Archived: Speke Care Home (Residential)

Speke Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager who had been registered with CQC since March 2017. 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 previous inspection the service had been in the process of changing providers, during this inspection we saw that this had not taken place.

During our last inspection we had identified that there were issues with medicines, recruitment processes and care plans. At this inspection we saw that improvements had been made.

During our last inspection we had identified an issue with medication administration regarding recording of returned medications. On this inspection we saw an improvement and all records were in good order. Medicines were managed safely.

Care plans and risk assessments were person centred and they detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.

At our last inspection we met a representative of a company that was proposing to take over the management of the service but the manager told us that this company was no longer involved. Two other consultants were providing management support. The manager told us that the provider had not visited the home “for years”. We were unable to see how the provider had effective input or oversight of the service.

The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

There was a safeguarding policy in place and staff were aware of the safeguarding procedure in relation to safeguarding adults and all were aware of the need to inform the manager immediately.

There were a range of audits in place to assess and monitor the quality and safety of the service provided. Examples included, medication audits, infection control audit and premises checks. People’s views and opinions on the service provided were regularly sought. For example, there was evidence of satisfaction surveys being carried out.

There continued to be sufficient staff employed at the home to meet people’s care needs. The staffing levels were maintained when the number of people living in the home decreased. This contributed to the quality of the care being delivered.

The staff were friendly, welcoming and we observed good relationships were maintained with people living in the home and a kind and respectful approach to people’s care. The manager continued to be a visible presence in and about the home and it was obvious that she knew the people who lived in the home well.

The service had a manager who had been registered with CQC since March 2017. 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 service was in the process of changing providers and we met the prospective new provider during the inspection.

The service had been placed in special measures following the previous inspections of the home. However, in response to the improvements that had been made we took the home out of special measures.

Staff who administered medication had been medication trained. The majority of medication records were completely legibly and properly signed for, however we found some areas for further improvement.

For the most part, appropriate recruitment processes and checks had been made before new staff started working at the home. However, the references obtained for one new staff member did not match what was on their application form. We also saw that not all induction records had been completed by new staff at the beginning of their employment.

The décor in the home was tired and dated and in need of refurbishment. For example, we saw poor quality curtains and old furniture that needed replacing. It was very hot in some rooms and the registered manager told us that they were not able to adjust the heating or turn off individual radiators.

Each person had an individual care file that contained an assessment of the person’s needs. These were written in a person-centred style, however we saw that there was a poor assessment form that was inappropriate and impossible for staff to complete in any meaningful way. Some information was long-winded and repetitive.

The policies for the home were in need of updating to ensure the staff had appropriate guidance for working in the home.

The Mental Capacity Act 2005 and the associated Deprivation of Liberties Safeguards legislation had been adhered to in the home. The provider told us that some people at the home lacked capacity and that a number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We found that in applying for these safeguards, people’s’ legal right to consent to and be involved in any decision making had been respected.

There were enough staff employed at the home to meet people’s care needs. The staff were friendly, welcoming and had good relationships with people living in the home and a kind and respectful approach to people’s care. The manager was a visible presence in and about the home and it was obvious that she knew the people who lived in the home well.

We spoke with the registered manager and she was open and honest and told us that she was committed to delivering a quality service. One person who lived at the home told us they felt safe at the home. They had no worries or concerns. People’s relatives also told us they felt their family members were safe.

Infection control standards at the home were good and standards were monitored and managed. Maintenance records were up to date and legible, this meant the home was a safe environment. The registered manager had systems in place to ensure that people were protected from the risk of harm or abuse. The home had quality assurance processes including audits and satisfaction questionnaires.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime.

We undertook a comprehensive inspection on the 19 October 2015. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 inspection. We found that the provider had made improvements in some areas but we also found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained.

We undertook a further inspection on the 19 and 20 May 2016. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 and October 2015 inspections. We found that the provider had made improvements in some minor areas. We also found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained. The service was again rated inadequate.

We undertook this inspection to follow up the breaches identified at the May 2016 inspection. We found the breach of Regulation 11 had been met but the breaches of Regulations 9, 12, 17 and 18 remained and we identified a new breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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 home required a registered manager but there was not one currently in post. The last registered manager left the home in January 2015.

We found concerns with the safe storage of medicines as the temperatures of the storage areas were not properly monitored. We also found concerns with the way that risks were monitored in the home.

We found that staffing levels were not adequate to safely meet the needs of the people who lived in the home.

The home had improved the way that it monitored people’s needs under the Mental Capacity Act 2005. Deprivation of Liberty Safeguard (DoLS) applications had been made to the local authority and staff had a better understanding of the issues as they had been trained.

Nutrition and hydration management was found to be unsafe and people were at risk of not receiving prescribed nutritional supplements.

Care was provided by staff who knew the people who lived in the home and how they liked to be supported. We observed warm, positive interactions and people were happy with the care that they were receiving.

We found that the practices in the home were not adequately audited or monitored and that the management and provider oversight in the home did not provider safe or effective care.

The overall rating for this service is 'Inadequate' and the service therefore remains 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.

We undertook a comprehensive inspection on the 19 October 2015. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 inspection. We found that the provider had made improvements in some areas but we also found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained.

We undertook this inspection on the 19 and 20 May 2016. Our inspection visit was unannounced. During this visit we followed up the breaches identified during the April 2015 and October 2015 inspections. We found that the provider had made improvements in some minor areas. We also found a number of continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found breaches of Regulations, 9, 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 remained.

Speke Care Home provides accommodation for people who do not require nursing care. It is a privately owned service which provides accommodation for up to 49 adults. The service is located in the Speke area of Merseyside. At the time of the inspection, 20 people lived in the service, as an agreement was in place that the service does not admit any new people until improvements had been made and sustained.

There was no registered manager of the home at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Just as 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.

Although we found improvements that are outlined in this report, we also found some similar concerns to those we identified at our last inspections.

People who lived in the service were offered their medicines in a safe way and at the right times. However, staff took no action to ensure the well-being of people who consistently declined their medicine. Issues with two people’s medication meant that the use of medicines remained unsafe. Staff did not have adequate information to administer medicine safely to these two people in an emergency situation. A small number of medicines were inadequately labelled by the supplying pharmacy. Staff had not sought clarification so as to make sure they gave the medicine safely. This placed people at risk of harm.

Arrangements to ensure that people received the correct medicines had improved and the storage, and timing of medicines had also improved however issues with two people’s medication meant that the way in which medication was managed remained unsafe. We saw that there were medicines were no clear instructions available for staff to give medicines safely. Where instructions were available, staff were not competent to administer. This placed people at risk of harm.

The service was not consistently respecting and involving people who use services in the care they received. The provider had started to implement a new care plan and assessment record from May 2016. We looked at six care plans and for example, only two of the care plans had been updated but still did not have all of the persons details in place.

Staff members were not always following the Mental Capacity Act (2005) for people who lacked capacity to make decisions. For example one person’s Deprivation of Liberty (DoLS) was out of date and had expired 28 April 2016. This meant that the person may have since been deprived of their liberty unlawfully. People’s mental capacity had not always been assessed and there was no information for the staff to help them support a person with fluctuating capacity.

We saw that people’s health care needs were not accurately assessed. For example people’s nutritional risks were not properly assessed and managed. We found that people’s care was not planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met. Records regarding care delivery were not checked as accurate or up to date leaving people at risk of not having their individual need’s monitored or met.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that where required not all the necessary DoLS applications had been made.

Staff told us they did feel supported by the new manager. They said they had been sufficiently trained. Appraisals and supervision had begun to be provided, however not all staff had received them. Staff training was being provided internally and also by an external provider. We observed staff using moving and handling techniques with people inappropriately although the acting manager informed us that they had all been re-trained.

The arrangements for the management of the service were poor and the current auditing processes did not identify problems with the service.

We saw that the provision of adequate nutrition had improved and the budget for food available in the service had increased. Picture menus had been implemented however the kitchen staff were not aware of nutritional supplements for one person and were only providing one supplement daily for another person who was prescribed two daily.

The reporting and addressing of safeguarding had increased and records were available that showed that safeguarding and complaints were being investigated and addressed.

Staffing levels had significantly increased and the positive impact of these was evident. Staff were unrushed and able to communicate effectively with people living in the service.

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.”

As part of this inspection, we spoke with 12 people who lived at the home, three relatives, the manager, six staff and the local authority.

Is the service safe?

The majority of people, relatives and staff we spoke with told us that staffing levels at the home had improved and this had, had a positive impact on the service.

On our previous inspection of the service in 31 March 2014, we found the premises were not entirely suitable to maintain the safety of people living in the service. We asked the provider to submit an action plan outlining the improvements they intended to make. We found during this visit, although some progress had been made, it was insufficient.

We saw that additional concerns were identified at this inspection. There were a number of malodorous areas, cracked glass in windows, out of date fire risk assessment and a smoking area that had not been assessed for safety. We contacted the Fire Authority following our inspection, who attended the service at our request.

We also found serious shortfalls in the cleanliness and management of the home's facilities and equipment.

Is the service effective?

On our previous visit to the home in 31 March 2014, we found the provider's arrangements to monitor the service and provide quality of care were not effective. Enforcement action was taken. At this inspection we found that the additional staff had increased the staff's ability to deliver care on a daily basis. We also found that systems to monitor the quality of the service overall had not improved sufficiently to increase and sustain any improvements.

The majority of people and relatives we spoke with said staff were kind and understood their needs. We found that the staff we spoke with demonstrated a good knowledge of people's needs and the care they required. People told us that improvements had been made following the increase of staff.

Is the service caring?

On our previous visit to the home in 31 March 2014, we found peoples care was not always effectively planned or actions taken to deliver care that met people's needs. At this inspection we saw that some improvements in the planning of care had been made. We did see that an increase in staffing numbers meant the staff had more time to deliver care.

Most of the people we spoke with said staff were kind and treated them with dignity and respect. One person raised concerns about the attitude of a member of staff, we discussed this with the manager and requested that a safeguarding referral was made. Following the inspection we rang the registered manager who told us a safeguarding referral had been made.

Is the service responsive?

On our previous visit to the home in 31 March 2014 we saw that the people living in the service had expressed dissatisfaction with the activities that were available. We asked the provider to submit an action plan outlining the improvements they intended to make.

We found during this inspection that insufficient progress had been made. People's dissatisfaction with the range of social activities was still evident and there was limited evidence that people's social and activity needs were met.

Is the service well led?

The service has a manager registered with CQC. We reviewed the quality monitoring audits that were undertaken to monitor the quality and safety of the service provided. We found the audits identified the risks or shortfalls in the homes performance. There were no arrangements in place to address these identified shortfalls.

The provider's had not sent out surveys to people living in the service to obtain their views or opinions of the care they had received. They had sent out surveys to relatives and had received four although generally positive all stated that there were not enough activities. There were no plans in place to action this or to survey people who lived in the home, in order to obtain their opinion. We saw copies of the minutes of meetings we were unable to evidence how often the meetings were held, how people were informed of the meetings or the contents of the meeting or what actions were taken as a result of communicating with people and staff.

We were introduced to an individual by the registered manager and told that they were the homeowner. This person was not the registered provider or manager we have requested that the provider clarifies the role of the person we were introduced to as the home owner.

The findings of our inspection are based on our observations and the views of people who used the service, relatives and staff. We found that staff on both the residential and EMI units were very busy in trying to meet the needs of the people who used the service and as a result people were left unattended in the communal areas for long periods of time. Therefore, people who used the service were at risk of not receiving the care and support they required as staff were not readily available to observe them and meet their needs.

We found that people who use the service staff and others are not protected from the risk of unsafe or unsuitable premises. We also found that the provider did not have effective systems in place to assess and monitor the quality of the service provision.

Speke Care Home provided people who used the service and their families with sufficient and appropriate information about their support and treatment to enable them to make informed decisions.

We found that people were protected from the risks associated with medicines because the provider had made changes to ensure that appropriate arrangements were in place to manage medicines.

During our previous inspection we had concerns over the management and recording of safeguarding incidents. We found during this inspection, that improvements had been made relating to the recording and reporting of safeguarding incidents.

We found that the service had implemented an effective system to identify, assess and manage risks to the health safety and welfare of people who used the service and others.

People told us that they had felt safe living at Speke Care Home and we found that staff were aware of how to identify and report potential safeguarding occurrences. However we found that records relating to protecting people were not sufficiently robust.

The provider did not follow clear procedures in practice, which were monitored and reviewed relating to the storage and disposal of medicines.

The provider did not have a quality monitoring policy and system in place. Some auditing of the service had been undertaken but processes were not robust enough and left gaps which created risks for the people who used this service.

This service cares for people with a range of dementia conditions and conversation with some of the residents was limited due to their dementia condition. We therefore spent much of the time in the communal areas making observations of how people were being cared for.We observed staff assisting people who required care and support with personal care. We saw that staff treated people with respect and ensured their privacy when supporting them. They provided support or attention as people requested it. We spoke with one person about the care and support they received. They said they were happy living at the service and said that staff were polite and kind.