Archived: Scarletts

Scarletts is a ‘care home’. 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 we looked at both during this inspection.

Scarletts accommodates and provides personal care for up to 50 older people. At the time of this inspection, there were 18 people accommodated, who were vulnerable due to their age and frailty, and in some cases had specific and complex needs, including varying levels of dementia related needs and end of life.

The service had no registered manager in post. However, a new manager who intended to apply for registration had started work at the service on the day 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.

We carried out an unannounced comprehensive inspection of Scarletts in June 2017 and we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was poor leadership, management and provider oversight of the service resulting in people receiving poor care and risks to people’s health and welfare not being adequately protected. We took immediate enforcement action to restrict admissions and placed conditions on the provider’s registration to improve the assessment of risk, leadership, staffing and oversight.

The service was given an overall judgement rating of ‘inadequate’ and is therefore in special measures.

We continued to keep Scarletts under review and following information from whistle-blowers and the local authority, we carried out unannounced, focused inspections in September 2017 and December 2017 and met with the provider’s representatives in January 2018. These inspections focused on the areas of ‘Safe’ and ‘Well led’. We also checked the provider’s progress in addressing the breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified at our comprehensive inspection in June 2017.

We found continued and widespread concerns with the governance, leadership and provider oversight of the service resulting in a failure to address recurring areas of risk to people and to learn lessons when things had gone wrong. There was a failure to drive and sustain improvement.

The local authority safeguarding and quality monitoring teams continued to monitor the service through regular visits and support, mitigating the risk to people using the service.

You can read the reports from our previous inspections, by selecting the 'all reports' link for Scarletts on our website at www.cqc.org.uk

This inspection focused on the areas of ‘Safe’ and ‘Well-led’. We found that sufficient improvement had not been made since our last inspection and the provider was continuing to fail to meet the requirements of the regulations, commonly referred to as The Fundamental Standards of Quality and Safety.

Risk management processes continue to be ineffective and the provider continued to demonstrate a lack of understanding of the risks affecting people living at Scarletts. Staff were not equipped with the right information and skills so that people receive safe and appropriate care. People were not protected from the unsafe management of medicines.

Robust and sustainable auditing and monitoring systems were not in place to ensure that the quality and safety of care was consistently assessed, monitored and improved. Failures in the service continued to be widespread and demonstrated the provider's inability to make and sustain improvements. We continue to have concerns about the provider’s oversight of the service, inconsistent governance and leadership.

Some of the conditions that were placed on the provider’s registration to try to encourage improvement after our inspection in June 2017 have not been met.

The Commission is currently considering its enforcement powers. This includes taking action in line with our enforcement procedures to begin the process of cancelling the provider's registration.

Scarletts is a ‘care home’. 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 we looked at both during this inspection.

Scarletts accommodates and provides personal care for up to 50 older people. At the time of this inspection, there were 23 people accommodated, who were vulnerable due to their age and frailty, and in some cases had specific and complex needs, including varying levels of dementia related needs and end of life.

Scarletts is in Special Measures, which resulted from an Inadequate rating following a comprehensive inspection undertaken in June 2017. The purpose of Special Measures is to ensure providers found to be providing inadequate care significantly improve. We keep services placed into Special Measures under review and, if we have not taken immediate action to propose to cancel the providers’ registration of the service, will be inspected again within six months. The expectation is that providers found to be providing inadequate care should have made significant improvements within this timeframe.

At the inspection in June 2017, we identified a number of breaches of legal requirements. There was poor leadership, management and provider oversight of the service, which led to people receiving poor care and risks to their health and welfare not adequately protected. We took immediate enforcement action to restrict further admissions and to improve leadership, staffing and oversight. We shared our concerns with the local authority. In response, the local authority monitored the care people received and held regular meetings involving healthcare professionals to support the provider through the improvement process.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Scarletts on our website at www.cqc.org.uk

We continued to keep Scarletts under review. The reports the provider submitted regularly to us did not provide the information we needed to demonstrate the progress they were making in improving the service for people. It was therefore necessary and within the six month timescale to re-inspect again on 12 September 2017. The inspection focused on the areas of ‘Safe’ and ‘Well led’. The provider had not made sufficient improvement and the service remained Inadequate in these areas. Despite support provided by a team of senior managers, managers and care staff brought in from the provider's services in Leicestershire, there continued to be a lack of provider and managerial oversight and a failure to recognise, identify and act on significant concerns affecting the quality and safety of care for people. We took further enforcement action, with the agreement of the provider revised the existing conditions, and imposed further conditions on the service registration in an effort to force improvement.

You can read the report from our last focused inspection, by selecting the 'all reports' link for Scarletts on our website at www.cqc.org.uk

After the inspection on 12 September 2017, we received concerns in relation to staffing, management and provider oversight. As a result, we undertook this focused inspection to look at those concerns and this report only covers our findings in relation to those. This inspection did not assess performance against all five key areas and focused only on the areas ‘Safe’ and ‘Well Led’. The ratings from the previous comprehensive inspection for the other three key questions were included in calculating the overall rating in this inspection. We will be returning to the service to provide a comprehensive overview of each key question.

The service did not have a registered manager in post. 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 provider had replaced the management team they had previously brought in with a new manager and the Commission was processing their application for registration.

We continue to have concerns about the provider’s oversight of the service, inconsistent governance and leadership. A reliance on multiple and various managers to act on issues of concern continued without giving any effective direction or support. This in turn led to a failure to address recurring areas of risk to people’s health, safety and welfare, and to drive and sustain improvement.

A high staff turnover and failure to support and retain staff impacted on staffing numbers, deployment of staff and skill mix which meant people’s needs were not always met safely, effectively or consistently, or in a way that reflected their preferences and choice. People’s experiences of care varied considerably depending on which staff were providing it and how well they knew them.

The local authority safeguarding and quality monitoring teams continued to monitor the service through regular visits and support, mitigating the risk to people using the service.

In the latter part of December 2017 the provider engaged further external consultancy support. At a meeting on 23 January 2018, the external consultants shared with us an extensive action plan they had drawn up to address and drive improvement and meet fundamental standards of care and safety. They confirmed the beginning of March 2018 was the expected target date for completion.

The Commission is continuing to monitor this service and will be returning to carry out a full and unannounced comprehensive inspection. If not enough improvement is made within the 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.

For adult social care services, the maximum time or being in Special Measures will usually be no more than 12 months. If the service has demonstrated improvements when we next inspect it and it is not rated as inadequate for any of the key questions it will no longer be in Special Measures.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

Scarletts is a care home that provides accommodation and personal care for up to 50 older people who are vulnerable due to their age and frailty, and in some cases have specific and complex needs, including varying levels of dementia related needs and end of life. There were 31 people using the service at the time of the inspection.

We carried out an unannounced comprehensive inspection of Scarletts on 6 and 8 June 2017, and we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was given an overall judgement rating of 'inadequate' and was placed into Special Measures.

Services in Special Measures are 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.

Following the inspection in June 2017, we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they were going to do immediately to address them. An action plan was returned to us the following day. We took immediate enforcement action to restrict admissions, to ensure adequate staffing levels and to ensure that effective leadership and oversight was in place to mitigate the risk to people. This inspection was undertaken within the six months timescale because we received further information of concern from the local authority and whistle blowers which related to poor staffing levels and poor care. Because of this, we wanted to check that the enforcement action were had been taken was resulting in improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Scarletts on our website at www.cqc.org.uk

The registered manager left the service after the last inspection and management support was being provided by a team from the provider’s services in Leicestershire. An acting manager was in place at the time of this 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.

This inspection focused on the areas of safe and well-led. We found that sufficient improvements had not been made since our last inspection in June 2017 and the provider was continuing to fail to meet the requirements of the regulations, commonly referred to as The Fundamental Standards of Quality and Safety. These breaches had led to the continued failure to adequately care and protect people and exposed them to the risk of harm. The Commission is currently considering its enforcement powers. This service will continue to be kept under review and, if needed, could be escalated to further 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 found there had been a lack of oversight of the service by the provider to ensure the service delivered was of a good quality and safe, and continued to improve. People’s safety and welfare were compromised because the provider did not have in place robust and effective quality monitoring and assurance processes to identify issues that presented a potential risk to people. Thorough risk assessments had not been carried routinely to identify risks in relation to people’s healthcare needs, the physical environment and equipment; necessary maintenance work and health and safety precautions had not been taken within the home to protect people from risk of harm. Cleanliness in the service had been neglected.

Scarletts is a care home that provides accommodation and personal care for up to 50 older people who are vulnerable due to their age and frailty, and in some cases have specific and complex needs, including varying levels of dementia related needs and end of life. On the day of our inspection there were 40 people using the service. This was an unannounced inspection.

Scarletts comprises of four units over two floors; Forest View and Muntjac on the ground floor and Squirrel and Badgers on the first floor.

There was a registered manager in post. 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 culture within the home did not promote a holistic approach to people's care to ensure their physical, mental and emotional needs were being met. Robust and sustainable audit and monitoring systems were not in place to ensure that the quality of care was consistently assessed, monitored and improved. Quality assurance systems had failed to identify the issues we found during our inspection.

There was not an effective system in place to ensure there were sufficient numbers of staff on duty to support people and meet their needs, particularly at night. There were not enough staff to provide adequate supervision, nutritional support, stimulation and meaningful activity. This had a direct impact on people’s safety and welfare. . There were a high incidence of falls in the service and we were concerned that this was due to a lack of staff being available to support and monitor people effectively.

People were at risk due to poor monitoring of environmental factors and essential maintenance not taking place when needed. People’s care had not been co-ordinated or managed to ensure their specific needs were being met. Risks to people injuring themselves or others were not appropriately managed. People's medicines were not being managed effectively to protect them from the associated risks of not receiving prescribed medicines.

The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, we observed some interactions which were not respectful. Staff were not supporting people in a consistent and planned way. They did not always respond appropriately and in a timely manner to all of people's needs.

Care plans were task focused and not personalised or centred on individual’s needs. They contained conflicting information and did not give clear guidance to staff to enable them to support people safely and effectively

Training and development was not sufficient in some areas to show that people's healthcare conditions and support needs were fully understood by staff. Staff demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS.) However, this wasn’t always seen in practice. People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

Staff were aware of their responsibilities with regard to safeguarding people from abuse and knew how to report concerns. However, they did not recognise or understand the wider aspects of safeguarding people from risk as identified in this report.

Following this inspection we sent an urgent action letter to the provider telling them about our findings and the seriousness of our concerns. We requested an urgent action plan from them telling us what they are going to do immediately to address them. An action plan was returned to us the following day. We also shared our concerns with the local authority and their safeguarding team. We took immediate enforcement action to restrict admissions and force improvement.

We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Commission is considering its enforcement powers.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. The service 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.

At our last inspection of this service on 28 April 2015. We found that the provider was not meeting expectations in relation to documenting and regularly reviewing peoples care plans. There was also a lack of auditing documents for example checking that staff supervision had been provided. We also found medicines were not being managed safely and aspects of the accommodation were not safe. This was regarding some radiators without covers and poor quality clinical waste bins. At this inspection we found the provider had taken action to improve all of these areas.

The service has 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.

People were protected from the risk of abuse as staff had attended training to ensure they had a good understanding of their roles and responsibilities if they suspected abuse was happening. The manager had shared information with the local authority when needed.

People were supported by a sufficient number of suitably experienced support staff, although a senior post was vacant. The provider had ensured appropriate recruitment checks were carried out on staff before they started work. Staff had been recruited safely and had the skills and knowledge to provide care and support in ways that people preferred.

The provider had systems in place to manage medicines and people were supported to take their prescribed medicines safely.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that decisions were taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are all in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People at the service were subject to the Deprivation of Liberty Safeguards (DoLS). Staff had been trained and had a good understanding of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Positive and caring relationships had been developed between people and staff. Staff responded to people’s needs in a compassionate and caring manner. People were supported to make day to day decisions and were treated with dignity and respect at all times. People were given choices in their daily routines and their privacy and dignity was respected. People were supported and enabled to be as independent as possible in all aspects of their lives.

Staff were supported and supervised in their roles. People, where able, were involved in the planning and reviewing of their care and support.

Staff ensured that people’s health needs were effectively monitored and appropriately managed with input from relevant health care professionals. People were treated with kindness and respect by staff who knew them well. People were supported to maintain a nutritionally balanced diet and sufficient fluid intake to maintain good health.

People were supported to maintain relationships with friends and family so that they were not socially isolated. There was an open culture and staff were supported to provide care that was centred on the individual. The manager was open and approachable and enabled people who used the service to express their views.

People were supported to report any concerns or complaints and they felt they would be taken seriously. People who used the service, or their representatives, were encouraged to be involved in decisions about the service. The provider had systems in place to check the quality of the service and take the views and concerns of people and their relatives into account to make improvements to the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Staff had received appropriate training and received regular supervision from senior staff. They attended daily shift handovers where the needs of the people who used the service were discussed to ensure that the relevant information was passed on to other staff.

Care records contained detailed assessments of people's needs that had been carried out prior to them moving to the service. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area and were awaiting refresher training due to recent changes to the guidance. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that two applications had been submitted, proper policies and procedures were in place. This meant that relevant staff had been trained to understand when an application should be made, and how to submit one.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One person said, "The staff are great they couldn't do anything any better."

Is the service effective?

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 the people well. People we spoke with told us that, "The staff know what I like and dislike.' Specialist dietary needs had been identified in care plans where required. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

The training that staff had received equipped them to meet the needs of the people who used the service.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Where people's care needs had changed appropriate referrals to the appropriate health professional had been made and any recommendations had been acted on. Care plans and risk assessments were promptly updated following a change in a persons assessed needs.

Where people had raised a concern, the manager had taken action to address the concerns promptly and to the satisfaction of the complainant.

Is the service well led?

The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving. Staff told us they were clear about their roles and responsibilities and that they received excellent support and supervision from the manager. Staff had a good understanding of the ethos of the service. This helped to ensure that people received a good quality service at all times.

People's bedrooms were personalised with their own personal effects. Maintenance and cleaning staff were on duty in the home and contributed to people being protected by a safe environment.

Assessment and care planning was not always sufficiently detailed to ensure people received care and support in ways that met their needs and preferences.

We found that systems for receipt, storage, administration, recording and disposal of medicines were safe. Staff recruitment and induction systems were robust.

Staff told us they enjoyed working at the home and felt well supported by the manager. We saw records that evidenced up to date staff rotas and a training plan for staff.

People who lived at the home and their relatives told us they were able to discuss any concerns with the manager, and that these were addressed in a timely manner. The manager told us there were meetings held with staff and people who lived at the home and future events and the development of the home were discussed. One relative told us, 'They could do with bringing things [furniture and decoration] up to date a bit more, but at the end of the day the standard of care X receives here is excellent.'

We saw that the organisation had systems in place to monitor the quality of the service provided and the actions taken to address any that needed addressing.