Background to this inspection
Updated
22 September 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. The way in which the inspection was conducted also corresponds to the new Health and Social Care 2008 (Regulated Activities) Regulations 2014 that came into force on the 1 April 2015
This inspection took place on 09 and 11 March 2015 and was unannounced. The inspection was carried out by an Adult Social Care (ASC) Inspection Manager and an ASC Inspector.
Prior to our visit we looked at any information we had received about the home and any information sent to us by the provider since the home’s last inspection. This included concerning information sent to us by the Local Authority.
During this inspection we spoke with seven people who lived at the home, two relatives, eight care staff, the provider, a healthcare professional, the Local Authority, the Environmental Health Services and the Health and Safety Executive.
We looked at the communal areas that people shared in the home and with their permission visited people’s bedrooms. We also looked at a range of records including five care records, nine medication records, recruitment records for five members of staff, training records relating to the staff team, staff rotas, policies and procedures, records relating to health and safety and records relating to the quality checks undertaken by the service.
Updated
22 September 2015
At our last inspection in December 2014, we identified breaches of legal requirements. We issued the provider with three warning notices in relation to these breaches. The breaches related to Regulation 9, care and welfare; Regulation 13, the management of medicines and Regulation 21 requirements relating to workers, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The warning notices advised the provider that further enforcement action would be taken unless they complied with the requirements of the regulations by the 27 February 2015.
We undertook this comprehensive inspection on the 09 and 11 March 2015. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the December inspection. We found the provider had not taken appropriate action and the Regulations 9 and 13 had still not been complied with.
Ryecroft Private Residential Home provides residential care for up to a maximum of fourteen people. Bedrooms are single occupancy and people are provided with support in respect of their personal care.
There was no registered manager of the home at the time of our inspection. 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.’
During this inspection, we found breaches of Regulations 9,10,11,12,13,15,16,18,20,22,23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulations 9,11,12,13,15,17,18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches are being followed up and we will report on any action when it is complete.
We found similar concerns to those we identified at our last visit with regards to the management of medicines at the home. Storage, administration and record keeping was poor and unsafe in respect of medicines and people did not always receive the medications prescribed for them. This placed people at risk of harm.
Although people said they felt safe with staff and their relatives confirmed this, the provider and staff had a limited understanding of safeguarding and how to respond appropriately to allegations of abuse. We found three incidences where the provider had not responded appropriately to allegations of abuse. This meant people were not safeguarded against the risk of abuse.
Accidents and incidents were not properly recorded or monitored to ensure that appropriate action was taken to prevent further incidences. Where people had repeated falls, no professional advice had been sought so that the person received appropriate support. Staff had not been trained in safe moving and handling techniques and lacked the moving and handling equipment to meet people’s mobility needs safely.
People and their relatives told us the home was short staffed. Staff confirmed this and we saw that staff were too busy tending to people’s personal care needs to interact socially with people to ensure their well-being. Staff were working excessive hours without a day off, some staff had gone off poorly with physical exhaustion and agency staff were used at night as the provider did not have sufficient staff to cover the night shifts. This placed people’s health, welfare and safety at significant risk.
Prior to our visit the Local Authority had alerted us to concerns about the safety of the premises and its equipment. We found these concerns to be warranted during our visit. Electrical faults, heating systems, emergency pull cords and bath hoists were all faulty and we noted a number of other concerns with the interior of the home.
The cleanliness of the home was poor. The kitchen and its facilities were dirty, and some food in the kitchen had either been opened but not dated or was out of date. This meant there was a risk it was unsafe to use. There were no consistent cleaning routines in place and no cleaning audits had been undertaken to ensure that satisfactory standards of cleanliness and infection control were being maintained. We made a referral to Environmental Health following our visit.
At our previous inspection we found the provider’s staff recruitment practices unsafe. During this inspection we found that adequate improvements had been made to comply with the regulation that had been previously breached. We did however raise some concerns with the provider about the quality of references that had been sought in relation to persons employed. We asked them to explore these in more detail.
Staff told us they did not feel supported by the providers. They said they had not been sufficiently trained and lacked the safety equipment to do their job. We saw from staff files, that staff had not received appropriate appraisals, supervision and training. Two new members of staff for instance had received no training in order to provide support to people safely.
The provider had not complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards in the delivery of care and had not ensured people consented to the care they received. Staff we spoke with had a limited understand of what was required and had not received any training. People’s emotional needs were not appropriately assessed and the support provided adequately planned or delivered.
People received sufficient quantities of food and drink and had a choice in the meals that they received. Their satisfaction with the menu options provided however had not been checked. Where people had special dietary requirements, the planning and delivery of care failed to provide sufficient information to ensure people’s special nutritional needs were met.
Staff were observed to be caring, warm and positive in their interactions with people who lived at the home but had little time to chat to people. People’s privacy and dignity needs however were not always met in the delivery of care. For example, people’s confidential information in relation to prescribed creams and their application were visibly displayed in people’s bedrooms for visitors to the home to see. We had discussed removing these items at the last inspection, but the provider failed to do this. People were unable to have a proper bath or shower as there were no adequate facilities available to do this. Staff had to wash people using a bowl of water in their rooms.
There were no social activities provided for people at the home. One person told us “There is nothing to do and nowhere to go. It’s a waiting room to die”. Some people spent most of the time in their rooms or sat silently in the communal lounge all day.
Care records were poor and did not adequately assess people’s needs or risks. Care records were not up to date and people’s care had not been reviewed for some time. Dementia care planning was poor and professional support for people’s emotional needs had not been obtained. Professional advice and support for people’s mobility and continence needs had also not been sought in some cases.
The service was not well led. The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety and failed to seek people’s views on the quality of the service they received. The culture at the home was not open or transparent and staff were not supported or responded to appropriately by the provider. We discussed the issues we had identified at this inspection directly with the provider and expressed our concerns. We found a lack of accountability and responsibility by the provider in the acknowledgement of any of the concerns we raised.