Background to this inspection
Updated
24 August 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This comprehensive inspection was carried out by one inspector on 16 and 18 July 2018 and was unannounced.
Prior to the inspection we reviewed the contents of notifications received by the service. Services have to notify us of certain incidents that occur in the service, these are called notifications.
Some people using the service were unable to communicate their views about the care they received. We therefore carried out observations to assess their experiences throughout our inspection. We spoke with four people using the service, two relatives, three care staff, three nurses, two domestic staff, the registered manager and to both partners in the business.
We reviewed five care records, four staff personnel files and a sample of records relating to the management of the service.
Updated
24 August 2018
On 7 and 8 September 2016 the service was rated good overall. At this inspection in July 2018 we identified widespread failings which put people at the potential risk of harm. The service was found to be in breach of Regulations 9, 10, 11, 12, 13, 14, 15, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service is now rated inadequate overall.
The service had 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.
Prior to this inspection, the ill health one of the business partners meant they had been unable to be involved in the day to day running of the service as they had in the past. This meant that the other business partner and the registered manager had sole responsibility for the day to day running of the service.
Alexandra House Nursing and Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Alexandra House Nursing and Residential Home is registered to provide a service to 25 older people, some of whom may be living with dementia. At the time of inspection there were 19 people using the service.
Following this inspection we were so concerned that we informed Norfolk County Council and the Clinical Commissioning Group (CCG) of our findings. We also took urgent action to prevent the service taking on new admissions.
The service was not safe. Risks in the premises had not been identified and action had not been taken to protect people from harm. Equipment had not been serviced by competent persons to ensure it was safe for use. Appropriate checks had not been carried out on the water systems and fire safety systems to ensure peoples health, safety and welfare.
Risks to people were not being planned for or appropriate actions taken to minimise these. This included risks associated with dehydration, malnutrition and pressure ulcers. People who were at risk of choking were not being supported and supervised appropriately to reduce this risk. Systems were not in place to protect people from the risks of abuse. Staff had not received safeguarding training.
The service was not consistently clean and the registered manager had failed to address concerns about cleanliness which were observed by the CCG in June 2018.
There were not enough staff to consistently meet the needs of people using the service, to include their social and emotional needs. The service did not practice safe recruitment procedures to ensure that staff were of good character and were safe to work with people living within the service.
Medicines were not managed or administered safely. Some people had not received their medicines in line with the instructions of the prescriber and the service had taken no action regarding this.
The service was not complying with the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s capacity was not assessed appropriately and the service did not encourage and enable people to make decisions.
Staff did not receive appropriate training in subjects relevant to the people they cared for. This included training in using equipment such as hoists. Staff did not have the opportunity to have supervision or one to one sessions with their manager. The registered manager did not carry out clinical supervision of nurses. There was a poor culture in the service with staff including the registered manager not identifying the poor practice of themselves and others.
People were not involved in the planning of their care and their views were not reflected in their care records. Staff did not always uphold people’s dignity and respect. People were not encouraged and enabled to be independent.
People received generic care which was not personalised to them as an individual. Not all staff knew people as individuals and care records did not provide information to them about the people they were caring for.
There were no end of life care plans in place for people. This meant that the service could not ensure people’s preferences were met at the end of their life. People did not have access to meaningful activity and engagement. People we spoke with told us they were bored.
There was no quality assurance system in place at the service and the registered manager failed to identify the shortfalls we found. This meant that people continued to receive poor quality care which did not meet their needs. The provider had not implemented a system to ensure that an appropriately qualified person was overseeing the quality of the service and performance of the registered manager on their behalf.
The registered manager did not have a knowledge of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 or the framework by which we inspect care homes.
The overall rating for this service is 'Inadequate' and the service therefore is 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.