Archived: Langford/Kennet

Updated 28 November 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, under the Care Act 2014.

The inspection was prompted in part by whistleblowing and the lack of ongoing assurance that the required improvements were being implemented following the last inspection

Inspection team:

The inspection of Langford and Kennett was completed by one inspector for the people accommodated under the service ASC registration and one hospital inspector for those people who were inpatients. A team of inspectors inspected the other locations which are situated on the same site.

Service and service type:

Langford and Kennet are a care home for 16 adults and provides complex nursing care for those with neuro degenerative or previous brain injury. 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.

A registered manager was not in post. The service did not have a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The home manager told us they were to apply for registration with CQC, to become the registered manager.

Notice of inspection:

The inspection took place on the 13 March 2019 and was unannounced. At the time of the inspection there were 15 people and one hospital patient accommodated.

What we did:

During the inspection we spoke with two people, one relative and one member of staff. We looked at information relating to people’s care, including three care files, and records from visits with health and social care professionals. We looked at information relating to staffing, such as handover records, meeting minutes, rota’s, training records and agency staff profiles. We also reviewed information regarding the management of the service. This included accident and incident records, the quality improvement plan, checks of equipment, fire safety checks, complaints records.

Updated 28 November 2019

About the service:

Langford and Kennet are two eight bedded units that are managed as one service and provide complex nursing care for people with neuro degenerative or previous brain injury.

Langford and Kennet are one of six adult social care locations at Glenside, which also has a hospital that is registered separately with CQC. 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.

Each of the services is registered with CQC separately. This means each service has its own inspection report. The ratings for each service may be different because of the specific needs of the people living in each service. Some of the systems are managed centrally for all services; for example, maintenance, systems to manage and review accidents and incidents, and the systems for ordering and managing medicines. Physiotherapy and occupational staff cover the whole site, also facilities such as the hydrotherapy pool are shared by people in all services.

One adult social care location (Pembroke Lodge) is currently closed as there were ongoing issues with the provision of heating and hot water.

The hospital is also currently closed due to flooding, caused by a major water leak. People from the hospital were transferred at short notice to some of the adult social care (ASC) locations. Works to repair the fabric of the hospital building are currently underway. As Langford and Kennet were temporarily accommodating people from the hospital we reviewed aspects of these peoples care and support in line with the expectations of their inpatient status. The Langford area is being used to accommodate people under the ASC registration and the Kennet area for those people previously accommodated in the hospital

The provider notified us of the temporary arrangements for hospital patients while refurbishments take place. However, Langford and Kennet will not be correctly registered with CQC if these arrangements become long-term. The provider will need to submit applications to CQC to register appropriately if the closure of the hospital continues.

At this inspection we found that people were placed at risk due to management shortfalls. We found systemic overarching poor management systems and that the required improvements were not prioritised. There had been sudden and continuing persistent changes of senior management. There was a lack of regulatory response from the provider. There were issues with poor recruitment procedures, and a lack of investment in equipment and maintenance of the property. The morale of the staff was low, and they were reluctant to give feedback because of fear of reprisals. This had an impact on the care people received.

People’s experience of using this service:

The service was rated Requires Improvement at the comprehensive inspection dated July 2018. The rating for the focussed inspection undertaken on the 7 November 2019 remained the same.

For people receiving adult social care we found:

• Staffing levels had improved since the last inspection.

• Information about pain management was not always clear.

• Three out of eight people living at Langford had a history of epilepsy seizures, however, epilepsy management training was non-compulsory.

• Environmental risk assessments relating to fire safety, infection control, maintenance or temperature check were out-of-date.

• There were no logs of maintenance work requested by staff or carried out in the service. We saw there were areas requiring urgent maintenance and potentially posing a threat to people’s health and safety.

• When agency staff were used, the service did not always ensure they were qualified and knowledgeable enough to lead a shift.

• The unit manager was not supported by the provider to ensure they could focus on making improvements. This included an ineffective maintenance function, and not having recruitment support from a human resources team.

• The service did not have a registered manager in post. The service was being managed by an interim manager.

For the hospital patients we found:

• There was little evidence to show how standards of cleanliness and hygiene were maintained. There was no process, checklist, or audits completed within the organisation relating to infection control. Safety systems were not implemented to protect patients effectively from communicable diseases or to maintain infection control and hygiene. Staff didn’t always decontaminate their hands immediately before and after every episode of direct contact.

• The maintenance of facilities and premises did not keep people safe.

• The clinical care for the people who were hospital patients was not safe. Staff were not able to identify and respond appropriately to changing risks to people who use services. National Early Warning Scores (NEWS) was not in use.

• There were not comprehensive risk assessments carried out for people who use services and risk management plans were not developed in line with national guidance. We reviewed several sets of patient notes and found that the management of risks was not being properly identified or monitored.

• Nursing assessments and documentation were not in keeping with standards for nursing. People’s individual care records, including clinical data, were not written and managed in a way that kept people safe. Information needed to deliver safe care and treatment was not available to relevant staff in a timely and accessible way. Care plans were not always updated as the provider required.

• Medicines were overall safely managed.

• Staff told us that staff were very negative about the provider and this caused friction among staff.

Also, as patients from the hospital had been transferred to other wards, not necessarily their speciality, staff felt there were unrealistic expectations placed on them for patient needs outside their scope of experience.

• Staff told us they had no confidence in senior management as there was no communication, however, the newly appointed CEO was perceived as someone who would listen to the staff.

• Staff were concerned that the hospital (which was closed due to a flood) would not re-open and their jobs would be at risk.

Whilst we saw that some improvements had been made these were not sufficient and additional areas of concern were identified. As a result the rating from this inspection is now inadequate .

Rating at last inspection: This service was rated Requires Improvement at the comprehensive inspection published on 30 August 2018.

Why we inspected:

This inspection was brought forward due to information of risk or concern. Since the inspection visit in October 2018 we received ongoing whistleblowing concerns. After the last inspection CQC requested assurances from the provider about the action they would take to improve the service. To date, these assurances have not been forthcoming. We did not inspect the key questions Effective, Caring and Responsive because ongoing monitoring did not raise any information about risks or concerns in these areas.

Enforcement:

Following the focus inspection in November 2018 we imposed a condition on the providers registration. The provider was required to submit monthly improvement action plans to CQC from February 2019. These have not been received We also issued four warning notices following the focus inspection at Glenside Hospital in November 2018.

Follow up:

This service is now rated as Inadequate and placed on special measures. 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.

If not enough improvement is made within this timeframe and the rating of inadequate is repeated for any key question or overall, we will take action in line with our enforcement procedures. This will be to begin the process of preventing the provider from operating this service. This process will lead to cancelling the provider’s 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, urgent enforcement action will be escalated. Where necessary, another inspection will be conducted within the next 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.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk