Archived: Safe Harbour Dementia Care Home

We considered our inspection findings to answer questions we always ask; is the service Safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

The service was not safe. We found concerns about the way medicines were managed at the home. Overall, we found that appropriate arrangements for the obtaining, recording, handling, using and safe administration of medicines were still not in place and this put people at risk of harm. People's insulin was still not always appropriately managed and medicines were not always offered at appropriate times.

The provider had failed to act in the best interests of a person who had refused personal care. As a result their health and welfare had been compromised. Appropriate referrals to the relevant health professionals had not been made when the needs of another person had changed. This put a person at risk of harm.

Is the service effective?

The service was not effective in meeting the needs or upholding the rights of people who lacked capacity. Although some improvements had been made since our last inspection, the provider still had little regard for the Mental Capacity Act 2005. Some staff had still not received any training to assist their understanding of the Mental Capacity Act.

Improvements had been made to make the home more dementia friendly. However, there was still a risk that people could become disorientated and confused because the provider did not ensure that doorways to people's personal space were personalised and easily identifiable.

Is the service responsive?

When people's needs changed or new risks emerged, the service was not always responsive and people were put at risk of harm.

The provider had sent the Commission numerous action plans following previous failings that had been accepted by the provider. However, they had not taken sufficient actions that ensured people received good care.

Is the service caring?

We observed that the staff were caring during most of our observations. Staff spoke to people in a caring and compassionate manner. When people became confused and upset, staff dealt with the situation calmly and were attentive to people's needs. However, people's dignity was not always promoted.

Is the service well-led?

The service was not well-led. Although systems were in place to monitor the quality of the service provided, these were not effective and failed to pick up the most of the concerns we had found. Where their checks had identified concerns, action was not taken to ensure they had been addressed and systems put in place to prevent them from happening again. The provider's visits to the home had not been documented and concerns we had found had not been identified by them.

This was the third inspection since May 2013 where we have identified the service had failed to provide us with notifications and therefore it was clear that lessons from past failings had not been learnt.

Our inspection team was made up of an inspection manager, one inspector, and a pharmacist. We followed up our concerns that were identified on 10 November 2014. We identified further concerns that put people at risk of harm. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

The service was not safe. We found concerns about the way medicines were managed at the home. Overall, we found that appropriate arrangements for the obtaining, recording, handling, using and safe administration of medicines were still not in place and this put people at risk of harm. People's insulin was still not managed safely.

Equipment was not adequately maintained. We saw that the beds for two people were not safe and this put people at risk of harm.

The provider had failed to follow local safeguarding procedures and report all adverse incidents that occurred to the local authority. This meant that people were not fully protected against the risks of abuse.

Is the service effective?

The service was not effective in meeting the needs, or upholding the rights of people who lacked capacity. The provider still had little regard for the Mental Capacity Act 2005.

Staff were not adequately supported to provide people with care that was safe and effective. There were still significant shortfalls for training with regard to the Mental Capacity Act 2005 (MCA).

People were still not cared for in a dementia friendly environment.

Is the service responsive?

The service was not responsive to people's needs. When people's needs changed or new risks emerged, the service was not always responsive and people were put at risk of harm.

The provider had still not taken sufficient actions since the previous inspection to ensure that people received good quality care that was safe and effective.

Is the service caring?

The service was not always caring. The provider did not consider the views of people's relatives when decisions needed to be made around relocating people within the home.

A person's independence was not always promoted as they were not always able to access their own personal space without the assistance of staff.

We observed that the staff were caring and people's dignity was promoted. Staff spoke to people in a caring and compassionate manner. When people became confused and upset, staff dealt with the situation calmly and were attentive to people's needs.

Is the service well-led?

The service was not well led. A new manager and head of services had been working at the service six days prior to our inspection.

The systems that were in place to monitor the quality of the service provided were not effective and failed to pick up the concerns we had found. This compromised the health, welfare and safety of people who used the service.

The provider had again failed to provide us with statutory notifications even after assurances that they had been made when required.

We considered our inspection findings to answer questions we always ask; Is the service Safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found;

Is the service safe?

We found that people were not always kept safe in this service.

We found concerns about the way medicines were managed at the home. Overall, we found that appropriate arrangements for the obtaining, recording, handling, using and safe administration of medicines were still not in place. It was not possible to account for all medicines, as nurses had not always accurately recorded the quantity received into the home, or how much had been brought forward from the previous month. We saw records that showed people living in the home had not always been given their medicines and creams because stock had run out and arrangements for new supplies had not been made. We found that medicines were not always offered at appropriate times.

We found one person had refused a high number of their daily doses of insulin. We found the service failed to respond appropriately and put the person at risk of going into a diabetic coma.The provider had failed to notify the relevant authorities when a serious incident or injury had occurred. Therefore reasonable steps hadn't been taken to identify the possibility of abuse and prevent abuse from happening.

Although staff were knowledgeable of the types of abuse that could occur and how to report it, it was clear the policies and procedures the service had in place had not been followed. This meant the service was not safe and was putting people at risk of harm

People who used the service were unable to communicate with us during our inspection so they were not able to tell us if they felt safe living at the home.

Is the service effective?

The service was not effective in meeting the needs or upholding the rights of people who lacked capacity. People had refused their medication and records suggested they were to be given their medication covertly. The provider had no regard to the Mental Capacity Act 2005 and no informed decision had been made in the best interests of the people concerned.

We spoke to two nurses who were on duty about practices around covert administration of medication in line with the Mental Capacity Act 2005. We questioned them around the best practice guidelines, and whether they were aware of them. Both of them were unable to answer questions around expectations within these guidelines.

We saw there was no dementia friendly signage in the home and some bedrooms did not identify whose room it was. This meant people could become more confused and distressed.

Is the service caring?

We observed how people were supported during our inspection. Staff spoke to people in a caring and compassionate manner. When people became confused and upset, staff dealt with the situation calmly and were attentive to people's needs. However, there was one occasion during lunchtime where staff did not acknowledge a person who became upset.

Is the service responsive?

When people's needs changed, the service was not always responsive and people were put at risk of harm. The provider had not considered the Mental Capacity Act 2005 and we could not see any evidence that the appropriate referrals to the relevant health professionals had been made. Care plans had also not been put in place when the needs of people had changed or new risks emerged.

Is the service well led?

The service was not well led. On our arrival at the home, the acting manager was not present. We asked for the person in charge. The administration officer for the home advised that the two nurses on duty were in charge. We spoke to the nurse's and neither of them were aware of who had overall managerial responsibility within the home when the acting manager was not present.

Although systems were in place to monitor the quality of the service provided, these were not effective. With the exception of medication management, these systems had not been used since our previous inspection on 2 June 2014. Medication audits had failed to pick up some of the serious concerns we found. The acting manager confirmed that other than medication audits, no other audits had taken place since the former deputy manager had left. Therefore the concerns we found on this inspection had not been picked up.

There was no evidence of any visits the owner made to the home or if any of the discrepancies identified by us had been identified by staff at the home. .

This is a summary of what we found;

Is the service safe?

We looked at medicines and records about medicines for 20 of the 29 people who were living in the home on the day of our visit. We found some concerns about medicines handling for each of those people. We found that changes and some improvements since our last inspection had been made but they had not resulted in safer handling of medicines. We saw that audits on how medicines were being handled had been completed. However, the last audit completed on 10 May 2014 had not identified any concerns with medicines handling. This meant that people were still not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff knew what action to take if they recognised signs of abuse and were aware of the whistle blowing process should they have any concerns. Discussions with staff demonstrated they were knowledgeable about the different types of abuse that could occur.

We found that people had been cared for in an environment that was clean and hygienic. We examined the cleaning schedules for the kitchen and the rest of the home and saw they were completed on a daily basis. Were concerns were identified we saw they were documented and followed up where necessary.

There were enough staff on duty at the home to meet the needs of the people who used the service. We saw that before any member of staff began employment with the company two references were obtained. We saw that Criminal Record Bureau (CRB) disclosure checks, and more recently Disclosure and Barring Service (DBS) checks were completed. This ensured that people were supported by people of a suitable character.

Is the service effective?

It was clear from our observations and discussions with care assistant's that they had a good understanding of people's care and support needs and that they knew people well. One relative told us; "If there are any concerns they ring me straight away and call for a Doctor promptly". We saw two examples that demonstrated the home had consulted a dietician where there had been concerns around people's weight loss. As a result both the people concerned had gained weight since their intervention.

Staff told us that they felt well supported by the new management team and they had the information they needed for their roles.

Is the service caring?

People were supported by kind and attentive staff. Staff spoke to people in a caring and compassionate manner. When people became confused and upset, staff dealt with the situation calmly and were attentive to people's needs. One relative told us; "The care is good. The staff are patient and I can't fault them really".

Is the service responsive?

People's needs had been assessed before they moved into the home. People had access to activities that were important to them. A member of the management team told us about plans to introduce a sensory room to aid stimulation for people with dementia care needs.

Records and discussions with staff showed that where there was a concern about a person's health needs the advice and support of various professionals in the multi-disciplinary team had been sought.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff understood their roles and responsibility to maintain people's safety. People told us they had completed a recent satisfaction survey. We were told they were in the process of being analysed and responded to.

Following concerns raised at previous inspections, changes to the management team had been made and an acting manager had been appointed eight weeks prior to this inspection. We were told the recruitment process for a permanent manager was on going and the acting manager would take up the post of head of services, the person who has overall responsibility for the management of the service. The provider was aware that once they had appointed a full time manager, they would be required to be registered with us without delay in order for the provider to be compliant with the conditions of its registration. A registered manager had not been in place at the home since June 2013.

We found that the carpets and laminate flooring had been replaced throughout the home.

Staff told us that they were supported in their roles and had received training in relation to safeguarding, the Mental Capacity Act 2005 (MCA), fire training and person centered training.

We saw the home had introduced a variety of audits for care planning, environment and accidents / incidents.

However, we found appropriate arrangements still had not been made in relation to obtaining medication. As at our last visit we saw that people had run out of some of their prescribed. We saw that three people had run out of one of their prescribed medicines for periods between one and nine days. If medicines are not obtained in a timely manner people's health could be at risk. We saw that many people in the home were prescribed medicines to be taken 'when required'. There was still only limited information available to guide staff as to how to give these medicines. There was also no information to guide nurses when selecting the appropriate dose of medication for each person, when a choice of dose was prescribed.

We found the carpets had not been replaced and the trip hazards were still present as at our last inspection.

We found that not all staff were not supported in their roles as they had not received the training that was required such as safeguarding of vulnerable adults. The service had not informed us of any recent safeguarding incidents that had taken place. This is a legal requirement. We looked at the systems in place for managing medicines. We found that appropriate arrangements for the recording, administration and safe handling of medicines were not in place. We looked around the building. We found that the carpets throughout the building were not in a good condition. This put people at risk. We found that the systems in place for monitoring the care provided were not adequate. We saw there was no analysis or action plans in relation to concerns that were raised.