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.
The inspection took place on 20 and 21 April 2017 and was unannounced.
Devonshire House and Lodge is a purpose built nursing home providing residential and nursing care for up to 77 people. Devonshire House and Lodge is part of the corporate group Harbour Healthcare. The home is divided into five units, two nursing units and three residential units. On the days of the inspection 52 people were living at the home. Devonshire House and Lodge provides care for older people who may also have mental health needs which includes people living with dementia.
A manager was employed to manage the service who was in the process of registering with Care Quality Commission. 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. The manager had only been employed for three weeks and was in the process of getting to know the service.
Prior to our inspection we received information of concern that there were insufficient staff and equipment to meet people’s needs safely. Concerns were also raised that people’s dignity was not always respected by staff, there were no emergency evacuation plans for people, medicines management and administration was unsafe and people’s records were often unclear and completed inconsistently.
Following the inspection, we received further concerns from health and social care professionals about the safety of people living at Devonshire House and Lodge.
At our last inspection on 2 and 3 November 2016, we found breaches of regulation. People’s care plans were not always easy to understand and were not reviewed regularly. Risks to people’s health and safety were not always assessed and actions identified to mitigate risks were not always followed. Records to monitor people’s health needs or concerns were not always completed correctly and people’s care plans did not contain clear information for staff about how to protect people’s rights, if they were assessed as lacking capacity. Staff were not always deployed effectively and did not always have competence, skills and experience to provide safe care and treatment. Equipment used by the service provider was not always assessed as being safe for their individual’s needs and people’s personal emergency evacuation plans (PEEPs) were not always clear. Audits were in place but these had not always been completed accurately or action taken as a result. Following the inspection they sent us an action plan which said they would meet all these requirements by 28 February 2017. At this inspection we checked whether improvements had been made.
During the inspection, we were informed the police were undertaking an investigation into unexplained bruising sustained by one person. Explanations for the bruising had not been recorded. This is also being investigated under the local authority safeguarding procedures.
We found staff were not always deployed effectively to keep people safe and meet their needs. We observed people who were calling for help receive no response from staff. People told us staff did not always respond to call bells or concerns promptly. People told us there was not always enough to do to occupy their minds and to keep them entertained. Comments included, “It’s boring living here, nothing to do is there?” and “There’s nothing to do much.” People’s care plans did not always give clear information about people’s preferences or how they wanted their needs to be met.
People were not always protected from risks associated with their care because risk assessments were not always in place; or did not provide clear guidance and direction to staff about how to keep people safe. When guidance was available, this was not always followed by staff. Incidents were not always recorded effectively which meant learning to reduce the risk of future incidents could be lost.
People were at risk of the spread of infection because staff had not all received training on infection control. People’s risk assessments and care plans did not contain clear information for staff to follow and appropriate protective clothing was not always readily available. People’s needs were not all recorded on a personal evacuation plan to be used in the event of an emergency.
People’s medicines were not always managed and administered safely. Staff had not ensured there were always sufficient medicines available for people and that medicines administration records (MARs), were completed accurately. People’s changing healthcare needs were not always recorded accurately, identified or acted upon. The provider had not ensured information and recommendations from external professionals had been embedded in practice. Staff were not always available to provide the support people required when eating and drinking. When people had not had enough to drink, records did not always show what action had been taken.
Some staff members understood how the Mental Capacity Act 2005 (MCA) applied to their role but records did not always give clear information about why someone had been assessed as lacking the capacity to make a certain decision. This meant their human rights may not always have been supported or respected. People’s dignity and confidentiality was not always protected and staff did not always show respect for the environment people lived in. The vision and values of the provider were not always reflected in the way staff worked.
It was not always clear who had responsibility for monitoring different aspects of the service and maintaining quality. The provider did not effectively follow systems and processes in place to help monitor the quality of care people received or act upon the results. When quality monitoring activities had identified gaps in the quality of the service, these had not always been acted upon. People’s concerns and complaints had not always been reported, recorded or acted upon. For example people and relatives told us they had reported to staff when personal items or clothing had gone missing but action had not always been taken.
People told us they enjoyed the food and said that staff were kind. Comments included, “The food is lovely and the chef is fantastic” and “The food is good, I mean really good.” Staff told us they enjoyed providing care and knew people well.
New staff received a thorough induction. Staff had received training and the manager was reviewing all staff training to help ensure all staff training was adequate and up to date.
People told us they felt safe using the service and that staff protected their privacy. Comments included, “I feel safe here because I like the staff.” Staff confirmed they knew how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.
People had sufficient equipment and aids to meet their individual needs.
Staff told us they had confidence in the new manager and felt able to raise any ideas or concerns.
We asked the provider to respond to the immediate concerns we had about people’s safety at Devonshire House and Lodge. They sent us a plan detailing what action they would take to ensure people were safe. This included not admitting anyone to the service until they were confident the service was safely meeting people’s needs. This plan will be kept under review.
We found six breaches of the regulations. We are taking further action against this provider and will report on this when it is completed. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded. You can see what action we told the provider to take for two of the breaches at the back of the full version of the report.