Archived: Four Winds Residential Home

Updated 21 December 2015

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 over three days on 21, 22 and 28 October 2015 and was unannounced which meant the provider and staff did not know we were coming.

The inspection team consisted of two adult social care inspectors and a specialist advisor in electrical installation.

Environmental health conducted inspections of the building and the kitchen and nutrition on 21 October 2015.

The Fire Service also conducted an inspection on the 21 October 2015 at the request of the provider’s buildings manager.

Prior to the inspection we reviewed information we held about the home, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

During this inspection we spoke to five people who live at Four Winds Residential Home. We also spoke with the registered managers, three senior care staff, the cook, the activities co-ordinator, the area manager, the operations director and one care staff. We also spoke with the buildings manager.

We carried out observations of meal times using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We undertook general observations of how staff interacted with people as they went about their work.

We looked at four people’s care records and six people’s medicines records. We examined five staff files including recruitment, supervision and training records. We also looked at other records relating to the management of the home including building safety, health and safety, quality assurance and complaints.

Updated 21 December 2015

This inspection took place on 21, 22 and 28 October 2015 and was unannounced. We last inspected the service on 21 April 2015.

We completed an unannounced comprehensive inspection of this service on 3 and 5 February 2015 and found the provider was failing to meet legal requirements. Specifically the provider had breached Regulations 9, 13, 18, 23 and 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

During our February 2015 inspection we concluded people were not being protected against the risks of receiving care that was inappropriate or unsafe. Assessments of the needs of people were not current so did not meet their individual needs or ensure the welfare and safety of people.

People were not protected against the risk of the unsafe use and management of medicines. There was no safe system in place for the recording and administration of medicines. The registered managers did not have suitable arrangements in place for obtaining and acting in accordance with the consent of people in relation to the care provided for them in accordance with the Mental Capacity Act (MCA) 2005. People were cared for by staff who were not always supported or trained to deliver care safety and to an appropriate standard. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

We undertook an unannounced focused inspection on 21 April 2015 as part of our on-going enforcement activity and to confirm that they now met legal requirements but we found continued breaches of legal requirements. Specifically this related to Regulations 12, 17, 11, 9 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In summary the provider did not have effective systems in place to identify, assess, mitigate or manage the risks to the health and safety of people who used the service and others. The provider did not ensure the safety of the premises. The provider did not ensure the proper and safe management of medicines. The registered managers did not have suitable arrangements in place for obtaining and acting in accordance with, the consent of people in relation to the care provided for them in accordance with the Mental Capacity Act (2005). People were not protected against the risks of receiving care that was inappropriate or unsafe. Assessments of the needs of people were not current so did not meet individual needs or ensure the welfare and safety of people. People were cared for by staff who were not always supported or trained to deliver care safely and to an appropriate standard.

Four Winds Residential Home is registered to provide residential care to 26 people some of whom are living with dementia. At the time of our inspection there were 17 people living at the service.

The home had two registered managers who had been registered with the Commission since June 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.

There were not enough staff on duty overnight to ensure a safe evacuation of people in the event of a fire. There were inadequate fire precautions including a lack of external emergency lighting; defective fire doors and no smoke detectors in the electrical cupboard and medicine cupboard. Some work was needed in relation to damaged asbestos in the boiler room and a self-closing mechanism needed to be fitted to the smoking room.

Environmental risk assessments were in place but these were dated 2011. They had been signed as being reviewed on an annual basis but there was no written record of what the review involved.

Portable appliance testing (PAT) had been completed however a portable heater, which had failed the test on three occasions, was still in use, even though records stated it had been put in the bin.

There were some risk assessments in place for people and others were integrated into the care plan document. Documents did not effectively identify risks or specify how they should be managed.

Medicines were not recorded or managed in a safe way. Medicine administration records did not correspond to information in people’s care records so people were at risk of receiving an incorrect dose of medicine. We found out of date vials of medicine with no record of when the person had last received this medicine or whether it was still prescribed for them.

Not all accidents and incidents were recorded as such and so were not investigated appropriately.

Inspectors identified concerns of a safeguarding nature which the registered managers had not recognised.

We found a lack of understanding of the Mental Capacity Act (2005) Code of Practice. One person had been assessed as having capacity to make a certain decision yet a best interest decision had still been made on their behalf. Care records documented that relatives acted in people’s best interest but we saw no documentary evidence to support whether relatives had a legal right to do this.

Where people had formal Lasting Power of Attorneys the provider had failed to ensure they had a copy of this paperwork.

People had access to health care professionals. The advice they gave was not always followed up on and information was lost within professional records sheets as care plans hadn’t been updated to reflect the new information.

Some care plans did not contain specific information on how to reassure, divert and orient people.

Audits were completed however they had not been effective in identifying the concerns we identified during the inspection. The operations director said, “The current audit isn’t robust enough” in response to concerns raised about medicines administration.

Quality assurance systems were in place but questionnaires and surveys were sent to people, relatives and stakeholders on a frequent basis. A low return rate was received which meant the value and effectiveness of the system was difficult to assess.

Care plan audits did not effectively assess the quality and timeliness of information contained in care plans. They failed to identify where care plans needed to be updated in response to changes in strategies, changes in medicine administration and in general care needs.

The registered managers did not have effective systems to keep up to date with best practice and relied upon staff being their, “Eyes and ears to new ideas.” One of the registered manager’s said, “Staff don’t come forward with suggestions.”

One registered manager told us they liked to be part of the staff handover but it was not logged. They said, “I like the seniors to come to me so I don’t lose track of what’s happening in the home.” It is the responsibility of the registered managers to ensure they are up to date with information pertaining to the safe management of the home. We concluded that the registered managers did not have effective systems in place to support and enable them to do this effectively.

Staff training was up to date, although we noted that some training was still to be booked such as equality and diversity.

Staff were receiving regular supervision and an annual appraisal and they said they felt well supported by the management of the home.

Complaints were investigated and recorded and action was taken in response to concerns, however the action did not lead to a review and update of care plans so information was lost.

We observed warm relationships with people but staff did not understand the significance of specific equipment, such as red plates, and how these should be used to support people living with dementia.

An activities coordinator was in post who was enthusiastic and knowledgeable. They had identified the need to develop activities for the men living in the home and were currently researching this. They had introduced pet therapy and reminiscence sessions and were bringing in external people to support activities, such as the knitting club and memories from the war era.

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.

You can see what action we told the provider to take at the back of the full version of the report.