Archived: Devonia EMI Home

During this inspection we considered the domains of ‘Safe’ and ‘Well-led’ and reviewed seven of the nine breaches of regulations identified at our November 2015 inspection. Of the seven breaches reviewed, five remained unmet. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Devonia EMI Home on our website at www.cqc.org.uk

Devonia EMI Home is a family-run home that has been established for over 30 years. It provides accommodation and care for up to 12 ladies, over the age of 65, some of whom are living with dementia. At the time of our visit there were three people in residence and the provider had agreed to a voluntary suspension on new admissions due to on-going failures to meet requirements of the regulations.

The service did not have a registered manager and the provider was in breach of their registration conditions. 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 previous registered manager had deregistered with us in September 2014 and had not worked at the service since May 2014. The service did not have a manager at the time of this inspection and the day-to-date running of the service was being managed by the provider.

There was a lack of effective leadership. The provider had been in breach of regulations since September 2014. They did not have a system to assess, monitor and improve the quality and safety of the service or to respond to known risks.

People were at risk of harm. The provider had failed to assess risks to people’s safety and to provide staff with the necessary guidance and training to meet their needs. Some people who used the service presented on occasions with behaviours that could be described as challenging. Staff had not been trained in how to support people with these needs and there was insufficient guidance on the use of medicines prescribed on an ‘as needed’ basis to manage behaviours. Where people needed support to move, some staff had not been trained in safe moving and handling procedures and staff did not always use mobility aids to promote safe practice. Records relating to people’s care and to the management of the service were not always accurate.

There were enough staff on duty but some staff had not received training to enable them to support people in a safe way. Although the staff on duty were able to describe how they would identify and respond to any allegation of abuse, some staff had not received training in safeguarding adults at risk.

The provider failed to notify the Commission of significant events as required by law. They had not displayed the rating of the service given at the last inspection. Services are required to display their rating so that people can easily understand the performance of the service.

Relatives spoke highly of the service and staff. During our visit there was a calm atmosphere. There was very little by way of activity or stimulation for people.

People received their medicines safely and staff followed clear procedures for the management and storage of medicines.

There were systems in place to promote safe recruitment decisions and to assess whether new staff were safe to work with adults at risk.

The provider had taken action to improve fire safety equipment and processes within the service following action taken by the Fire Service.

We found five continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. Two breaches from the inspection in November 2015 were not reviewed as part of this inspection.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC has now cancelled the provider's registration.

We spoke with five of the ten people living at the home. We also spoke with the registered manager, staff and vising health professionals. We observed care in communal areas and viewed records relating to care, staffing and the management of the home.

We considered five outcomes during this inspection. These being

Outcome 2 Consent to care and treatment

Outcome 4 Care and welfare of people who use services

Outcome 10 Safety and suitability of premises

Outcome 12 Requirements relating to workers

Outcome 16 Assessing and monitoring the quality of the service

We considered all the evidence we had gathered under the outcomes inspected. We used the information to answer the five questions we always ask.

Is the service safe?

The service was not always safe as all necessary pre-employment checks were not completed prior to the staff starting work. The hot water was not managed safely.

A person said the staff 'are very good to you and help you'. When we asked them a second person told us they felt 'very safe'. One person said 'all the staff are nice and I would tell someone if I was unhappy'. Whilst another said 'any problems and I would tell the staff'. One visitor said 'I visit as often as I can and (my relative) always seems clean and well cared for. I have no worries about them when I'm not here'.

Staff told us they had adequate time to provide care and they were supported to attend training and updates.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found the home to be meeting the requirements of the Deprivation of Liberty Safeguards. People's human rights were therefore properly recognised, respected and promoted.

The provider told us hot water taps did not have thermostatic regulators fitted as these had been in place but had resulted in leaks and the plumber had removed them. The temperature that hot water could be supplied at via the boiler had been reduced. However, this meant water was not stored at a temperature hot enough to prevent the risk of legionella. Therefore, whilst people were protected from the risk of scalding they were not protected from the risks of water borne infections.

Staff had completed safeguarding adult training and other essential training. They were able to tell us what they would do if they had any concerns about people's safety or welfare. However, we found that not all essential pre-employment checks had been completed prior to people commencing employment.

We have asked the provider to tell us what they are going to do to ensure they have all necessary information about all staff prior to staff commencing employment and to ensure that the risks from water borne infections are managed.

Is the service effective?

People were receiving a service which met their needs. The provider and staff were knowledgeable about people's care needs and how to meet them. Staff had received training to ensure they had the skills necessary to care for people. The manager and staff were aware of who to contact for specialist advice and when this may be required. We saw, where necessary, external health professionals were appropriately contacted.

People were positive about the service provided. They were supported to lead lives of their choosing and enjoyed their leisure activities. People told us they were supported to attend health appointments. During the inspection the provider identified that a person was not as alert as they usually were. They contacted the person's GP who attended and prescribed antibiotics for a chest infection. This showed the provider was aware when people were unwell and took necessary action.

However, we found that care plans and individual risk assessments were not promptly updated when a person was readmitted to the home following a hospital admission. This meant staff may not have had all necessary information to effectively meet the person's needs.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring care records and risk assessments accurately reflect people's current needs.

Is the service caring?

People were supported by kind and attentive staff. People said they were treated with respect and dignity by the care staff. People also told they were happy with the way they were supported. People said they were happy living at the home. One said 'The food is good, the staff are nice and I like living here'. Four of the five relatives we spoke with were very positive about the home and care their relative received. We saw people were able to laugh with the provider and staff.

Staff said they had time to meet people's identified needs and could provide the care and support people needed. Staff were aware of people's rights and respected these.

Is the service responsive?

The service could be flexible and responsive to people's changing and urgent needs. For example, a person had been discharged from hospital and required the use of a specific piece of moving and handling equipment. The provider was arranging for this equipment to be available during the inspection. The provider told us how they had moved a person to a ground floor bedroom to reduce the risks associated with the person walking around the home at night. This showed people's changing needs could be supported.

Procedures were in place to manage unexpected events which could interrupt the smooth running of the service. However, staff were unclear of the action they should take should the fire alarms sound.

Is the service well-led?

The provider was required to have a registered manager. The provider was in day to day contact with the home which did not have a registered manager managing the home at the time of the inspection. The provider told us they had recruited a new manager and was waiting for pre-employment checks to have been completed before they commenced work at the home. Most quality monitoring by the provider was informal and not recorded. For example, people's views were informally gathered on a daily basis when the provider spoke with them. People were able to make suggestions and voice their opinions. Systems were in place to ensure any accidents or incidents were reported to the provider and any necessary action taken.

People were supported to be able to eat and drink sufficient amounts to meet their needs. The people we spoke with during our visit told us they were happy with the food served at the home.

We found the home to be clean and tidy. There were cleaning schedules and checklists in place for housekeeping staff. We spoke with a person living at the home who said, "My room is cleaned every day practically."

Medicines were prescribed and given to people appropriately. People we spoke with said that they received their medication on time and when they needed it.

We inspected the records of four members of staff and found evidence of training received, such as medication administration, infection control, food hygiene, moving and handling. We found that members of staff received formal supervision and an annual appraisal.

We saw members of staff responded to requests and asked people if they needed anything. We saw one person required help to clean their glasses and we saw that a member of staff helped them do that. One person requested to be moved to another part of the room, and the member of staff assisted them to do so. We looked at the person's care plan and found the member of staff had followed it appropriately.