Archived: Evergreen Residential Home

At our last inspection on 27 January 2015 we had identified breaches of Regulation 9 Person centred care, Regulation 10 Dignity and respect, Regulation 11 Need for consent and Regulation 15 Premises and equipment. We had also made seven recommendations about cleanliness, skills and knowledge of staff and their deployment, food choices, the manner in which staff care for people, the development of a quality assurance system and gathering feedback from people to improve the service. The provider sent us an action plan outlining the improvements they intended to make saying they would be completed by 30 September 2015.

During this inspection we looked at whether or not those improvements had been made. We also looked at areas of concern raised with us by the whistle-blowers. We found that improvements still needed to be made in regard to all the previously identified breaches of regulations and the seven recommendations. We also found breaches of Regulation 12 Safe care and treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 14 Meeting Nutritional and Hydration needs and Regulation 17 Good governance. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

Evergreen Residential Home is a care home for up to 17 adults living with dementia, cognitive impairment or a learning disability. The building is a converted hotel over six floors and is situated in the South Cliff area of Scarborough. At the time of our visit there were 15 people living at the service.

There was a registered manager in post at this service. 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 and associated Regulations about how the service is run. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Although people and their relatives told us they felt safe we found that this service was not providing consistently safe care. Safe care practices had not been used when moving people. We observed staff moving people by transferring using an unsafe manoeuvre when a hoist should have been used. Staff had not been trained to use a hoist and there was none on the premises which compromised people’s safety.

Risk assessments had not always been completed or been amended to reflect people's changing needs which meant that staff may not be aware of the current needs of people. When risk assessments were in place we saw that staff had not always followed the guidelines within them. In one case there was a delay caused by staff not following guidance provided by a doctor which could have had led to a poor outcome for the person.

The provider had not carried out servicing and maintenance checks within all areas of the service which meant they were not carrying out their duties under the Health and Safety at Work Act 1974.

Medicines were not managed safely. There was no record of nutritional supplements received into the service. Creams were found in one person’s room but were prescribed for a different person. There were no records of who had these creams applied which meant that someone may have been receiving the wrong topical medicine. There had been no audits of medicines carried out.

We found the service had met the requirements of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). However, some people at the service were not able to tell us if their freedom was restricted but we could see that there were no recorded decisions about why, for instance, those people did not go out in the fresh air. The registered manager had made applications to deprive people of their liberty lawfully but was not working within the principles of the Mental Capacity Act. They did not accept that people should be allowed to make unwise decisions. In one case they had applied three times to have a person deprived of their liberty when they had been deemed to have capacity. This showed a lack of understanding of the legislation.

Staff were not trained consistently and therefore did not have the skills required to meet everyone’s needs. They were not supported through supervision or appraisal and did not have development plans in place.

Adaptations had not been made to the environment to make it more suitable for people living with dementia. Servicing and maintenance of the property was not up to date which placed people’s safety at risk.

People looked well cared for but were not animated unless they received visitors or were engaged fully in activity because they were not stimulated. There was no dedicated activities organiser, only a volunteer who came and organised activity when they could.

These were examples of institutionalised practice which denied the dignity, privacy, choice and independence of people. For example clothes were accepted from families to share out amongst others and some rooms only had access through a toilet.

Personal life history documents were not completed for people and so staff did have guidance about peoples history and what was important to them. We did not see staff taking time to talk with people at length and so there was insufficient evidence that staff knew people well.

Pre admission assessments had not always been completed for people before coming to live at the service. Care plans were not detailed and risks had not always been identified which meant that people were at risk of not receiving the appropriate care.

No complaints had been made to the service according to the registered manager so no records were available. There was a complaints policy and procedure. We saw records of compliments being received.

Some documents were available which the registered manager called audits. However they only identified whether documents were present in the care plan audit. The home weekly audit identified that some areas were good or very good when in fact we saw that there were hazards and poorly maintained areas within the service. In addition the links between the services advertised and the training organised for staff had not been made. Record keeping was poor and statutory notifications had not always been made to CQC.

Because there has been a lack of improvement at this service since our inspection in January 2015 and because further serious issues have been identified at this inspection we have concerns about the provision and management of this service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

The service 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.

We found that people were consulted about their care and that the home sought people's consent to their care and treatment. We saw that care plans took account of people's capacity to make decisions.

We saw that the home assessed people's care needs and that staff had training in caring for people with a dementia. Care plans took account of people's dementia care needs to make sure that people received the care they needed.

People were protected from risk of harm through the correct recruitment practice, staff training and appropriate checks. There were sufficient staff available to meet their needs.

Effective management systems were in place to promote people's wellbeing and safety.