Scholars Mews Care Home

Updated 3 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Four inspectors and an Expert by Experience completed this inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. One of these inspectors made telephone calls to relatives to gain their feedback on the care provided.

Service and service type

Scholars Mews Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Scholars Mews Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 17 October 2023 and ended on 24 October 2023. We visited the location on 17 18, 19 and 24 October 2023. Our visit on 18 October 2023 was during the night.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. This information helps support our inspections We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people and 7 relatives about their experience of the care provided. We spent time with the people who lived at the home observing the quality of care and support they received. This helped us to understand the experiences of people who we were unable to communicate with us.

We spoke with 22 members of staff including the deputy manager who was managing the home at the time of our visit, 6 senior members of care staff, 10 members of care staff, the sous chef, 2 regional support managers, a regional director, and the operations director. We also spoke to a healthcare professional about their experience of the care provided.

We reviewed a range of records. This included information contained in 7 people's care records and multiple medicine records. We also looked at 2 staff recruitment files and records related to the overall management and quality assurance of the service.

Updated 3 January 2024

About the service

Scholars Mews Care Home is a residential care home providing accommodation with personal care for up to 64 people. It is a purpose-built home in which care is provided across 3 floors. Residential care was being provided on the ground floor and dementia care was being provided on the first and second floor. At the time of our inspection visit there were 43 people living at the home. Some of these people were living with dementia, physical disabilities and mental health conditions.

People’s experience of using this service and what we found

People were not safeguarded from abuse and avoidable harm because safeguarding systems were ineffective in keeping people safe. Staff did not always report allegations of abuse in a timely way. Staff did not always feel able to challenge unsafe or poor practice because their concerns were not always listened to or acted upon.

People’s injuries were not always recorded or reported. Where injuries were reported, these had not always been investigated. This practice prevented the provider completing a thorough review to identify the cause of injury which increased the risk of improper treatment. The provider completed an analysis to identify patterns and trends of accidents within the home. However, this was not accurate because accidents and incidents were not always recorded and reported in line with the providers expectations. Where people had fallen, it was not always clear what action had been taken to reduce the risk of re-occurrence.

Staff did not always take action to mitigate any identified risks to people’s health. Risk assessment tools did not always accurately reflect changes in people’s health. There was limited information in care plans to ensure staff knew how to minimise risks to people’s health and well-being.

The provider did not always ensure there were enough suitably skilled and competent staff on duty which compromised people's health and safety. Senior staff in particular had insufficient time to fulfil their duties. Staff competency was not always assessed to ensure staff had the right skills to deliver safe and effective care.

Medicines were not always managed safely. In each of the medication rooms we found large quantities of medicines that needed to be returned to the pharmacy. These were not stored in line with the providers policy or best practice guidance. Some people needed medicines on an 'as required' (PRN) basis to treat short term conditions such as pain or anxiety. Where medicines had been prescribed to help people manage levels of distress, it was not always clear when these medicines should be considered as guidance contained vague information. There was limited evidence to show a clear rationale for the administration of some PRN medicines.

There had been a period of managerial instability in the home. The provider and senior leaders failed to ensure the home had the right level of support, competency, and skill to provide people with safe, effective, and compassionate care. The provider's systems and processes for monitoring the quality of the service were not effective. The serious and widespread issues found at this inspection had not been identified through internal quality monitoring audits and checks.

People were not always well supported or treated with respect and compassion. People’s privacy was not always respected and promoted.

People were not always supported as individuals, or in line with their needs and preferences. There was a culture where staff encouraged people to stay in their bedrooms. Some people expressed distress through their behaviour. Records did not show this was always responded to consistently.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 26 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, staffing numbers and risk management specifically related to falls. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

Enforcement

We have identified breaches in relation to safeguarding, staffing, risk management, dignity and respect, person centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.