Background to this inspection
Updated
20 September 2019
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 13 and 15 November 2018 and was unannounced. The inspection was conducted by an inspector, an inspection manager, an expert-by-experience and a specialist advisor. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The specialist advisor was a nurse with a specialism in dementia care. At the time of our inspection, 31 people were using the service. Five people were on a short stay and 26 people lived at the home longer term.
As part of our inspection planning, we sought feedback from the local authority quality monitoring team and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We referred to other information we held about the service to help inform our inspection planning. This included notifications, which contain information about important events which the provider is required to send us by law. We also reviewed monthly reports submitted by the provider, which they were required to send to us as part of our enforcement action undertaken following the last inspection in September 2017.
During our inspection, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. As part of our inspection, we spoke with eight people living at the home and three people’s visiting relatives and friends. We spoke with a domestic staff member, the cook and the activity coordinator, along with eight care and nursing staff members, including an agency care staff member and an agency nurse during our inspection. We spoke with the deputy manager, the registered manager and a director of the service, and four professionals involved in people’s care. We sampled documents related to the quality and safety of the service, including records related to eleven people’s care and two staff members’ recruitment files chosen at random. We received additional information requested from the registered manager after our inspection.
Updated
20 September 2019
This inspection took place on 13 and 15 November 2018 and was unannounced. This service has been rated ‘Requires improvement’ overall over the four previous inspections. At our last inspections in May 2017 and September 2017, we identified breaches of the regulations related to safe care and treatment and governance. After the inspection in May 2017, we undertook enforcement action in relation to those breaches, however the provider failed to achieve compliance with the regulations. After the inspection in September 2017, we undertook more significant enforcement action to impose conditions on the provider’s registration. This required the provider to submit monthly reports to the Commission, about actions they took to improve the safety and oversight of the service.
At this inspection in November 2018, we found again that the provider had still not made sufficient improvements and has remained in breach of those regulations since May 2017. This has continued to put people at risk of poor and unsafe care. This inspection identified an additional two breaches of the regulations related to person-centred care and the provider’s failure to submit notifications to the Commission as required. We have taken further enforcement action in line with our processes, in response to this inspection and we have rated the service ‘Inadequate’ overall.
Redhouse Nursing Home is a ‘care home’ with nursing. 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. Redhouse Nursing Home accommodates up to 34 older people in one adapted building.
There was a registered manager who was present during our inspection and had registered in March 2018. 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.
People continued to be at risk of poor and unsafe care as the provider had still failed to provide a consistently safe service. We found various examples of how people’s risks were still not effectively assessed, monitored and mitigated. Lessons were not learned to improve the safety of the service and practices at the home put people at increased risk of harm. This amounted to a continued breach of the regulations in relation to safe care and treatment.
People’s relatives and friends felt the service was safe. One person told us they felt the service was safe, however this was not consistent feedback because two people told us they did not feel safe. Some improvements had been made to how some people’s risks were managed including people’s support with medicines and staffing level changes. Recruitment processes had not always been followed as planned to ensure people’s safety. The registered manager told us they intended to use an improved audit, and to appoint a new infection control lead to support ongoing improvements and ensure good infection control practices at the home.
Staff told us they felt supported and spoke positively about the supervision and training provided, however we found continued concerns that staff were not always equipped with the skills and knowledge to meet all people’s needs. People could not be confident all of their needs would be effectively monitored and met although we saw some positive examples of how people were supported. People were not supported to have maximum choice and control of their lives and staff did not support all people in the least restrictive ways possible.
We received mixed feedback about the food on offer and people’s own choices and preferences were not routinely gathered to help inform menu planning. Although we often found positive practice in these areas, improvements were required to ensure people always received safe and effective support in relation to their dietary and hydration needs and to access healthcare services when needed.
Although we often saw caring interactions from some staff, some people’s feedback showed staff did not demonstrate a consistently caring approach. We saw staff were often engaged in other tasks and did not often have opportunity to spend quality time and interact well with people. People were not involved in their care as far as possible and opportunities to gather people’s views about their care were missed.
Although we identified some people’s positive experiences of the service, we identified a breach of the regulations due to the continued concerns that people did not all receive care in line with their needs and wishes. People’s needs and preferences were not effectively gathered and met and this put people at risk of poor care. Improvements were required to how people’s care was planned, including end of life care. We found continued concerns around people’s poor access to activities. The design of the home including dining arrangements were not always developed around people’s needs and preferences. There was a complaints process and complaints had been recorded, logged, and responded to. Other systems such as regular care reviews were not in place however to help capture people’s feedback and identify any concerns or complaints they had, for example for some people who told us they did not feel comfortable making a complaint.
We found continued concerns in relation to the governance and leadership of the service. Despite some improvements since our last inspection, sufficient improvements were not made overall and systems and processes still failed to effectively assess, monitor and improve the quality and safety of the service. This put people at risk of poor and unsafe care and amounted to a continued breach of the regulations in relation to governance.
Systems failed to ensure risks to people’s health and wellbeing were shared, and that risks were effectively assessed, monitored and mitigated to safely meet all people’s needs. People were not given routine opportunities to discuss their care, and where some people had expressed needs and preferences, these were not always met. Incidents and shortfalls in the safety of people’s care were not rectified and learned from and this put people at risk of harm.
The overall rating for this 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 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.
You can see what action we told the provider to take at the back of the full version of the report.