We carried out an unannounced inspection of this service on 18 July 2017. At our previous inspection, on 27 July 2017, we rated the service as ‘requires improvement’. At this inspection, we found that the service still required improvement and a number of Regulatory breaches were identified. You can see the action we have taken in response to these breaches at the back of our report.
The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘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.
The service is registered to provide accommodation and personal care for up to 64 people. Care is delivered to people across four separate units. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection we were informed that 50 people were using the service.
The home had a registered manager. 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.
At this inspection, we found that the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that unsafe and unsuitable care was not always being identified and rectified by the registered manager or provider.
The safe staffing levels set by the provider were not maintained to ensure staff were available to keep people safe and meet people’s care needs.
Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed to promote their safety. Effective systems were not in place to protect people from the risks associated with infections.
Safety incidents were not always reported and responded to effectively, which meant the risk of further incidents was not always reduced.
The legal requirements of the Deprivation of Liberty Safeguards (DoLS) were not followed. This meant people were at risk of being restricted in an unlawful manner.
People were supported to access health and social care professionals. However, this was not always facilitated in a timely manner to promote people’s health, safety and wellbeing.
Staff received some training to help them support people. However, there were significant training gaps that left people at risk of receiving poor, unsafe care.
People’s feedback about their care was not always acted upon to improve the quality of care.
Most people described the staff as kind and caring. However, some people were not always treated with dignity and their right to privacy was not always respected. People were not always supported to make every day decisions about their care.
People did not always receive care in accordance with their care preferences and the information staff needed to provide consistent, effective care was not always available for them to follow. This meant some people were at risk of receiving unsuitable, inconsistent care.
People were supported to engage in leisure and social based activities. However, these did not always meet people’s individual needs and were not always enjoyable experiences.
Staff were recruited safely and they knew how to recognise abuse. However, improvements were needed to ensure potential abuse was consistently reported.
People received their regular medicines as prescribed. However, improvements were needed to ensure medicines were managed safely.
People were supported to eat and drink. However, people did not always have positive mealtime experiences.
Staff told us they felt supported by the management team. However some people and the staff did not have confidence in the managers. This meant some people were reluctant to complain about their care.
People’s consent was sought before support was provided. Staff understood and applied the requirements of the Mental Capacity Act 2005 which meant people were supported to receive care that was in their best interests when they were unable to make decisions for themselves.
Formal complaints were investigated in accordance with the provider’s complaints policy.