Archived: Aldwick Residential Care Home

Updated 10 August 2016

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.

This inspection took place on the 4, 5 and 6 July 2016 and was unannounced. On day one, one inspector undertook the inspection with a specialist professional advisor in mental health and an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was mental health. On days, two and three, one inspector undertook the inspection.

Before the inspection, the provider completed a Provider Information Return (PIR). This form asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. We reviewed information we held about the service. This included previous inspection reports and statutory notifications. A notification is information about important events the provider and registered manager is required to send us this by law.

During the inspection, we spoke with 12 people who were living at the service. We spoke with two visiting mental health professionals, the chef, five members of care staff, a senior support worker and the registered manager. We also spent time observing people in the communal living areas.

We looked at the care plans and associated records for six people. We reviewed other records, including the registered manager's internal checks and audits, staff training records, staff rotas, accidents, incidents and complaints. Records for four staff were reviewed, which included checks on newly appointed staff and staff supervision records.

The service was last inspected on 6 January 2014 when no concerns were identified.

Updated 10 August 2016

This unannounced inspection took place on 4, 5 and 6 July 2016.

Aldwick Residential Care Home, provides care and support for up to 27 people with a variety of mental health needs. At the time of our inspection there were 15 people living at the home.

The facilities consisted of two terraced houses, which had been knocked through to form one house. There was one communal dining area, one lounge, three toilets, one shower room and two bathrooms. However, there was only a hot water supply to one bathroom. The garden was unkempt and had a designated smoking area for people to use.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered provider visited the service on the second day of our visit at the request of the inspector.

The service did not have appropriate systems in place to protect people from harm. The registered manager had not ensured all staff working at the service received safeguarding training and staff were unsure of how to report issues of concern. Staff recruitment processes were not robust and the necessary checks had not been undertaken to ensure staff had been recruited safely.

Building works started at the service were incomplete. The provider had run out of funds and was unable to pay the contractor to complete the works. The building was unsafe and some rooms did not have fire detectors. There was inadequate compartmentation between rooms that would result in a fire spreading. Fire equipment had not been checked, the fire risk assessment was out of date and not all staff had been trained in what to do in the event of a fire. We contacted the West Sussex Fire and Rescue Service to report our concerns. A Fire and Rescue Inspector carried out an inspection on the third day of our visit, which resulted in two prohibition notices being served on the provider. This resulted in people needing to move to alternative accommodation within 7 days of the notice being issued unless the provider was able to make the building safe.

We also shared our concerns with West Sussex Adults Team, The Health and Safety Executive, Environmental Health and Building Control.

Staffing levels were insufficient to support people's needs and people did not always receive care and support when required.

Risks to people's health and wellbeing were not appropriately assessed and reviewed. Care plans were not sufficiently detailed to provide an accurate description of people's care and support needs.

Medicines were not managed safely. There was no system for checking the stock of medicines or to monitor the competency of staff responsible for administering medicines. Changes had been made to the prescribing instructions without evidence this was supported by an appropriate healthcare practitioner. The dates of when creams had been opened were not being recorded, this presented a risk because after the expiry date, prescription creams may not be safe or they may lose their effectiveness.

Staff were not knowledgeable about the people they supported. Staff had inappropriate experience and qualifications. In spite of their best efforts and hard work to provide care in a supportive and friendly way, they lacked experience and training. Staff had received induction training that did not provide them with the skills and knowledge to deal with the complex needs of people using the service and they were reliant on the guidance of the registered manager, who was completing a mental health awareness training. This training had not been completed and the registered manager was not certified as competent. As part of their induction training, staff had not received training in behaviour that may challenge, de-escalation techniques or mental health. This meant that they were not appropriately skilled to deal with potentially challenging and stressful situations for people as well as themselves.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Members of staff we spoke with did not have a full and up to date understanding of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of adults by ensuring that if there are restrictions on their freedom and liberty these are assessed by appropriately trained professionals. We found that appropriate DoLS applications had been made, and staff were acting in accordance with DoLS authorisations. However, we found the registered manager had made decisions for people who had capacity, in their best interest without involving relevant external professionals, such as a social worker and / or advocate.

As support plans and risks assessments were not up to date potentially, people were not protected from taking unacceptable risks, including those associated with nutrition and hydration.

Although people were treated in a caring and respectful manner, staff did not always engage with people when given the opportunity. People, who used the service, or their representatives, were not always encouraged to contribute to the planning of their care.

People did not receive person centred care as the care records did not give adequate information required for individualised care.

People told us that they were not given the opportunity to choose the way that their individual and group activities would be delivered.

Key documents were missing and records not kept up to date. The support plans for people using the service were missing, incomplete or did not contain up to date and regularly reviewed information. This meant staff was not able to perform their duties efficiently.

People's views were not taken into account and used to make improvements to the service. Processes were not in place to deal with people's complaints and concerns. When complaints had been raised and reported to the registered manager, the issues raised were not responded to and acted upon.

There was no overall leadership of the service in place. The service lacked an open culture; serious incidents, which had occurred, had not been reported to the appropriate authorities in a timely way.

Systems in the service that were meant to monitor and identify improvements were not effective and records were not always maintained and completed in full. This lack of effective governance led to all people not receiving safe and consistent care.

At the time of our visit, the registered manager and provider acknowledged the shortfalls. The provider informed us they did not have the funds to make the building safe and meet the Regulatory Reform (Fire Safety) Order 2005 – Prohibition Notices, which had been served. Consequently, all 15 individuals residing at Aldwick Residential Care Home, vacated the building and were found alternative accommodation by West Sussex County Council.

Since our visit, the provider applied to voluntarily de-register their service with The Care Quality Commission to close.

The overall rating for this service is 'Inadequate' and had the provider not voluntarily applied to de-register their service, the service would have been put in 'Special measures'.

Services in special measures are kept under review and, if we had not taken immediate action to propose to cancel the provider’s registration of the service, they would have been inspected again within six months.

The expectation is that providers found to be providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement had made within this timeframe so that there had of been a rating of inadequate for any key question or overall, we would have taken action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This would lead to cancelling their registration or to varying the terms of their registration within six months if they had not improved.

For adult social care services, the maximum time for being in special measures would usually be no more than 12 months. If the service had demonstrated improvements when we inspect it and it was no longer rated as inadequate for any of the five key questions it would have no longer be in special measures.

During this inspection, we found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found three breaches of the Care Quality Commission (Registration) Regulations 2009.