Archived: Chy Byghan

The service was rated as Requires Improvement at the last inspection in March 2017 when we identified three breaches of the regulations. We identified concerns included how the service operated under the Mental Capacity Act (2005) and concerns about the submission of Deprivation of Liberty safeguard applications to ensure people were not unlawfully detained. We also identified that the provider was not fully assessing the risks to people or doing all that was reasonable practicable to mitigate any risks. We identified that staff were not receiving the appropriate level of support, training or supervision to enable them to safely carry out their duties.

Following the last inspection in March 2017 the service sent us an action plan stating what action it was taking to meet the requirements of the regulations. This inspection is based on information about increased risk which preceded the planned inspection visit to check on the action the service had taken to meet the requirements of the regulations.

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.

Chy Byghan is a care home which offers personal care and support for up to 19 predominantly older people. At the time of the inspection there were 13 people living at the service. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia.

At this inspection we found concerns with the safety of fire systems. For example, the fire protection system was not currently operating as designed. For example the provider told us a heat sensor had been disabled by an electrician in November 2017 because it was defective and a fire exit had been closed off. The service did not have a fire safety risk assessment in place potentially putting people at risk of harm. We found issues with the safe running of the electrical system. The electrical system was repeatedly ‘tripping off’ and cutting the power supply. There was currently a high loading on the electrical system due to the use of four electrical heaters in various rooms. When the electricity supply was cut off the pressure relieving air mattresses used by one person deflated putting people’s skin integrity at risk, and where people were dependent on electrical heaters for warmth, these were not available to provide heating during these periods. A fire door on a person’s room on the ground floor was kept open with a wooden wedge. The person who used this room required the use of oxygen dispensed from a cylinder. The failure to keep the fire door shut when oxygen was being used posed a fire risk to all those using the service.

We had concerns about the provision of adequate heating to people living at Chy Byghan and the risk this caused to the service users of becoming cold. There was a fault with the heating and hot water boiler. The boiler fault meant that three bedrooms and the lounge were currently not being heated by the radiators served by the boiler. The current heating arrangement in the rooms which were not being heated by the central heating system, was through the use of portable electric heaters. These radiators were not always sufficient to keep these rooms at an adequate ambient temperature. The lounge particularly did not have adequate heating from the available electric heater.

Nine rooms including two bedrooms upstairs did not have a supply of hot water. This meant staff had to carry hot water upstairs in order to provide personal care to a person who was cared fr in bed and very frail. The hot water available across the rest of the service was checked and found to be only available at a tepid temperature. Maintenance records showed that the gas boiler had not received an annual service since June 2016. This meant that service users did not have an adequate supply of safely delivered hot water in order to meet their needs.

We had concerns about current and future appropriate staffing levels for the service. This was because one-third of the current core staff group had resigned because of uncertainty about the financial security of the service. The provider was heavily reliant on agency staff to maintain the staffing rota. On the day of inspection the service was already one staff member short of the three staff members usually allocated to cover the morning shift from 8:00am to 2:30pm. We saw that one of the remaining two staff had to leave the service for one hour and forty-five minutes during the morning, leaving only one staff member available to provide care and support for 13 people. Staff told us they did not consider the service to be safe because of the current level of staff absence and uncertainty about the future of the service.

Overnight staffing cover was limited to one member of care staff to provide care and support to 13 residents. The staffing rota showed that the night period was planned to be shared by two staff members on seven occasions between 12 February and 14 March 2018. Staff told us these shifts were having to be shared because the staff responsible for care overnight were also needed to cover for the day shift on the following day. Therefore these staff could not cover the entire night shift if they were to have enough sleep to work the following day. We saw that one staff member worked from 2:00pm on 11 Feb through till 2.00am on 12 Feb and then resumed work at 6:45am to finish at 2:30pm on 12 February. This meant that this staff member had only had 4.75 hours sleep over the course of 24 hours on duty. This placed an additional pressure on staff working when tired. This had the potential to put people at risk of harm.

The medicines administration system was unsafe. We checked the medicine records of all 13 people living at Chy Byghan. We found multiple incidents where medicines had been administered but not signed by staff as given. We also found one incident where a medicine had been signed as administered but was still in stock. We saw medicines audits conducted over the last six months that recorded two queries about whether a person’s Warfarin medication had been administered. This had not been followed up with medical professionals. Records stated it was ‘unclear’ if the medication had been given. There were no records of any follow-up discussions with staff or attempts to obtain medical advice putting the person at risk. The provider had also not ensured there was enough stock of one medicine to be administered. This had the potential to put people at risk of harm.

There was no care plan or risk assessments in place for a person who had moved into the service in January 2018. From a review of the person’s hospital health assessment we saw the person had serious health concerns that had not been appropriately assessed or planned for, during their stay at Chy Byghan. Plans to ensure people who required repositioning to protect their skin were not consistently followed. These issues had the potential to put people at risk of harm.

The sluice room which contained chemicals hazardous to health was unlocked. We were told it could not be locked because the key had been lost. The boiler cupboard was similarly required to be kept locked to keep people safe but was open because the key was lost. The cupboard holding the service’s electrical circuitry had a sign stating ‘keep locked’ and ‘high voltage’ and we found this too was unlocked. Staff found the key for this and locked it when the need for it to be locked was pointed out.

There were inadequate governance arrangements in place to monitor and assure the quality of the service. Staff felt the provider was not addressing the serious issues facing the service.

The provider told us the financial viability of the service was in serious doubt. The question of the financial viability of the service put people who lived at Chy Byghan at risk of not receiving the care service they require.

The overall rating for this provider is now ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. 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.

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. The breach of Regulation 12, Safe Care and Treatment, had continued since the previous inspection in March 2017. The CQC has imposed Conditions on the Registration of the service in light of the risks to people using the service.

We carried out this unannounced inspection on 13 and 14 March 2017. This is the first inspection to be carried out at the service under the current registration.

The inspection was prompted in part by notification of an incident following which a person using the service may have been harmed by another person using the service. This incident is subject to further investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk between people using the service. This inspection examined those risks.

The service is required to have a registered manager and at the time of our inspection a registered manager was in post. 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.

Where people did not have the capacity to make certain decisions for themselves the provider had not acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. The service had not followed the guidelines of the Mental Capacity Act regarding decisions to restrict a person’s liberty. A person who was unable to leave their bed due to poor health had their bedroom locked at all times. The registered manager told us this was done to protect the person from other people entering their room. However, no consultation or best interest process had been followed to ensure this action was appropriate or had been consented to. In addition, seven people who were not at liberty to leave the service due to health conditions had not been subject to the legally required Deprivation of Liberty safeguards authorisation process. The registered manager made appropriate applications following the first day of inspection.

The service had failed to follow professional advice regarding safe manual handling and repositioning practices for a person who was unable to leave their bed. The person’s skin integrity had deteriorated.

Training and supervision systems were not effective. The service used a training matrix to identify when staff needed training. However we found there were gaps in required training.

Arrangements for the induction and training of new staff were not robust. There was a lack of recording around the induction to evidence it was in line with accepted national standards.

The service had not followed its policy for the provision of regular formalised and recorded supervision. The registered manager did not receive supervision.

We found there was limited functioning of the boiler which supplied hot water to ground floor bathrooms. This had been raised as an issue by a relative of a person who lived at Chy Byghan. The registered manager told us the boiler needed extensive works or replacement and as an interim measure a plumber had fitted a pump to the existing boiler. This meant the boiler could supply hot water with a short delay before supply when the hot water tap was turned on.

People told us they felt safe living at Chy Byghan and with the staff who supported them. People told us, “I am really happy here” and “I have friends here. I get on with the residents and all the staff. I feel safe." Relatives said, “My [relative] is very happy living at Chy Byghan. It is a happy home and the staff are really lovely” and “Great, it’s like a home from home”.

Care and support was provided by a consistent staff team, who knew people well and understood their needs. The service employed a part-time activities co-ordinator who had developed a range of personalised and interactive activities such as quizzes and live music events that people told us they really enjoyed. The service had begun to arrange to support small groups of people to enjoy activities in the local community and enjoyed visits into the service by local students. There was a relaxed and happy atmosphere in the service throughout the inspection. It was clear that staff and everyone who lived at Chy Byghan looked out for each other and there was a happy, family feel to the service.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were suitable to meet people’s needs and wishes. Staff completed a recruitment process to help ensure they had the appropriate skills and knowledge.

Staff knew how to recognise and report the signs of abuse and said they would have no hesitation in doing so.

People were supported to eat and drink enough and maintain a balanced diet and were involved in meal planning. We saw minutes from residents meetings demonstrating that people discussed and suggested different options for meals they would like. Menu planning was done in a way which combined healthy eating with the choices people made about their food.

People were supported to maintain good health, have access to healthcare services and receive on-going healthcare support. Staff supported people to arrange and attend appointments to see their GP and other necessary healthcare appointments.

Care records were up to date and had been regularly reviewed. However we found discrepancies between information held in people’s care plans and risk assessments

People and their families were given information about how to complain. The registered manager and owner were visible in the service, regularly working alongside staff to provide care and support for people.

There were not consistently effective quality assurance systems in place to make sure that areas for improvement were identified and addressed. For example, people’s personal monies were not regularly audited. Quality assurance processes had not identified issues with staff training and supervision processes.

People and their families were involved in the running of the service and were regularly asked for their views through on-going conversations with staff and surveys.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 you can see the action we have told the provider to take at the end of this report.