Archived: Solent View Care Home

The home accommodates up to 19 people and at the time of our inspection 17 people were living at the home, two of whom were in a shared room. The accommodation was based on two floors connected by a passenger lift. The kitchen, sluice room and staff offices were based on the third floor of the home.

This inspection took place on 26 and 27 February 2018 and was unannounced.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

We identified widespread and systemic failings during this inspection. The provider’s governance arrangements had not been effective in ensuring the fundamental standards of safety and quality were met. Appropriate quality assurance systems were not in place, there was a lack of resilience in the management structure and an accessible complaints procedure was not in place.

Staff who administered medicines were not always trained and people did not always receive their medicines as prescribed. Medicines were not always stored safely or recorded in accordance with best practice guidance.

Areas of the home were not clean, including the sluice room and a bathroom. Infection control arrangements were not adequate to prevent the risk of cross contamination. The laundry room was not fit for purpose. Legionella risk assessments and infection control audits had not been completed.

Individual and environmental risks to people were not always managed effectively, including risks posed by choking and pressure injuries. Not all staff had completed fire safety training, including senior staff who were expected to take charge in an emergency.

Action had been taken to reduce the risk of people falling; however, records of people’s falls were not completed accurately to allow the provider to identify patterns or trends.

Safe recruitment procedures were not always followed to help ensure only suitable staff were employed. Not all staff had completed essential training to undertake their roles.

People had mixed views about the food and choices were not offered in an effective way for people living with dementia. We could not be assured that people’s dietary and hydration needs were met consistently.

Staff followed legislation designed to protect people’s rights. However, assessments of people’s ability to make specific decisions had not always been completed.

Some adaptations had been made to the home to make it supportive of the people who lived there, but the home was not accessible to people who used wheelchairs and some people reported excessive levels of noise that upset them.

Some staff showed a lack of consideration for people’s dignity, for example in the way they cared for their clothes and stored continence aids in their rooms.

Most people were complimentary about the attitude of staff, but some described them as “off-hand” or “unhelpful” at times. We observed some positive interactions between people and staff, but also heard inappropriate language being used by staff who were not always discreet.

Staff demonstrated a good understanding of people’s individual needs, although records of the care they provided did not confirm that the needs of four people being cared for in bed had been met.

Staff described how they supported people at the end of their lives, but most had not completed end of life training and people’s end of life wishes had not been recorded in their care plans.

The provider sought and acted on feedback from people, but action taken was not always effective. There was not a policy in place to ensure staff acted in an open and transparent way when people came to harm.

Staff completed pre-admission assessments before people moved to the home and supported people to access healthcare services. They understood their safeguarding responsibilities and there were enough staff deployed to meet people’s needs.

Staff promoted independence and usually involved people in discussions about their care. People had access to a range of activities including one-to-one conversations with an activities coordinator.

Staff were happy working at the home and felt supported in their roles by the registered manager.

We identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about the commission’s regulatory response to the breaches will be added to the report after any representations and appeals have been concluded.

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 provider’s registration of the service, will be inspected again within six months. The expectation is that 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 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 provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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

The inspection was unannounced and was carried out on 29 March 2017 and 06 April 2017 by one inspector.

There was a registered manager in place at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

People and their families told us they felt the home was safe, however, there were not always enough staff to meet people’s needs. We have made a recommendation about this.

The systems in place to monitor the quality and safety of the service were not robust. Staff were aware of the risks relating to people they supported, however people’s care records did not always reflect those risks.

There were suitable systems in place to ensure the safe storage and administration of medicines. However, the medicine stock management system was not robust. Medicines were administered by staff who had received appropriate training and assessments.

Staff and the registered manager had received safeguarding training and were able to demonstrate an understanding of the provider’s safeguarding policy and explain the action they would take if they identified any concerns. Accidents and incidents were monitored and remedial actions identified to reduce the risk of reoccurrence.

People were supported by staff who had received an induction into the home and appropriate training, professional development and supervision to enable them to meet people’s individual needs.

Staff followed legislation designed to protect people’s rights and ensure decisions were the least restrictive and made in their best interests. Healthcare professionals, such as chiropodists, opticians, GPs and dentists were involved in people’s care when necessary.

Staff developed caring and positive relationships with people and were sensitive to their individual choices and treated them with dignity and respect. People were encouraged to maintain relationships that were important to them.

People were supported to have enough to eat and drink. Mealtimes were a social event and staff supported people, when necessary in a patient and friendly manner.

Staff were responsive to people’s communication styles and gave people information and choices in ways that they could understand. They were patient when engaging with people who could not communicate verbally and who used a variety of signs, noises and body language to express themselves. Staff were able to understand people and respond to what was being said.

People and when appropriate their families were involved in discussions about their care planning, which reflected their assessed needs.

People and their families told us they felt the home was well-led and were positive about the registered manager and the head of care. Staff were aware of the provider’s vision and values, how they related to their work and spoke positively about the culture and management of the home.

There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service. They were also supported to raise complaints should they wish to.

There was a registered manager in place. 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.

This comprehensive inspection was carried out to check on the service’s progress in meeting the requirements made as a result of the previous inspection on 24 and 27 July 2015. Following that inspection, the service was rated inadequate and placed in Special Measures. This meant we started to use our enforcement powers to monitor and check the service and if no improvements were noted we could consider cancelling or varying the conditions of the provider’s registration. We issued three warning notices to the provider and the registered manager; these were for breaches of regulations relating to safeguarding people from abuse, the governance arrangements and the failure to send us notifications of significant events. We also issued requirement notices for breaches of two further regulations; these related to safe care and treatment of people and the need for consent. The provider sent us an action plan stating how they were going to meet the regulations.

At this inspection, on 5 February 2016, we found action had been taken to meet the regulations, although some further improvements were identified.

Most individual risks to people’s safety had been identified and were being managed appropriately, although further information was needed to enable staff to support two people to prevent pressure injuries developing.

Staff sought consent from people before providing care and the registered manager had assessed people’s ability to make certain decisions. However, legislation designed to protect people’s rights was not always followed as senior staff had not understand the process fully.

People told us they felt safe and their needs were met. Staff knew how to care for people effectively, although some had received initial or refresher training in key subjects, such as safeguarding people from abuse, food hygiene, medicines administration and dementia awareness. Therefore, they may not have been supporting people safely or in accordance with current best practice.

Effective systems were in place to assess, monitor and improve the service provided, although the system used to monitor staff training had not been kept up to date. Improvements had been made to fire safety arrangements and concerns we had previously identified with the lack of restrictors on first floor windows had been addressed fully.

The arrangements for managing medicines were safe and an additional medicines round had been introduced to help make sure people received their medicines at the right time. There were sufficient staff to meet people’s needs and recruitment practices were safe.

People were satisfied with the quality of the food and received appropriate support to eat and drink enough. They had access to healthcare services when needed.

People were treated with kindness and compassion in their day-to-day care. Staff knew people well and treated them with dignity and respect. People’s privacy was protected at all times and they were involved in planning the care and support they received.

Staff empowered people to make choices about all aspects of their lives. They delivered care in a personalised way according to people’s individual needs. Care plans contained comprehensive information about how people wished to be cared for and were reviewed regularly.

The provider sought feedback from people and had a process in place to act on issues raised. There was a suitable complaints procedure in place and people knew how to complain.

The service had an open and transparent culture and people had a positive relationship with the registered manager. Staff felt supported by management and worked well as a team.

At the time of this inspection there were 17 people living at the home. We spoke with the registered manager, a member of staff and one prospective member of staff. We also looked at three staff personnel files.

We found there were effective recruitment and selection processes in place. All necessary pre-employment checks were conducted. People were cared for by suitably qualified, skilled and experienced staff.

At the time of our inspection there were 17 people living at the home. We spoke with three people using the service, a community nurse, six members of staff and the registered manager. We looked at care plans and related records of care for six people. Following the inspection we discussed our concerns with the local safeguarding authority.

We looked at outcomes relating to: care and welfare; safeguarding; requirements relating to workers; staffing; assessing and monitoring the quality of service provision. We considered all the evidence we had gathered under the outcomes we inspected and used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found:

Is the service safe?

We found aspects of the service were not safe. There were sufficient staff to meet people's needs. Risks relating to falls and the use of bedrails were managed effectively. For example, we observed staff using a hoist safely to transfer people between chairs.

Most risks relating to the environment were managed safely, although risks relating to active bee hives kept in the home's garden had not been assessed. Arrangements for dealing with emergencies were not robust.

The risk of people developing pressure injuries was not managed effectively. Staff did not understand a tool being used to assess people's level of risk; preventative measures needed to reduce the risk were not documented in care plans. A community nurse, who visited the home regularly, expressed some concerns about the monitoring and referral of people with pressure injuries.

People were not protected against the risks of malnutrition and dehydration as appropriate action was not always taken when people lost weight.

The provider did not respond appropriately to incidents of abuse. Not all staff had been trained in the safeguarding of vulnerable adults. We identified three incidents where people living at the home had been physically abused by other people living at the home. None had been reported to the local safeguarding authority.

Recruitment practices were not safe. Appropriate checks were not undertaken before staff began work. Until full checks have been completed, staff should not be allowed to take people out of the home unless they are supervised. These restrictions were not applied and this put people at risk of abuse.

Is the service effective?

The service was not always effective. People told us staff supported them appropriately and provided a good level of care. One person told us, 'Everything's OK'. Another said, 'I get all the help I need'.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found one person was subject to DoLS, which had been authorised by the relevant authority. However, other people whose liberty was being restricted were not subject to legal authorisation.

The provider was unable to demonstrate that the principles and guidelines of the MCA and its code of practice had been followed. Suitable arrangements were not in place to ensure decisions were made in people's best interests. Staff were not able to demonstrate a good understanding of the MCA.

Is the service caring?

We found the service were caring. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We saw staff interacting well with people and it was clear staff knew them well. Staff reassured people while supporting them to move position and encouraged them to use equipment to help prevent them from falling.

Is the service responsive?

The service was not always responsive to people's needs. Care plans did not contain sufficient information to ensure people's individual continence needs were met.

People who displayed behaviour that challenged the service were not always supported appropriately. Triggers were not always recorded and records were not kept to show whether support strategies had been implemented.

Suitable activities were not designed or planned to provide mental stimulation to meet people's welfare needs.

Is the service well-led?

Not all aspects of the service were well-led. The provider did not have a current system in place to regularly seek the views of people using the service, their relatives or staff.