Archived: Molescroft Court

Updated 16 February 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 registered 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.

The inspection took place on 14 December 2016 and was unannounced. The inspection team consisted of one adult social care (ASC) inspector and an Expert by Experience. An Expert by Experience is someone who has personal experience of using or caring for someone who uses / used this type of service. The Expert by Experience who assisted with this inspection had experience of supporting people who used health and social care services.

Before this inspection we reviewed the information we held about the home. This included information we had received from the local authority that commissioned a service from the registered provider and notifications we had received from the registered provider. Notifications are documents that the registered provider submits to the Care Quality Commission (CQC) to inform us of important events that happen in the service.

The registered provider was not asked to submit a provider information return (PIR) prior to this inspection. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection we spoke with six people who lived at the home, two relatives, five members of staff, the deputy manager and a registered manager from another service in the organisation. We looked around communal areas of the home and bedrooms (with people's permission). We also spent time looking at records, which included the care records for three people who lived at the home, the recruitment and training records for three new members of staff and other records relating to the management of the home, including quality assurance, staff training, health and safety and medication.

Updated 16 February 2017

The home is registered to provide accommodation and care (not including nursing care) for up to 44 older people, some of whom may be living with dementia. On the day of the inspection there were 26 people living at the home. The home is situated in Beverley, a market town in the East Riding of Yorkshire. There are currently three units within the home; The House, The Annexe and The Haven. Each unit has lounge areas, dining areas, bedrooms and toilets, and The House has communal bathrooms and shower rooms. People living in The Annexe and The Haven have en-suite facilities. Accommodation in The Annexe and The Haven is on the ground floor and accommodation in The House has two floors; there is a passenger lift in The House so people are able to access the first floor if they cannot manage the stairs. There are laundry facilities in The House and The Haven.

The overall rating for this service is ‘Requires Improvement’. However, the service has been placed in ‘special measures’. We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive inspections. The ‘inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. In this instance the continued breach of regulation has been in the same key question and relates to the safe administration of medication.

This inspection took place on 14 December 2016 and was unannounced. We previously visited the service 6 July 2016. The focused inspection in July was carried out to check on improvements made to the service since the previous comprehensive inspection on 10 and 11 May 2016 when we issued warning notices in respect of three breaches of regulation.

At the inspection in May we found that there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medication was not administered safely and recording was unsafe. We issued the registered provider with a warning notice. When we returned to the home in July 2016 we found that they continued to be in breach of this regulation. A Notice of Proposal was issued that added conditions to the registered provider's registration. The conditions required the registered provider to submit information about staff training on the administration of medication and staff competency checks. We received this information within the required timescale. In addition to this, the registered provider was required to send the Care Quality Commission (CQC) copies of monthly medication audits. This condition of the registered provider’s registration is still in place.

During this inspection we found that the registered provider continued to be in breach of Regulation 12 relating to the management of medicines. Despite staff training on the administration of medication and staff competency checks being up to date, errors in administration and recording continued to be made. This means that the registered provider remains in Special Measures.

The registered provider told us they were aware that medication errors continued to be made. Because of this, they had made the decision to reduce the number of units to two instead of three, meaning there would be two medication systems in place for staff to manage instead of three, and less medication ‘rounds’ each day. In addition to this, they had decided to have one senior care worker on duty whose sole responsibility was to manage and administer medication in the two units. It was anticipated that this would reduce the number of errors being made.

At the inspection in May 2016 we found that there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because there were insufficient numbers of staff employed to ensure people received the care and support they required. We issued the registered provider with a warning notice. When we returned to the home in July 2016 we found that the registered provider had employed additional staff so they were no longer in breach of this regulation.

At the inspection on 14 December 2016 we found that the registered provider was again in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as there were insufficient numbers of staff employed to ensure that people’s care needs were met by a consistent group of staff. However, the registered provider had already identified this and had made the decision to reduce the number of units where people were accommodated from three to two. They were confident this would result in there being enough staff employed to ensure people’s assessed needs could be met.

This was a breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made a requirement in respect of Regulation 18: Staffing.

At the inspection in May 2016 we found there was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of quality monitoring. The registered provider was issued with a requirement. This breach was not reviewed at the inspection in July 2016.

At the inspection on 14 December 2016 we found that, although some recording had improved, quality audits had not taken place consistently and the medication audits identified that errors in the management and recording of medication continued to take place. This is a repeat breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the inspection in July 2016 we found there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of induction training for staff. We issued the registered provider with a requirement. The registered provider submitted an action plan on 5 September 2016 that informed us of the action they would take to become compliant with this regulation. At the inspection on 14 December 2016 we found that induction training had improved and that the registered provider was no longer in breach of this regulation.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with CQC. A registered manager is a person who has registered with CQC 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. In the absence of a registered manager, the home was being managed by the deputy manager with assistance from two experienced registered managers of other services operated by the same organisation.

The deputy manager was following the home's recruitment and selection policies to ensure that only people considered suitable to work with vulnerable people were working at Molescroft Court.

Staff told us that they received appropriate training, including induction training, and this was supported by the records we reviewed. Staff were also happy with the level of supervision they received.

People told us that they felt safe whilst they were living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

The manager and staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us that staff were caring and that their privacy and dignity was respected.

People's nutritional needs had been assessed and people told us they were satisfied with the meals provided. We observed that people's individual food and drink requirements were met.