24 December 2021
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
One inspector and an Expert by Experience completed a site visit. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
A S Care is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 changes were being made to the registered manager position. The current registered manager had stepped down and was in the process of cancelling their registration. An acting manager had been appointed and was in the process of submitting their registered manager application. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This was an unannounced inspection.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority. We used all of this information to plan our inspection.
During the inspection
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with five people about their experience of living at the service and two visiting relatives and a visiting health care professional. We spoke with the acting manager, two senior care staff, two domestic staff, the cook and three care staff.
We reviewed a range of records. This included in part, seven’s people's care records and multiple medication records. We looked at three staff files in relation to recruitment. We looked at a variety of records relating to the management of the service, including incident analysis, we checked the health and safety of the internal and external environment.
After the inspection
We continued to seek clarification from the provider to validate evidence found. This included but was not limited to the provider's training data, policies, procedures, meeting records, audits and checks.
24 December 2021
About the service
A S Care is a residential care home providing accommodation and personal care for up to 25 older people, including people living with dementia. At the time of our inspection, there were 16 people living at the service.
People’s experience of using this service and what we found
Action was required to protect people from abuse and avoidable harm. Staff required refresher training to ensure they fully understood their role and responsibilities.
Some people were living with dementia and experienced periods of heightened anxiety that impacted on their emotional and behavioural wellbeing. The provider had planned specific refresher training to support staff’s understanding and enhance their skills.
Incident management processes were not fully effective. Incidents had not been analysed for themes, patterns, and any learning to reduce reoccurrence.
Medicines management systems and processes had recently been improved by the provider However, further action was identified as required to ensure people received their medicines safely. The provider took immediate action and implemented further changes, including staff refresher training.
Infection prevention and control measures was impacted by the quality of some flooring and furnishings that were difficult to keep clean and hygienic and needed replacing. Best practice guidance was not fully adhered to.
Staffing levels were found not to be sufficient to meet people’s individual needs and safety. The provider took immediate action and increased staffing levels in the afternoon. Improvements to safe staff recruitment practice had recently been implemented.
Since the last inspection, there had been changes with the management of the service. At the time of the inspection, the current registered manager had stepped down from their position and was in the process of de-registering. An acting manager had been in post four weeks and was in the position of submitting their registered manager application.
The provider’s systems and processes used to assess, monitor and mitigate risks were not fully effective in developing and driving improvements. The acting manager had developed an action plan and showed a commitment to make the required improvements. The provider acknowledged they needed to improve their oversight and had appointed a new compliance manager to assist them.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 24 February 2018).
Why we inspected
We received anonymous safeguarding and moving and handling concerns. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.
We found some evidence during this inspection that staff required refresher training in how to protect people from the risk of abuse and avoidable harm. We found no concern how people were supported in relation to moving and handling.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. We have found evidence that the provider needs to make improvements.
Please see the Safe and Well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A S Care on our website at www.cqc.org.uk.
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to how people were protected from avoidable harm and abuse, and the systems and processes used to monitor quality and safety.
Please see the action we have told the provider to take at the end of this report.
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.