About the service Conifer Lodge residential Home is a residential care home providing personal care for up to 20 people aged 65 and over. At the time of the inspection there were 15 people receiving care.
People’s experience of using this service and what we found
People were not provided with safe care.
People were exposed to the risk of acquiring infectious diseases including Covid-19 because infection control procedures were not managed safely. The service has had two previous outbreaks of Covid-19. Despite this, lessons were not learned and, government guidance not followed to minimise the risk of further outbreaks. Personal protective equipment (PPE) was not always disposed of safely and, the service was not cleaned every day. Not all staff had received infection control training.
People were exposed to the continued risks of harm and abuse and, action was not taken to prevent further incidents occurring. Incidents were not investigated or reported to agencies including local authority safeguarding teams and CQC.
Some people’s care needs and risks were not met because they were not assessed when first admitted to the service or when their needs changed. Staff were unable to support and monitor people safely because there were not enough of them on duty all the time.
Environmental risks were not addressed. An electrical wire was hanging loose from a toilet ceiling and, it was unclear whether it was connected to the mains. Hazardous material had also not been secured safely.
Safe recruitment procedures were not always followed which posed risks to people’s welfare. Staff were not supported in their roles and, when they raised concerns they were not always listened to. Supervisions, appraisals and team meetings were not undertaken.
The service was not well-led. Leadership and oversight of the service was poorly coordinated and relationships between managers and the nominated individual were not cordial. Records to support effective quality assurance of the service were not in place.
People were not always supported to have maximum choice and control of their lives. Policies and systems in the service did not support this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was inadequate (published 15 January 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
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 coronavirus and other infection outbreaks effectively.
We planned to undertake a targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 safe care and treatment and Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
However, the registered manger informed us immediately prior to the inspection of serious concerns in the service. These included, but were not limited to, infection control, assessing and monitoring risks of people’s safety, staffing, reporting and recording incidents and, safe management of the service. We therefore carried out a focussed inspection to examine the risks identified inspecting the whole of the safe and well-led key questions. The overall rating for the service has not changed following this inspection and remains Inadequate.
Enforcement
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 people’s safe care and treatment (Infection control practices, lack of care plans and risk assessments to monitor people safely, safeguarding people from harm and abuse, and staffing staffing), reporting serious incidents and poor management of the service at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
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 to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures:
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.