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.
We carried out a responsive unannounced inspection of this home on the 02 and 03 August 2018 following concerns which had been raised by the local authority about the safety and welfare of people. At our last inspection of this home we had rated it Good. At this inspection we found concerns for the safety and welfare of people. The registered provider had failed to be compliant with all of the required Regulations.
Challoner House is a ‘care home’ and is registered to accommodate up to 49 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection 42 people were accommodated at the home.
The registered manager had just left the service the week before our inspection but was currently still registered with 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.
We found peoples safety was compromised in some areas. There were inadequate numbers of permanent staff and the home was reliant on agency staff especially at night. The provider had been running the services with inadequate staffing levels which staff felt was unsafe and that they could not meet people’s needs safely.
Relevant recruitment checks were conducted before staff started working at the service to make sure staff were of good character and had the necessary skills. However, there were unexplained gaps in staff employment histories.
Staff understood safeguarding procedures to keep people safe. However, systems were not in place to monitor these
Environmental risks were not managed effectively; fire alarm tests were not up to date as recommend by fire safety regulations. People did not have individual personal evacuation plans to support staff in the event of an emergency. A legionnaires water risk assessment had needed to be reassessed since 2015. Infection control procedures needed to be more robust.
Risks associated with people’s care had not always been identified and assessments made to reduce these risks for people. Emergency call bells were not always available to people in the case of an emergency to call for help. Improvements were required for the safe management of medicines.
Staff did not receive regular support and one to one sessions or supervision to discuss areas of development and to enable them to carry out their roles effectively. Staff completed a range of training but felt it didn’t always support them. Dementia training was not always available to all staff.
People’s rights were not always protected because staff did not always understand and work within the principles of the Mental Capacity Act 2005 or Deprivation of liberty safeguards. These were in the process of being reviewed.
People care plans provided information to guide staff in how to support them. However, we found some contained inaccuracies and missing information. There were concerns with missing entries and gaps in charts to monitor people’s food and fluid and skin integrity.
People and their relatives told us staff treated them with kindness but people were not always treated with dignity and respect. People did not always receive care that was person centred and individual to their needs. People received varied meals including a choice of fresh food and drinks.
There were not meaningful activities and interactions in the home for people cared for in bed to reduce the risk of social isolation for people. People and staff told us people were lonely.
During our inspection we found there was a lack of effective management and leadership in the home. Staff felt unsupported and let down by management and morale was low amongst staff. Areas of concern we had identified during our inspection had not always been identified by the governance processes in the home. We could not be assured complaints were always responded to appropriately.
Records were not always accurate. The provider did not send in all notifications to CQC as required by law of all significant events.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.