Archived: Cascade 4 - Newick Road

We carried out an unannounced comprehensive inspection of this service on 3 December 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to people’s safety, nutrition, infection control, care and welfare, quality monitoring, medicines management, notifications, respect and consideration, consent and staff training and support.

We undertook this focused inspection to check that the provider had followed their plan in relation to the more serious breaches that related to safety, nutrition, infection control, care and welfare and quality monitoring and to confirm that they have now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

Cascade 4 Newick Road is a care home providing 24 hour care, support and accommodation for up to five people with mental health needs. The provider has a number of other care homes in the local area. At the time of our inspection there were three people using the service, this was because the home was preparing to close and alternative suitable placements were being sought for people to move on to.

This focused inspection took place on 19 March 2015 and was unannounced. Since our last inspection the registered manager had left and an interim manager had been appointed by the provider. 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.

During our last inspection we found that people were not kept safe as risks posed by visitors and behaviour that challenged the service were not managed appropriately. At this inspection we found that steps had been taken to manage risks such as smoking, the impact of visitors to the service and monitoring people’s mental health and wellbeing. We found that safeguarding incidents were been appropriately reported and addressed.

Previously we found that standards of cleanliness were poor and systems were not in place to control and prevent the spread of infection. In particular the kitchen was unclean. We found that cleaning schedules had been introduced to address this and saw that standards of cleanliness had improved which people we spoke with confirmed.

During our last inspection we found that there was not enough food available to support good nutrition and people were restricted from accessing the kitchen at night which meant they were unable to make snacks or drinks without asking for staff permission. Since our last inspection changes had been made to improve the quantity of food available. We found that there was a good selection of food including fresh fruit and vegetables and snacks that people could help themselves to. People told us that they had been involved in cooking sessions and confirmed that there was more food available.

Previously the provider had failed to assess, meet and review people’s needs appropriately. Care plans were incomplete in that they did not fully outline people’s current needs and the action staff should take to meet these. However, during this inspection we found that people’s care plans had been updated and were being reviewed at regular intervals. We saw that people had been involved in this process and contributed their thoughts on the support they felt they required.

We found that staff had begun to explore people’s leisure interests to support their engagement in the community and a weekly in-house ‘cinema night’ had been introduced which people told us they enjoyed.

At our last inspection we found that quality monitoring systems were ineffective as they did not always identify or address issues. During this inspection we found that more robust quality assurance systems had been introduced which had supported some improvements to the service.

At our previous comprehensive inspection on 3 December 2014 we also found breaches of legal requirements relating to medicines, staff training, consent, notifications of significant events and respecting people that use services. If the service does not close as planned we will carry out another unannounced inspection to check on all outstanding legal breaches.

This inspection took place on 3 December 2014 and was unannounced. We found that the provider had not taken sufficient action to address the shortfalls identified at the last inspection which took place on 18 August 2014. This was in areas around the care and welfare of people, nutrition, standards of cleanliness and hygiene and quality monitoring of the service.

Cascade 4 Newick Road is a care home providing 24 hour care, support and accommodation for up to five people with mental health needs. The provider has a number of other care homes in the local area.

There was a registered manager at the service who had been in post for about one year. 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.

At this inspection we found serious concerns about the safety and care of people who used the service. There were high levels of risk to the safety and welfare of people, including incidents of physical and verbal aggression affecting the safety and wellbeing of people who used the service. Issues identified at the last inspection had not been addressed to ensure that the premises were drug and alcohol free or to ensure people banned from the premises did not visit. This had a negative impact on people’s mental health and their behaviour. Risks to individuals were not proactively managed to ensure steps were taken to minimise any risks and protect them from harm.

At our last inspection we found that standards of cleanliness and hygiene were inadequate. Although some improvements had been made we found that the kitchen was still in an unacceptable state and the lack of cleanliness and hygiene posed an infection control risk.

Staff had not received training in relation to meeting the needs of people with a mental health diagnosis. Therefore they were not equipped with the knowledge and skills they needed to meet people’s needs effectively. Staff told us that they did not feel adequately equipped to support people effectively as they had not received training specific to people with mental health needs.

There had been no consideration given to Deprivation of Liberty Safeguards or consent issues in relation to the restrictions imposed on people who used the service. For example, care plans indicated times when people were restricted from leaving the premises and from using the kitchen, however, the appropriate procedures had not been followed to ensure this was lawful and in people’s best interests.

At our last inspection we found that there was limited choice of foods available for people to eat. We found that some steps had been taken to address this, however, there was still inadequate quantities of food to enable people to prepare meals and snacks for themselves.

There was a lack of joint working with health and social care professionals to ensure that the service was responsive to people’s needs. Care plans had been revised and updated using the ‘Recovery Star’ tool, however they still were not sufficiently personalised to outline individual needs and how to meet them. There was a lack of evidence that individuals made progress in line with their plans; how people were being supported to address their mental health needs and of their engagement in social, leisure and daily activities.

The provider could not demonstrate that a robust complaints system was in place to listen to and learn from people’s concerns.

Whilst people expressed their views in their one to one meetings with senior staff, staff did not always act in a way that demonstrated that people’s views were listened to, understood and acted upon. There was insufficient evidence to demonstrate how the service provided a supportive environment for people in a way that helped maximise their opportunities and potential towards achieving their individual goals and aspirations.

People who used the service had mixed views about how staff interacted with people. Some said staff were kind and caring and treated them with respect, whilst others expressed concern about how staff treated them.

The provider did not have effective systems in place to monitor and review incidents, concerns and complaints. This meant that there was inadequate learning from incidents to support improvements to the service. Quality monitoring systems were ineffective and did not protect people from inappropriate and unsafe care. The provider had failed to identify and address the shortfalls we found during this inspection and had failed to take adequate action to ensure that shortfalls identified at the previous inspection were addressed.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report. As we have identified continued breaches of regulation we have taken enforcement action against the provider.