Background to this inspection
Updated
27 July 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 inspection took place on 21 May 2018 and was unannounced. We also returned on the 23 May 2018. The provider and manager were given notice of the other date, as we needed to spend specific time with them to discuss aspects of the inspection and to gather further information.
On the first day the inspection team consisted of two inspectors’, a specialist advisor in nursing care and one expert by experience. An expert by experience is a person who has personal experience of using this type of service. On the second day one inspector completed the inspection.
Before the inspection we reviewed information we held about the service including feedback sent to us from other stakeholders, for example the local authority and members of the public. Providers are required to notify the Care Quality Commission about events and incidents that occur including unexpected deaths, injuries to people receiving care and safeguarding matters. We reviewed the notifications the provider had sent us prior to the inspection. We also spoke with the local clinical commissioning group quality assurance manager, and the local authority quality assurance manager.
To help us assess how people's care needs were being met we reviewed eight people's care records and other information, including risk assessments and medicines records. We reviewed three staff recruitment files, maintenance files and a selection of records which monitored the safety and quality of the service.
During the inspection we spoke with five people living at the service and three relatives. We spoke with the registered manager, clinical lead, and four members of care and catering staff. We also observed the interactions between staff and people living at the home.
Updated
27 July 2018
This inspection took place on 21 and 23 May 2018. The first day of our inspection visit was unannounced. The provider was given notice of the other date, as we needed to spend specific time with them to discuss aspects of the inspection and to gather further information.
Austhorpe House was last inspected in May 2017 and was rated as Requires Improvement. At that inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have enough suitably trained staff to meet people's needs, and the provider did not have robust recruitment practices. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Caring, Responsive and Well Led to at least good.
At this inspection, we found that improvements had not been made to ensure the provider delivered nursing and personal care that met legislative requirements. We found that the provider remained in breach of regulation 19 (Fit and proper persons employed). We also found a further four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.
Austhorpe House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Austhorpe House provides personal and nursing care for up to 28 people over two floors. At the time of our inspection, there were 20 people living there. Austhorpe House provides personal and nursing care to people living with a range of health conditions, including physical disabilities and people living with dementia.
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.
The provider continued to recruit staff that was not compliant with regulations. The checks made on potential employees were not sufficiently robust. The provider had failed to make improvements in recruiting their own staff and were reliant on the high use of temporary staff. This had impacted on the quality of service provided as people’s preferences had not always been met. We found there were inconsistencies in people’s care records. Risks to people’s safety were assessed but information was sometimes conflicting and lacking in detail about the action staff should take to minimise them. This presented concerns that, due to high levels of agency staff used, not all of them would be aware of the measures required to ensure people’s safety.
The provider had failed to provide sufficient numbers of suitably qualified and competent staff. This had led to incidences whereby the kitchen could not operate and cleaning schedules were not carried out.
People told us they felt safe at the service. Staff had an understanding of how to safeguard people from risk of abuse and were confident the registered manager would ensure any allegations of abuse were appropriately managed. Staff were trained in relevant areas, including health and safety and moving and handling. People’s medicines were not always managed safely, and records gave conflicting information
People were supported to have sufficient to eat and drink, but mealtime experiences were not always enjoyable for people. People felt that improvements needed to be made to the quality of the food, but efforts to do this by the registered manager had been inhibited by the provider. People's needs were not fully met by the adaptation, design or decoration of Austhorpe House. The premises required extensive refurbishment and redecoration to provide a homely environment that met the needs of the people living there. The provider had no plans in place at the time of our inspection to address this.
People and their relatives were not supported to participate in designing or reviewing their care. People's needs and choices were not always identified and delivered in line with current legislation and evidence-based guidance.
The provider had not identified they were not making sure people's privacy and dignity was respected. People's preferences had not always been identified so that staff could provide care in the way people wanted. Where they were known, staff did not always respect these. Staff did not always promote people’s independence, and the provider had failed to identify and provide equipment that would support this. Although staff were kind and caring, people did not always have their care provided in a dignified or private way.
People's care plans did not contain accurate, up to date or clear information for staff to help ensure that they provided a high standard of care and support to people.
Complaints to the service had been managed in line with the provider's stated procedure. People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time.
The provider's auditing system was not robust and had not identified the concerns we found during this inspection. The provider had not made improvements identified at the previous two inspections, and were not sufficiently responsive to concerns raised about the quality of the service made by commissioning bodies. Provider oversight of the home had not been sufficient.
The provider had not ensured that the registered manager received the support and guidance required to make the necessary improvements. The resources the registered manager had requested to meet people’s basic needs had not been provided.