Archived: Grimsargh House Care Home

Updated 22 February 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 was planned to check 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 inspection took place on the 21, 22 and 23 March and the 11 April 2016. The first and last days of the inspection were unannounced. The inspection team included four adult social care inspectors. Three inspectors were on site on the 21 March 2016 and two were on site on the 11 April 2016. The remaining two days included one adult social care inspector.

Before our inspection, we reviewed the information we held about the home, requested information from the Local Authority and Health Watch and reviewed available information in the public domain.

During the inspection we spoke with 12 people who lived in the home and four visitors to the home. We also spoke with 13 members of staff, including the registered manager, nominated individual, senior carers, carers, administrative staff and catering staff. We spoke with one visiting professional on the day of the inspection who was a district nurse. We also spoke with a number of social workers who had cause to visit the home following the safeguarding alerts we raised during the inspection.

We reviewed all of the available 24 care plans and information on people who were on respite at the home. We reviewed the available policies and procedures and saw how these were implemented. We reviewed the information available on the staff employed by the agency owned by the nominated individual of the home and reviewed the information held on people’s medicines.

We observed how staff interacted with people living in the home and how support was provided to meet people’s needs. We observed how long it took staff to answer call bells and how they approached tasks that took them away from what they were previously doing. We observed how people spent their days and how key parts of the day including meal times were undertaken.

We observed how staff and people living in the home interacted and we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We looked around the home including in people’s bedrooms, all communal areas and in the gardens. We also looked at how the home was secured and made safe including the testing of the fire alarm and professional testing of equipment.

Updated 22 February 2018

We inspected this service on the 21 and 22 March 2016 for full days and then again on the 23 March 2016 for a short period in the afternoon to give feedback and collate information. The inspection was completed under Code B, of the Criminal Procedures and Investigations Act 1996, as concerns had been shared with the Care Quality Commission (CQC) that led us to believe breaches of legal requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 would be found. We added a day to this inspection on the 11 April 2016 as further information of concern was shared with us. We also had not received adequate assurances that immediate action required to reduce identified risks had been completed.

The home was last inspected in March 2015 when we rated the service as requires improvement overall and requires improvement for the key questions of safe and responsive. The other key questions of effective, caring and well led were rated as good. We carried out this inspection to ascertain if improvements had been made to the key questions of safe and responsive and to follow up on the information received by the CQC. The information of concern we received identified potential breaches to a number of the regulations which led us to undertake a full comprehensive inspection of Grimsargh House.

During this inspection we found the home was in breach of 11 of the regulations designed to keep people safe in residential care homes. One of these was a failure to display the last inspection ratings from March 2015.This regulation is in place to ensure people living in the home and those visiting can see how well the home is delivering safe, effective and caring services that meet the needs of people living in the home.

Other concerns were noted around the safe recruitment of staff. We were concerned that there was a lack of available information to show us staff had been recruited that were of suitable character and were suitably trained. There was also a lack of information to show us staff had been supported whilst in their role at the home. This included a lack of formal induction to the role, ongoing training and supervision to ensure they were able to complete their role competently and confidently.

We found the food at the home to be of good quality and freshly prepared. However, when people required more support to ensure they did not become malnourished, we found they did not receive the support they required. This included a lack of referral for specialist support. We found this was also the case when people became a higher risk of falls and other accidents.

We looked at the information the home used to develop people’s care plans and found these were not routinely developed with the person being supported. There was a lack of valid consent acquired from people living in the home, for the care they received. Where people were beginning to develop early signs of dementia the home had not used the guidance within the Mental Capacity Act 2005 (MCA) to ensure these people were effectively supported.

The home had not assessed people’s needs in the event of an emergency including how to safely evacuate people. There was not a contingency plan in place to ensue people could continue to access a service in the event the home became uninhabitable.

Records used to administer medicines safely were poorly kept and omitted key information including how people should take their medicines. Care plans for medicines were not fully developed and no one in receipt of ‘as required’ medicines had a care plan, to inform staff of when these should be administered.

We found the home were not recording or acting on complaints in a responsive manner and there were no recorded complaints for the two years prior to the inspection. We were however aware of two complaints made in the last six weeks and heard one made on the second day of the inspection.

There was not a system of quality audit and the home was not monitoring how the service was being delivered. The policies and procedures at the home were not actively implemented making some audits and monitoring difficult to undertake.

The provider did not actively seek the views of people living in the home. This meant that the manager did not have a clear understanding of whether the service being delivered was what people wanted.

At the time of this inspection there was a registered manager in post who had worked at the home for over 30 years. 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.

Following the concerns noted in this inspection we issued notice to cancel the manager's registration. The manager did not provide representations to the commission for the notice and their registration was therefore cancelled on the 7 July 2016.

Following this inspection we were given assurances by the provider that specific action would be taken to reduce the risks to people living in the home. We were not assured the action had been taken and when we revisited the home on the 11 April 2016 we found additional concerns. The provider was also issued with a notice of proposal to cancel the provider’s registration. The commission received representations from the provider which were not upheld. The provider was therefore issued with a Notice of Decision to cancel their registration on the 6 October 2016.

Due to the concerns raised during this inspection we also issued an urgent Notice of Decision to the provider to ensure they could not accept any new people into the home on the 14 April 2016. The provider made appeals to the first tier tribunal against both the urgent Notice of Decision to restrict admissions and against their Notice of Decision to cancel their registration. Both of these appeals were joined and to be heard at the first tier tribunal.

The provider was inspected again in October 2016 and the report for the inspection is published. We did not find anything during that inspection to assure the commission the provider had taken appropriate steps to meet the requirements of the regulations.

In March 2017 there was an incident at Grimsargh House care home where the management and provider at the home took the steps of evacuating people to a nearby hotel. The commission found the incident which led to the evacuation was avoidable. We also found the evacuation was not managed in line with a suitable emergency evacuation plan. We found the provider had not taken, the action taken in a considered way, to ensure the safety and well-being of the people living in the home. The commission took urgent action to cancel the provider’s registration. At the time of the urgent action everyone living at Grimsargh house was moved to other suitable care homes.

The provider appealed against the urgent action taken and an appeal was heard at the first tier tribunal. The appeal was unsuccessful and as a consequence the provider’s registration is now cancelled and Grimsargh House is no longer a care home at the time of writing this report.

The overall rating for this provider was ‘Inadequate’ from the time of this inspection until its cancellation In February 2018. The home was kept in special measures from the time of this inspection until the registration allowing the regulated activity to be delivered from it was cancelled in February 2018. The commission and the Local Authority worked closely with the home from the time of this inspection until all people living at Grimsargh House were moved on in March 2017.

You can see what action we told the provider to take at the back of the full version of the report.