We inspected Samuel Hobson House on 11 November 2014. Samuel Hobson House is registered to provide accommodation and personal care for up to 39 people. People who use the service have physical health and/or mental health needs, such as dementia.
At the time of our inspection accommodation and care was provided to 22 people.
There was no registered manager 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.
The staff told us that the previous registered manager had left the service approximately two weeks before our inspection. Following our inspection, the provider contacted us to inform us they had recruited a new manager. We were not informed if the new manager was planning to register with us.
At the last inspection on 18 March 2014 we asked the provider to make improvements. These were in relation to the content and accuracy of the information contained in people’s care records and how the quality of care was assessed and monitored.
During this inspection we found that the provider had failed to make the required improvements. This meant the provider had continued not to meet the standards required to meet people’s care and welfare needs.
At this inspection, we also identified additional areas of unsafe, ineffective and unresponsive care. This was because the service was not well led. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their care in accordance with their care plans. This meant people were not always kept safe and their welfare and wellbeing was not consistently promoted.
There were insufficient numbers of staff to keep people safe and provide the right care at the right time. This also meant that people’s individual needs were not always met and the staff did not have time to consistently treat people with dignity and compassion.
People’s care records were not always accurate, up to date or secure. Information about people’s needs was not always available for the staff to use. This meant people were at risk of receiving unsafe or unsuitable care.
People were not consistently offered choices about their care and care records did not always contain information about people’s care preferences. This meant there was a risk that people’s care preferences may not be met.
People did not always receive the support they required to eat and drink in accordance with their care plans. This meant that people’s risks of malnutrition and dehydration were not always managed.
Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not being followed. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. This meant people could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves.
There were gaps in the staff’s knowledge and skills because the staff’s training needs had not been assessed and managed. This meant people received inconsistent and unsuitable care from the staff.
The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.
Effective systems were not in place to seek people’s views about the care. This meant that people’s views were not sought to make improvements to the care.
Systems were in place to store, administer and record people’s medicines. However people’s medicines were not always given in a manner that ensured their safety.
People were supported to access health and social care professionals, but improvements were required to ensure referrals for advice and support were made in a timely manner.
People and their relatives told us the staff were friendly and caring and we saw that people’s privacy was promoted by the staff. Relatives told us they were happy with how the staff communicated changes in people’s needs and they understood how to complain if they needed to share concerns about care.