Archived: Candle Court Care Home

We carried out an unannounced comprehensive inspection on 12 December 2016. At our last inspection in July 2016 we had concerns about people’s safety. We took enforcement action and the service was placed into special measures and an urgent Notice of Decision served against the provider to restrict admissions to the home.

Candle Court is a care home providing accommodation and care for up to 93 people, some of whom had dementia, physical disabilities and mental health needs. At the time of our inspection there were 65 people living at the service.

At the time of our inspection the service had not had a registered manager in post since February 2016. 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.

At our focused inspection in February 2016 we found the provider was not meeting the legal requirements for staff training which was ineffective and staff had not received regular supervision. People who lacked capacity to make decisions about their care and treatment did not have their mental capacity assessed by staff before making a decision to administer covert medicines (medicine hidden in food). A safeguarding incident had not been reported to the Commission or the local safeguarding authority and so people may not have always been protected from the risk of abuse. We asked the provider to make improvements and we received an action plan stating how they would meet these requirements.

At our last inspection in July 2016 we saw that the provider had made some improvements since our February 2016 inspection. We found the provider failed to meet the legal requirements for reporting and acting on safeguarding incidents and responding to unexplained injuries. In addition, the provider failed to assess risks to people’s safety, safely manage medicines, ensure that sufficient numbers of equipment used for transferring people were available, staffing levels were adequate to meet people’s needs, care records were accurate and up to date and quality assurance systems were effective. We took enforcement action against the registered provider. We imposed a condition on the provider to prevent them from admitting any new people to Candle Court without the prior written agreement from the Care Quality Commission. The provider was placed into special measures by CQC.

At our inspection on 12 December 2016, we found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found. We saw that some improvements had been made on the issues we reported on at our July 2016 inspection. The provider had met most of the actions pertaining to medicine management in their action plan. However, we found new concerns relating to medicine administration on the ground floor. This was confirmed by an external audit who noted more concerns about the management of medicines on the ground floor. We saw that medicine administration record (MAR) charts were not signed at the time medicines were administered and medicines were left in people’s rooms for care staff who were not trained to administer medicines. This put people at risk of receiving inappropriate or unsafe care and treatment.

We noted improvements in areas such as, staff support, care records for people receiving one to one care and PRN protocols, better facilities to store and charge moving and handling equipment. Staff told us they felt more supported and felt less rushed due to an increase in staffing levels. They felt senior management was approachable and more available to talk to about any concerns they had.

However, we found gaps in risk assessments for people with epilepsy, which we saw was acted on by staff on the day of our inspection. People’s individual needs were not always met by the service despite dependency levels being assessed and staffing levels increased. Records showed a high use of agency staff who often did not understand people’s needs. Accident and incident were not always recorded, therefore no evidence of learning from these. There were gaps in staff training in specialist areas, such as dementia and dealing with behaviours which challenge the service. People were not always treated with dignity and respect in one unit and care not always delivered in accordance with people’s plan of care.

The home was not dementia friendly and did not support people finding their way around or orientate to their surroundings.

Staff were positive about some of the changes/improvements but we saw that the leadership and management of the service was not consistent across the home. On the day of our inspection we saw that the unit lead on one floor was passionate about the way the unit ran. Activities required further improvement to ensure that people less able to participate in group activities were provided with activities to meet their needs. The environment was generally clean.

People felt staff were rushed and didn’t always have the time to provide them with the care they needed because they were always busy.

We found repeated breaches relating safe management of medicines and risks, care records, person centred care, respect and dignity, staffing and quality assurance and leadership.

You can see what action we asked the provider to take at the end of this report.

The service did not have a registered manager in post. This 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. A new manager had been appointed in June 2016 and would be submitting an application to become the registered manager.

At our comprehensive inspection in July 2015 we found that the provider was in breach of standards relating to medicine management and the numbers of hoists and slings available were insufficient to meet people’s individual needs.

At our last inspection in February 2016 we found the provider had made improvements to the way medicines were managed and the number of hoists available and in working order had improved. However, we noted new concerns. Staff were crushing tablets before administering them to some people, before obtaining authorisation from the doctor or pharmacist. Although there was a process for two nurses to check that the dose of warfarin administered was correct, these checks were not thorough enough, as staff had placed the wrong blood test result with someone’s medicines administration record. These issues were rectified during the inspection. Staff training had not been effective in ensuring that staff implementation of moving and handling techniques were correctly completed. We observed poor moving and handling techniques. The provider was not meeting the legal requirements for consent to care and treatment and staff training. We found that people who lacked capacity to make decisions about their care and treatment did not have their mental capacity assessed by staff before making a decision to administer covert medicines (medicine hidden in food) and there was no evidence that decisions had been made in their best interest.

We told the provider to take action to make improvements. We received an action plan from the provider stating that these issues would be addressed.

At this inspection on 22 and 27 July 2016, we found the provider had not made enough improvements.

The protocols for giving people some medicines were not person centred and did not always reflect people’s individual needs. Risk assessments were not detailed and did not provide information on how to mitigate risks. We observed that staff were rushed and unable to provide the care people needed due to insufficient staffing levels.

Care records had not been reviewed to ensure they were up to date and accurate and audits conducted were not effective in ensuring that problems found on the day of our visit had been addressed. Hoist equipment was not sufficient to meet people’s needs and medicines were not always given safely.

There was a staff recruitment procedure in place and the necessary checks carried out prior to staff working for the service.

People’s individual needs were not always met by the service and people reported that staff did not always respond to people’s needs in a timely manner. Call bells were not always responded to and some people said they were told not to use their call bells.

Although we observed people being treated with dignity and respect, people’s dignity was not always respected as they were having to wait too long to be assisted with personal care.

People were given a choice of meals from the set menu and gave mixed feedback about the quality of the food.

We observed that staff were caring and kind when interacting with people and providing people with personal care.

The management arrangements before the current manager started in June 2016 were not effective as the provider had not identified risks to people’s safety and wellbeing and had not made necessary improvements to the service. The audits carried out did not identify areas for improvement with medicines, staffing, recordkeeping and responding to unexplained injuries. The provider also failed to act on the recommendations of a pharmacist to make necessary improvements in managing medicines for people.

We found breaches of regulations relating to reporting of safeguarding incidents and responding to unexplained injuries, assessing risks to people’s safety, medicines, moving and handling equipment, staffing levels, care records and quality assurance.

We took enforcement action against the registered provider. We imposed a condition on the provider to prevent them from admitting any new people to Candle Court without the prior written agreement from the Care Quality Commission.

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

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

People and their relatives told us that they were involved and informed about decisions regarding care. One person said, "the staff explain things to me and asked what I want." People and their relatives told us that they received prompt support from medical and other professionals when they needed it. One person said, "I get to see the doctor quickly when I need to."

The manager explained that they carried out regular audits of care plans that focus on how the service was meeting the needs of people with dementia. People and relatives told us that staff were available when they needed them and had the skills to meet their needs. People and relatives told us that they could discuss any issues openly with the manager of the service. People said they felt, "safe" to discuss any issues with staff. A relative said, "the manager is always available to listen to what you have to say."

People felt that staff knew how to meet their needs. We saw that staff understood people's needs. People told that staff listened to them. Staff responded to any suggestions they made about the service.