannounced on 2, 4 and 5 October 2017. The inspection team consisted of two adult social care inspectors on the first and second days and one inspector on the third day.

Before the inspection, we received anonymous concerns regarding the provision of care at the service. We had also received information of concern about the management of medicines from the Clinical Commissioning Governance (CCG) Medicines management team and the delivery of care from local authority.

We spoke with six people who lived at the service and four people’s relatives. We also observed the lunch time experience of four people and undertook individual Short Observational Framework for Inspection (SOFI) observations in the communal lounge of five people. SOFI is a specific way of observing care to help us understand the experience of people who were unable to give us their views. We observed general interaction between people and staff and observed staff providing people with support to move.

We spoke with six care staff, an agency staff member, the provider, manager and administrator. We also spoke with 12 health and social care professionals who visited the service whilst we were there.

We looked at the care records of 10 people living at the service, which included, care plans, daily records and medication administration records. We also looked at records relating to the management of the service including staff rotas, accident and incident records, medication audits, staff recruitment files, records of the dates of staff training and supervision and the staff communication book.

Updated 15 February 2019

This inspection took place on the 2, 4,5 October 2017. The first day of our visits to the service was unannounced. Prior to the inspection we received information of concern around care and safety of people who used the service. We looked at those concerns as part of this inspection.

At the last comprehensive inspection 4, 5 and 12 May 2017 we found a breach regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider's quality assurance systems were not effective. We issued the provider with a warning notice requiring them to become compliant with this regulation by 18 September 2017.

We also identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not always managed safely and people's environment was not safely monitored. After the inspection, the registered provider wrote to us to inform us of the action they would take to meet legal requirements.

At this inspection found improvements had not been made and further concerns were identified. The CQC are now considering the appropriate regulatory response to the concerns we found. We will publish the actions we have taken at a later date.

St Helena’s is registered to provide accommodation and personal care for up to 33 people who require support with their personal care. They specialise in supporting older people. At the time of our inspection there were 24 people living at the service who were living with a range of age related conditions including dementia.

There was no registered manager in place. The last registered manager left the service 12 May 2017. 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 day to day management of the service was being overseen by a manager who had started working at the service 7 July 2017.

The provider had not addressed the shortfalls identified at the last inspection. They had no effective internal quality assurance systems in place to assess and monitor the service provided identify shortfalls and drive improvement. In addition action plans given to the provider to address shortfalls identified by external agencies in relation to the management and safe administration of medicines, fire safety, and care planning had not been fully completed. There was no clear plan in place for when, how and by whom actions would be addressed. Records were not properly maintained to make sure they were accurate and fully complete. Care plans did not always contain accurate information regarding people’s care needs and failed to record the guidance provided by health care professionals involved in their care.

Action had not been to ensure the management of medicines was safe. Staff did not have access to specific guidance for when PRN (as required) medication, including pain relieving medicines, could be administered to individuals or for how long before medical advice should be sought. Medicines were not always stored in line with good practice guidelines and medicine records and audits were not accurate.

People’s privacy was not always ensured or their dignity respected. Staff opened toilet doors when people were using the toilet, in view of others. People’s rights were not always upheld. People who had expressed the desire to vote had not been supported to register to do so.

Risks to people’s health and safety were not always safely managed. Staff were not always aware of and did not always use the equipment people had been assessed as needing, when supporting them to move or transfer. The provider had not ensured the risks of experiencing falls were kept under review when their needs changed and appropriate steps taken to mitigate the risk of them experiencing another fall.

The provider had not ensured that staff understood and always worked within the principles of the Mental Capacity Act to gain lawful consent for people’s care and treatment. Decision specific capacity assessments had not been completed and best interest decisions recorded as required. Despite this people were supported throughout our visits to make a number of choices regarding how they received their care and we observed staff seeking consent from people before initiating care interventions.

People and their relatives were not always listened to. Complaints were not recognised recorded or investigated appropriately.

Recruitment checks were not safe. Required identity and security checks had not always been completed before staff started work. There was no evidence that new staff and agency staff had completed an induction to the service before working unsupervised. Staff had not received the training and support they needed to meet people’s assessed needs effectively and keep up to date with current good practice. Staffing levels were not always sufficient to protect people from the risk of harm. People in communal areas of the service were left unsupervised for prolonged periods of time.

The CQC had not been notified about incidents of potential abuse and deaths as required.

People were not always provided with the opportunity to participate activities they found enjoyable and stimulating to help them maintain their physical and psychological health. People enjoyed the food on offer but were kept waiting for over half an hour for their food before being served.

People and their relatives were invited to attend meetings to offer their views and discuss any changes or improvements needed around the service. People and their relatives were complimentary about staff who they described as “Kind” and “Caring”. Family members described the service as “Clean”.

Health care professionals visited the service on a regular basis to review, monitor and treat people’s health needs.

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 registered provider’s registration of the service, will be inspected again within six months.

The expectation is that registered 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 registered 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 registered provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.