Background to this inspection
Updated
31 March 2015
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.
We carried out an inspection on 24 October 2014 and found that people’s support, care and treatment needs were not being met. We carried out a further inspection on 18 and 19 November 2014. This inspection was unannounced.
The inspection team consisted of two inspectors, a pharmacist inspector, a specialist advisor and an expert by experience. The specialist advisor had experience and expertise in elderly care. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert by experience was experienced in caring for an elderly person and also lived in a residential home.
Before our inspection we spoke with the local authority to share information they held about the home. The local authority was closely monitoring the service because of concerns relating to people’s care and welfare. We also looked at our own systems to see if we had received any concerns or compliments about the home. We analysed information on statutory notifications we had received from the provider. A statutory notification is information about important events which the provider is required to send us by law. We used this information to help us plan our inspection of the home.
On the day of our inspection we spoke with six people who used the service, one relative, four care staff, an activities coordinator, the cook, a kitchen assistant, one nurse, the deputy manager and the registered manager who was also the registered provider. We looked at three care plans, two risk assessments, nine medication administration records and accident reports.
During our inspection we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who live at the home. We used this because some people living at Gadlas Hall were unable to tell us in detail what it was like to live there. We also used it to record and analyse how people spent their time and how effective staff interactions were with people.
Updated
31 March 2015
This inspection took place on 24 October, 18 and 19 November 2014 and was unannounced. At our previous inspection in January 2014, we found the service compliant with the regulations that we looked at.
On 22 October 2014, the local authority shared concerns about people’s care and treatment. On 24 October 2014, we carried out a joint inspection with the local authority, continuing health care and the police. We found that people did not receive safe, appropriate care and treatment. The local authority has stopped further placements at the home until the provider makes improvements to ensure people receive the appropriate care, support and treatment.
Gadlas Hall provides accommodation, nursing and personal care for older people and people living with dementia. This home is registered to provide a service for 29 people; on the days of our inspection 26 people were living there.
The home had a registered manager in post who was present for our inspection. 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 registered manager at this service was also the registered provider.
At our inspection on 18 and 19 November 2014, we found that the provider had not taken sufficient action to address the concerns identified during our inspection on 24 October 2014 and people’s care, support and treatment needs were not being met.
During our inspection on 24 October 2014, we found that staff were not always available to assist people with their care and support needs. At our inspection on 18 and 19 November 2014, we found that the provider had not taken any action to ensure staff were always available to assist people when needed.
Staff were not always available to support people with their care needs. For example, people were not always supported each morning to get out of bed. This did not help people living with dementia to know the difference between night and day and increased the risk of people developing skin damage. Staff were not responsive to people’s needs and we observed that this caused one person to become distressed. This was also acknowledged by a care staff and the provider.
On 22 October 2014, the local authority shared information about inadequate management of pressure sores. At our inspection on 18 and 19 November 2014, we found that the provider had taken the necessary action to ensure that people received the appropriate wound care.
During our inspection on 24 October 2014, we found that the management of people’s prescribed medicines was not robust and placed people’s health at risk. At our inspection on 18 and 19 November 2014, we found that the provider had not taken sufficient action to improve the management of medicines.
Risk assessments were in place to tell staff how to support people safely. However, we found that although accidents had been recorded the provider had not taken any action to reduce the risk of further accidents. This was of concern as the provider told us that seven people were receiving treatment for injuries after sustaining a fall.
At our inspection on 24 October 2014, we found that people were not provided with support to eat and drink enough. During our inspection on 18 and 19 November 2014, we found that the provider had not taken any action to ensure people were provided with support to eat sufficient amounts. However, people were complimentary about the food and choices available to them.
The staff we spoke with understood their responsibility of sharing concerns about abuse with the provider. However, we found that the provider had not maintained a record of safeguarding referrals or to show what action had been taken to protect people from further harm.
The provider told us that staff had access to on-going training and this was confirmed by the staff we spoke with. However, a number of people who used the service were living with dementia. We found that not all staff had received dementia awareness training. We saw that not all staff showed a caring approach or patience with people living with dementia.
During our inspection on 24 October 2014, we found that medical intervention was not obtained for people when required. At our inspection on 18 and 19 November 2014, the people we spoke with and the care records we looked at showed that people had access to other healthcare services. However, we found that people were not always involved in decisions about their care and treatment.
People told us that they were able to maintain contact with people important to them. One relative said they were able to visit the home at any time.
The provider told us that they had not received any complaints. However, we found that people were not provided with information about how and who to share their concerns with. The provider acknowledged that there were no arrangements in place to enable people to express their concerns.
On 22 October 2014, the local authority shared concerns about the home being cold. On the first day of our inspection on 18 November 2014, the home was cold. The provider had not taken any action to monitor the heating within the home. The provider said there were no quality monitoring audit systems in place to address the concerns identified at our inspection on 24 October 2014. People remained at risk of receiving a service that was unsafe and ineffective. There was no clear leadership and we found that not everyone who used the service were aware of who the registered manager and provider was.