The inspection took place over two days on 22 and 26 June 2015. The visit on 22 June 2015 was unannounced. We notified the provider we were returning on 26 June 2015 to gather more evidence and to feedback our findings.
The last inspection of the service took place on 20, 22 and 26 January 2015 when the service was rated inadequate and we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and one breach of the Care Quality Commission (Registration) Regulations 2009. At the inspection on 22 June 2015 we found that the provider had taken action to meet some but not all of these breaches. There was evidence that they had focussed on improving some areas of the service. However, they had not taken enough action in other areas and we identified additional areas where people’s safety and wellbeing were at risk.
Cloisters Care Home is a nursing home for up to 58 older people with nursing needs. The ground floor was also for people who were living with the experience of dementia. At the time of our inspection 55 people were living at the home. The home is managed by Advinia Healthcare Limited, a private company who manage 16 residential and nursing homes and home care services in England and Scotland.
There was a registered manager in post. 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.
The staff followed practices which put people’s safety and wellbeing at risk.
Parts of the environment were not clean.
People’s medicines were not managed in a safe way.
We observed and people told us that they were not always treated with kindness and respect.
People’s privacy and dignity was not always respected.
People’s emotional and social needs were not always met. People were not always given care in a personalised way which met their individual needs.
The provider had audits and quality checks which they carried out but these had not identified areas of concern and they had not taken action to mitigate the risks to the health, safety and welfare of people who lived at the home.
Some people felt the culture of the home was not always positive, whilst others were satisfied with this.
The provider had taken action to improve some practices. For example, they had made sure call bells were accessible, they had improved the records of risk assessments and they had taken action to minimise the risks of repeated accidents and incidents.
There were procedures for safeguarding vulnerable people and the staff, people living at the home and visitors were aware of these.
The provider had improved the systems for obtaining and recording people’s consent to their care and treatment. They had assessed people’s capacity to consent.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLs). DoLS provides a process to make sure that providers only deprive people of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. The provider was aware of their responsibilities and had acted in accordance with the legal requirements.
The staff had regular meetings with their manager to appraise and discuss their work. They had been trained to understand their roles and responsibilities.
People’s nutritional needs had been assessed and recorded. They were provided with a choice and variety of freshly prepared meals.
We observed and people told us about some members of staff who were kind and caring and who took the time to listen to people.
People’s needs had been assessed and these were recorded in care plans.
The provider had a complaints procedure and had investigated and responded to complaints which had been made.
We found four breaches of the Health and Social Care Act 2008 and associated Regulations. We have taken against the provider for the breach of the Regulations in relation to the safe care and treatment of people using the service (Regulation 12) and the good governance of the service (Regulation 17).
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.
You can see what action we told the provider to take at the back of the full version of the report.