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Archived: Ryecroft Private Residential Care Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

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.

Inspection areas

Safe

Inadequate

Updated 22 September 2015

The service was not safe.

People’s individual risks in the planning and delivery of care were not adequately identified, assessed and managed. This placed people at risk of inappropriate and unsafe care.

People were not protected from potential abuse as the provider and their staff had a limited understanding of safeguarding procedures. The provider had failed to appropriately safeguard three incidences of potential abuse.

Accident and incident records were poor and the provider had failed to seek appropriate advice and support where people had had repeated falls so that further falls could be prevented.

People, relatives and staff told us the home was short staffed. We saw from the provider’s rota arrangements that staff were working excessive hours for long periods without rest days. Staff said they were exhausted.

Premises safety and cleanliness were poor and there were no health and safety or cleaning checks in place to ensure standards were maintained. We referred these issues to Environmental Health and the Health and Safety Executive.

Recruitment practices had improved. Appropriate references and criminal conviction checks for people commencing work at the home had been sought prior to appointment.

Effective

Inadequate

Updated 22 September 2015

The service was not effective.

Records showed that staff had not received adequate and appropriate training and supervision in their job role. This meant they may not have had the right skills, knowledge and support to do their job effectively.

The provider had not compiled with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure people received appropriate mental health support and where enabled to participate in and consent to decisions about their care.

People were given enough to eat and drink and were given a choice of foods to eat. Planning for people’s nutritional needs was poor and did not ensure where people had special nutritional needs these were met.

Care plans lacked sufficient up to date information about people’s health related illnesses, the signs to spot in the event of ill health and the action to take.

Caring

Requires improvement

Updated 22 September 2015

The service was not always caring and required improvement in some areas.

People and relatives spoke positively about the staff. Staff were kind and caring and people were relaxed and comfortable in their company. Staff had little time to socially interact with the people they supported as they were too busy tending to people’s personal care.

People’s privacy and dignity needs were not always respected and people’s right to confidentiality was not protected. People were also not able to get a bath or shower due to a lack of adequate facilities.

Responsive

Inadequate

Updated 22 September 2015

The service was not responsive.

There were no social activities on offer at the home and people often sat without any positive social interaction for long periods of time. This did not ensure people’s social and emotional well-being.

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. Care records required significant improvement.

Some people did not receive care that met their needs. For example, the home lacked adequately equipment to meet people’s needs safely and provide appropriate care and people had not always been referred to other professional services when their needs required it. After our inspection we made safeguarding referrals to the Local Authority in respect of three people’s care.

Well-led

Inadequate

Updated 22 September 2015

The service was not well led.

There were no effective quality assurance systems in place to identify and manage the risks to people’s health, safety and welfare. No adequate audits had been conducted in relation to care plans, health and safety, medication, accident/incidents or premises.

People’s satisfaction with the service had not been sought through the use of satisfaction questionnaires and staff felt that staff concerns comments and suggestions about the service were not taken on board by the provider.

We discussed the issues identified at this inspection with the provider and expressed our concerns. The provider failed to take accountability or responsibility for any of the issues raised.