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Archived: Ryecroft Private Residential Care Home Inadequate

Reports


Inspection carried out on 9 and 11 March 2015

During a routine inspection

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 carried out on 11 December 2014

During an inspection in response to concerns

This inspection was conducted in response to concerns raised with us by the Local Authority in relation to medicine management and the staff recruitment practices operated at the home. We used this information to plan our visit.

At the time of our inspection, a manager was employed at the home who was not registered with the Care Quality Commission. This meant that the manager's fitness to be the registered manager had not been assessed by the Care Quality Commission.

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 inspection team who carried out this inspection consisted of an adult social care inspection manager and an adult social care inspector. During the inspection, the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who used the service, the provider, the manager, a team leader, two care staff and the Local Authority. We also reviewed records relating to the management of the home which included three care records, a sample of medication records and six staff files. Below is a summary of what we found. The summary describes what people using the service, the provider and the staff told us, what we observed and the records we looked at.

Is the service safe?

The service was not safe. We looked at six staff files. We found that appropriate checks in relation to the safety and suitability of staff to work with vulnerable people had not been made prior to their employment.

We looked at the three people’s care records and found they contained insufficient information about people’s needs. Care was not adequately planned or risks properly identified and managed. This placed people at risk of receiving inappropriate and unsafe care that did not meet their needs.

Staff we spoke with shared their concerns about the care they were providing to one person who lived at the home. We reviewed this person’s care. We found that the person’s care had not been planned and the care provided was unsafe. For example, the provider did not have any moving and handling equipment in place to enable staff to safely meet the person’s mobility needs. This placed both the person and staff at risk of serious harm.

Medicines were poorly managed. Some people did not receive their medication when they needed them and some people did not receive some of their medication for significant periods. We observed a medication round in progress. The administration of medication was disorganised and unsafe. Staff records showed that all staff training in medicine administration was out of date. Records relating to the administration of medication were poor and inaccurate and medicines were not always stored securely. This meant people’s health and wellbeing was placed at serious risk.

Is the service effective?

The service was not effective. We found care plans did not provide sufficient detail to ensure people’s needs were met. Risks to people were increased as staff were provided with little information about what people’s risks were, how to manage them and how to respond to the risk should it occur.

For example, one person had dementia and sometimes displayed behaviour that posed a risk to themselves and others. The person’s care plan however failed to identify and provide any guidance to staff on how to support the person with dementia effectively so that they were able to communicate their needs and wishes. The risk management tools recommended by the person’s social worker had also not been used consistently to effectively monitor and safely manage any unwanted behaviours.

Is the service caring?

The service was not always caring. We observed staff supporting people throughout the day and noted they spoke pleasantly and treated people kindly and with respect.

We found however that people’s social and emotional needs were not always considered in the planning and delivery of care. For example, one person at the home was immobile. We visited the person and saw that they were sat in their bedroom with no television or radio and no means of accessing the communal areas downstairs for company. The person told us “I don’t want to be here”.

Is the service responsive?

The service was not responsive. People’s individual needs were not consistently met. For example, one person at the home was unwell and had not received their newly prescribed medication in a timely manner. We asked the team leader about this, who confirmed the medication had not yet been obtained. Two other people at the home had also not received all of their required medication as the home had run out of stock. This demonstrated that people’s health and welfare needs were not responded to appropriately or in a timely manner.

Is the service well led?

The service was not well led. The provider did not have effective systems in place to ensure that people’s needs and care were assessed, planned and delivered appropriately and in a safe manner. There were no robust procedures in place to ensure that staff employed were suitable for their job roles and the provider did not have appropriate arrangements in place to protect people from the unsafe use and management of medications.

We found that the provider had failed to provide satisfactory management and leadership in the delivery of the service which placed people at serious risk.

We had major concerns about the service during our visit. We discussed these with the new manager in post and the provider. We also made two safeguarding referrals to the Local Authority in relation to two people’s medication issues.

Inspection carried out on 26 June 2014

During a routine inspection

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who lived at the home, one relative, the registered manager, the deputy manager, two members of the care team and a medical professional. We also reviewed records relating to the management of the home which included three care records, daily written records, records relating to the safety and maintenance of the premises, audit records and records relating to feedback on the quality of service provided and its management.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People had been cared for in an environment that was safe and satisfactorily maintained. The home offered a pleasant, homely environment for people to live in. There were formal maintenance arrangements in place to ensure electrical, gas and fire alarm systems met recognised industry standards of safety.

We had concerns with the provider’s call bell system used by people who lived at the home to summon staff assistance. We identified that staff could only see information in relation to who was calling for help from the ground floor. This meant if staff were on the 1st or 2nd floor when the call bell was rung, they had to go back downstairs to the ground floor to find out who was calling or where the call was coming from. This meant there was a risk that people’s calls for help would not be met in a timely and responsive manner. Staff told us that to counteract this, they undertook regular checks on people to ensure their assistance needs were met. We spoke to the provider about the call bell system. They provided evidence that they were currently in discussions with the supplier of the call bell system to resolve this.

During our inspection of the home in February 2014 we found that people’s care records did not contain clear or sufficient information on people’s needs, risks or care. Information in relation to the involvement of other healthcare professionals in the person care was also disjointed. At this inspection, we found that sufficient improvements had been made.

Records showed that people’s needs and care were now clearly identified, assessed and regularly reviewed to ensure they remained effective and safe. Information in relation to the appointments people attended and the advice given by other healthcare professionals in relation to their care, was clearly documented and easy for staff to understand.

Is the service effective?

The people we spoke with as part of our visit told us that they were happy with the care they or their relative received. They told us staff looked after them well. The relative we spoke with said they were “Very pleased” with the care their relative received. They told us staff understood the person’s needs, monitored their health and well- being and respected the person’s choices in relation to their care. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well.

Is the service caring?

People were supported by kind and attentive staff. We saw that interactions between staff and people were positive and there was a warm, homely atmosphere at the home. People were relaxed and comfortable in the company of staff and the two people we spoke with said that staff treated them nicely and with respect.

Is the service responsive?

People’s needs were assessed both before and on admission to the home. Records confirmed people’s preferences and interests had been recorded and that care and support had been provided in accordance with their wishes. We saw records to indicate the service worked well with other healthcare professionals to ensure that people received the health and social care support they required. For example, we saw evidence that GPs, chiropodists, district nurse, continence and assistive technology services were all involved in people’s care and that their professional advice was followed by the home when it was given.

Is the service well led?

There was no registered manager post at the time of our visit. A new manager had been appointed and commenced employment at the home in March 2014. They recently submitted an application to the Care Quality Commission to become the registered manager. This application was still in progress at the time of our visit.

We reviewed the quality monitoring systems at the home that managed the risks to people’s health, safety and welfare and monitored the quality of the service. We found there were some systems in place to ensure that risks to people’s health, safety and welfare were effectively managed and that the service provided was a safe and of a satisfactory standard. For example, health and safety audits, home inspection checks and weekly meetings between the manager and the provider were carried out to plan for and act upon any improvements the service required. We noted however that some of the processes in place were inconsistent in terms of frequency and raised this with the new manager. The new manager told us about their plans to introduce some new quality checks at the home. They told us they had just introduced a new medication audit and had plans in place to commence regular care plan audits.

We saw that an annual satisfaction survey was conducted in February 2014 with people who lived at the home and/or their relatives in order to gain their feedback on the quality of the service provided. We saw their feedback was positive. Overall we found the home and its staff were satisfactorily managed. The two people and the relative we spoke with agreed with this. Comments included “No complaints about anybody or anything” and the new manager is “Absolutely brilliant”.

Inspection carried out on 18 February 2014

During an inspection to make sure that the improvements required had been made

We found during our last visit on 7th August 2013 that the planning of people’s care did not cover all of people’s individual needs or risks. A review of people’s care had not always been undertaken and professional advice not always been carried out or followed up. We found the provider’s local safeguarding policy did not provide clear guidance to staff on the action to take should an allegation of abuse be made and staff were unsure who to report concerns to outside of the organisation. We reviewed the provider’s progress during this visit and saw that the compliance with the regulation had been met.

We reviewed three care records. Care records showed that people’s needs were assessed and care planned. We saw that GP's and other healthcare professionals visited regularly and professional advice had been followed in relation to people’s health and welfare. Staff we spoke with were knowledgeable about people’s care and their day to day needs. People we spoke with said they were well looked after and that they enjoyed life at the home. This demonstrated that people had received care that met their health and welfare needs.

We saw that the provider however was in the process of transferring people’s assessment and care plan information into a new format. We found this made some of the information about people and the care they required unclear. We noted that care plan and risk assessment information had not been regularly reviewed or updated after significant changes and contained a lot of disjointed information about people's health and welfare. This meant that an accurate record in relation to each person’s needs and care had not been adequately maintained which placed them at risk of receiving inappropriate or unsafe care.

Staff we spoke with said they had received safeguarding training. When asked, they were able to describe the action to take and the agencies to notify should an allegation of abuse be made. Contact details for the local authority safeguarding team and Care Quality Commission were displayed in the manager’s office and on a communal noticeboard for staff and people who lived at the home to refer to. This meant there was clear information on what to do and who to contact should an allegation of abuse be made or witnessed.

Inspection carried out on 7 August 2013

During a routine inspection

We spoke with three people who lived at the home and two relatives. People told us they were well looked after. They said “help is at hand at all times", “staff are very good” and “I’m quite happy”. We saw people were treated kindly and with dignity and respect. People said they were given choices in how they lived their life at the home and that their consent was always sought by staff prior to providing care.

Care records were personalised and included information about a person's likes and dislikes. Information about people’s health and welfare needs and the care they required however was inaccurate and we could find no evidence that people’s care had been reviewed in light of their changing needs.

We reviewed three staff records. We found the provider had undertaken the necessary checks to ensure people had the necessary skills and suitability to work with vulnerable people.

People we spoke with said they had no concerns and felt safe with staff. Staff demonstrated a general awareness of abuse but did not know who to report concerns to outside of the organisation. We reviewed the provider’s safeguarding policy and found it did not provide clear guidance to staff on what to in the event of suspected abuse.

People said they had no complaints but they knew how to make a complaint. We reviewed the handling of two complaints and saw the provider had investigated and responded to the complaints in a sensitive, prompt manner to people’s satisfaction.

Inspection carried out on 24 July 2012

During an inspection to make sure that the improvements required had been made

People told us they felt well cared for and the manager and care workers listened to them. Some comments made were;

"When I’ve been ill the manager and staff have looked after me so well.”

“Sometimes when I’m ill I don’t want to see my doctor but the manager is very good with me and explains I really need to see him.”

I can’t fault the care and attention I receive I am very happy here.”

Inspection carried out on 20 April 2012

During a routine inspection

We spoke with people who used the service they told us they felt well cared for and respected by the care workers. Some comments made were;

“I have my routines that I like to stick to the girls are very good and understand what help I need.”

“I pretty much take care of myself but it’s nice to know that the staff are here if I need them.”

“This is my home from home.”

“The staff are very attentive and kind.”

A family member spoken with said they felt their mother was well cared for and the staff team were approachable and very kind.

We observed people being supported in a respectful and sensitive manner.

People spoken with told us they felt safe and supported by the staff team and would feel comfortable raising concerns with the registered manager or one of the providers. We were also told that they felt confident in speaking to the care workers and registered manager about the level of support they felt they needed. Some comments were;

“This is a small home and that is one of the reasons I chose it the girls are very gentle and respectful I feel very comfortable here.”

We sought information about the service offered at Ryecroft from Wirral Department of Adults Social Services (DASS) and Wirral Local Involvement Networks (LINKs). No issues of concern were raised.

Reports under our old system of regulation (including those from before CQC was created)