Archived: Lifestyle (Abbey Care) Limited Elizabeth - Swale

Updated 25 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 the 28 November 2016 and was unannounced. This meant the registered provider and staff did not know we were visiting.

The inspection team consisted of two adult social care inspectors and a pharmacy inspector.

Before our inspection, we reviewed the information we held about the home. We looked at statutory notifications that had been submitted by the home. Statutory notifications include information about important events which the registered provider is required to send us by law. We reviewed the feedback we had received from the local commissioners and placing authorities. This information was reviewed and used to assist us with our inspection.

The provider was not asked to complete a provider information return [PIR]. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

During the visits we spoke with nine people who used the service, six relatives, staff from a voluntary befriending group, a community nurse, the nominated individual, registered manager, deputy manager and six staff members. We undertook general observations and reviewed relevant records. These included five people’s care records, the medicine records for 14 people, six staff files and other relevant information such as policies and procedures.

Updated 25 March 2017

We carried out this inspection on the 28 November 2016. The inspection was unannounced, which meant the staff and registered provider did not know we would be visiting.

During an inspection in February 2015, we rated the home, ‘Requires improvement’ because we identified multiple breaches of the regulation. Within this rating, we found the ‘Safe’ domain was ‘Inadequate. These breaches of the regulation related to the delivery of safe care and treatment, safeguarding people from abuse; premises and equipment; consent to care or treatment; and maintaining people’s dignity.

We completed a focused inspection in August 2015 to look at what changes the registered provider had made since inspection in February 2015. We found that improvements had been made and the breaches of regulation had been addressed. The domain of ‘Safe’ was now rated as ‘Requires improvement,’ and the domain of ‘Caring’ had improved and was therefore rated as ‘Good.’ However, we needed to see that the improvements were sustained.

We completed this inspection to review the action the registered provider had taken since the last inspection and to see if the improvements identified during inspection in August 2015 had been sustained.

Lifestyle (Abbey Care) Limited - Elizabeth Swale is a residential care home, located on the Abbey Care Village site in Scorton. The service provides residential care for up to 54 people living with a dementia and does not provide nursing care. The home is divided into Elizabeth House, which is a two storey unit that can accommodate up to 30 people. The other unit is Swale House, which is located on the third floor of another home on the site and can accommodate 24 people. Swale House is currently being refurbished and is empty. At the time of inspection there were 27 people living at the service.

There has been a registered manager in place since March 2015. 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 this inspection, we found that people’s prescribed medicines were not safely managed. People did not receive their prescribed medicines when they needed them and medicine administration records were not accurately completed. We found people were at risk of harm because of the way medicines were managed.

There was a lack of information in people’s risk assessments and care plans. This meant they did not accurately reflect people’s risks and the care and support they needed from staff to keep people safe. We found that these risk assessments and care plans contained conflicting information, were not updated when people’s needs changed which meant that the information in them was not always accurate.

From our observations, we found that some people who used the service required two to one support. We looked at staffing levels to determine whether there was sufficient staff on duty to care for people safely. We requested information from the registered manager/provider about how they determined staffing levels; however we did not receive this information.

During inspection, we noted there was one senior carer and three care staff on duty throughout the day and two care staff during the night. When we arrived for inspection at 06:00, we could see that one person had experienced a fall, but had been left unattended whilst staff contacted 111 emergency services for assistance and checked the other people using the service to ensure they did not need assistance. This meant there were not enough staff on duty to provide safe care and support to people.

The dependency level record produced by the registered manager on 12 November 2016 showed 13 people were rated as having a high dependency; 15 people rated at a medium dependency and one person was rated as low dependency. Although the level of need had been assessed this did not translate into a change in staffing numbers, as the rotas showed no variation in staff on duty. On the day of the visit the number of people who lived at the home was 27 but this impact of this change was minimal. The registered manager worked in a supernumerary capacity and the deputy manager during the week who told us they would assist if needed but this was dependent upon their workload. We found from the review the dependency levels, discussions we staff and people and our observations there were insufficient staff on duty to meet the care and support needs of people. There were insufficient staff on duty overnight to ensure people could be safely evacuated from the home in the event of a fire.The registered provider accepted our concerns that there were insufficient staff to meet people’s needs and since the inspection they have being in the process of recruiting more staff. However the updated dependency tool they have provided still indicates that only two staff are needed overnight.

We found that although refurbishment work had been completed, this had not involved ensuring the lighting and heating were adequate. The registered provider was asked to ensure the lighting levels complied with health and safety guidance.

We found that regular checks of the hot water temperatures were completed. These checks revealed water was routinely between 38°c to 39°c, which is below the recommended temperature of 43 degrees Celsius (°c). The registered provider failed to notice that water temperatures were below recommended levels and failed to take action to increase water temperatures to safe levels. This meant people experience unsafe bathing temperatures and put them at risk of harm.

We observed staff washing plates and cutlery in the sink in the dining room. Although a thermostatic valve was in place, we found the hot water was below safe water temperatures. A domestic dish washer was in place, however could not accommodate all of the dishes. When we spoke with staff, they failed to recognise the risks posed to infection prevention and control because of unsafe water temperatures. Following inspection, the registered manager took action to obtain an industrial dishwasher.

A third of the people chose to sit in the lounge in their overcoats; staff told us this was because the people believed they were going to work, but individuals told us it was because they were cold. No ambient room thermometers were in place so staff could not check the temperature of the home so could not be assured the recommended temperature of 21°c was met. We found during the morning that the ambient room temperature in the communal areas was 19°c.

There was evidence to show that the registered provider was working within the principles of the Mental Capacity Act 2005 (MCA). However we found that staff could not always effectively demonstrate how best interest decisions were made and followed. This meant we could not be sure if staff fully understood the requirements of MCA.

Deprivation of Liberty Safeguards (DoLS) authorisations had started to be obtained; of the 12 authorisations sent, only five had been completed. We found that the conditions imposed were not always met and there was no system in place to monitor how staff were meeting conditions and that renewals were requested in a timely manner. Staff were unaware that people had the right to contest the DoLS authorisation and they were entitled to legal aid should they wish to make representations to the Court of Protection about their detention.

Staff were unaware that some of the people who used the service had been detained under a section of the Mental Health Act 1983 (amended 2007) and were now residing at the home under a community treatment order (CTO). This meant, staff had failed to obtain information about the conditions these people had to abide by or that the person had a right to appeal to the Mental Health Tribunal about their detention and were entitled to legal aid.

We asked the registered manager if anyone needed the support of an advocate. They told us that no-one currently required this type of support.

People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. Staff understood their responsibilities in respect of protecting people from the risk of harm. No safeguarding alerts had been raised in the last two years, which is considered unusual for this type of service, as people living with dementia can become agitated, which can lead to them coming into conflict with staff and other people. Recent accident and incident records showed people could become agitated and confrontational, which would suggest alerts may have been needed.

New staff had been employed following the home’s recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people worked at the service.

We found that one staff member had transferred from a sister home but the registered manager had not checked their recruitment file. This file showed the person had previously been a registered nurse but was suspended from practice; the previous home had not followed this matter up. In failing to check this recruitment file, the registered manager had failed to notice that the sister home had not completed robust recruitment procedures and had failed to investigate this matter to determine whether this staff member had been fit and safe to work at the service.

Staff were receiving support through supervision and received relevant training but the registered manager needed to ensure discussions focused on relevant practice such as staffing levels and training was effectively implemented.

An activities coordinator was in post three days per week. We found that a limited range of activities were provided at the service. During our inspection, we