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Reports


Inspection carried out on 4 October 2017

During a routine inspection

This inspection took place on 4 and 6 October 2017 and was unannounced. Redworth is a care home with nursing that is registered to provide care for up to 57 people. The home is located in Shildon, County Durham and is owned and run by Shaftesbury Care GRP Limited. At the time of our inspection 41 people were using the service.

At the last inspection on 26 August 2015 the service was rated Good but with a breach of regulation as it did not have a registered manager at that time. At this inspection we found the service remained Good.

The service had a registered manager. 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 told us staff at the service kept them safe. Risks to people using the service were assessed, and the premises and equipment were regularly checked to ensure they were safe for people to use. Medicines were managed safely by staff who had been trained to do so. Policies and procedures were in place to safeguard people from abuse. Staffing levels were monitored to ensure enough staff were deployed to support people safely. The provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff were supported to carry out their roles by regular training, supervisions and appraisals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this. People were supported to maintain a healthy diet and to access healthcare professionals to monitor and promote their health.

People and their relatives praised staff at the service, describing them as kind and caring. People said staff treated them with respect and helped to maintain their dignity. People were encouraged to maintain their independence. Throughout the inspection we saw numerous examples of kind and caring support being given. Policies and procedures were in place to arrange advocacy support should this be needed.

People received the care and support they wanted. Care records were personalised to people’s needs and wishes and were regularly reviewed to ensure they reflected people’s current support needs and preferences. People were supported to access activities they enjoyed. Policies and procedures were in place to investigate and respond to complaints.

Staff spoke very positively about the registered manager and the culture and values of the service. The registered manager and provider carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was regularly sought from people, relatives, external professionals and staff. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

Inspection carried out on 26/08/2015 01/09/2015

During a routine inspection

We carried out an unannounced comprehensive inspection of the service in March 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this comprehensive inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Redworth on our website at www.cqc.org.uk.

The home provides care for up to 57 older people, On the day of our inspection there were 22 people using the service, 12 people required nursing care.

The home had a recently appointed acting manager who is not yet registered with CQC. 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.

At the time of the inspection visit, our records show that no registered manager’s application had been submitted to CQC.

This is a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and under the Care Act 2014 Regulation 7 (b).

We spoke with care staff who told us they felt supported and that the acting manager was always available and approachable. Throughout the day we saw that people and staff were very comfortable and relaxed with the management team on duty. The atmosphere was calm and relaxed and we saw staff interacted with people in a friendly and respectful manner.

Care records contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary. We saw records were kept where people were assisted to attend appointments with various health and social care professionals to ensure they received care, treatment and support for their specific conditions.

We found people’s care plans had been written in a way to describe their care, treatment and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate that people or their representatives were involved in their care planning.

The staff that we spoke with understood the procedures they needed to follow to ensure that people were kept safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

Our observations during the inspection showed us that people were supported by sufficient numbers of staff. We saw staff were responsive to people’s needs and wishes.

We found robust systems in place for the safe management of medicines.

We found the premises were clean and hygienic with effective systems in place to control the spread of infections.

Those parts of the home that needed it had been refurbished to a high standard.

When we looked at the staff training records they showed us staff were supported to maintain and develop their skills through training and development activities. The staff we spoke with confirmed they attended both face to face and e-learning training to maintain their skills. They told us they had regular supervisions with a senior member of staff, where they had the opportunity to discuss their care practice and identify further training needs. We also viewed records that showed us there were robust recruitment processes in place.

The management team and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

During the inspection we saw staff were attentive and caring when supporting people. Comments from people who used the service were very consistent stating they were happy with the care, treatment and support they received. Other professionals we spoke with were positive about the care and support people received.

We observed people were encouraged to participate in activities that were meaningful to them. For example, we saw staff spending time engaging with people on a one to one basis, and others had visited a local railway museum on the previous day.

We saw people were encouraged to eat and drink sufficient amounts to meet their needs. We observed people being offered a selection of choices.

We found the building met the needs of the people who used the service. We were told that work on the refurbishment of the home will continue throughout the remainder of the year.

We saw a complaints procedure was displayed in the main reception of the home. This provided information on the action to take if someone wished to make a complaint.

We found an effective quality assurance system operated. The service had been regularly reviewed through a range of internal and external audits. Prompt action had been taken to improve the service or put right any shortfalls they had found. We found people who used the service, their representatives and other healthcare professionals were regularly asked for their views.

Inspection carried out on 24, 26 and 27 February 2015 and 4, 5 and 6 March 2015

During a routine inspection

This inspection took place over six days on 24, 26 and 27 February and 4, 5 and 6 March 2015. This was an unannounced inspection, which meant that the staff and provider did not know that we would be visiting.

Redworth provides nursing and personal care for up to 57 service users. The home is arranged over two floors. The majority of people with dementia type illness were based on the first floor of the home. During our inspection on 24, 26 and 27 February and 4, 5 and 6 March 2015 there were 28 service users at the home, 16 of whom were accommodated on the first floor.

The provider is required to have a registered manager at this home as condition of their registration. 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. We found that the registered manager was no longer in post at the home. CQC records showed that the previous manager remained registered at the home even though they were no longer employed by the provider. We found the acting home manager and deputy manager had both worked at the home for approximately five months prior to our inspection. However on 4 March 2015, CQC had not received any applications for the registration of a new manager.

At our previous inspection carried out on 27,28 October and 5 November 2014 we found the home was in breach of the following:

Regulation 9, Care and welfare of service users,

Regulation 10, Assessing and Monitoring the quality of service provision,

Regulation 11, Safeguarding service users from abuse,

Regulation 12, Cleanliness and infection control,

The provider was issued with a formal Warning Notice in respect of each of these areas.

At this inspection we found that improvements had not been made to meet these requirements and Redworth was inadequate in all areas we inspected.

We looked at guidance for providers in dementia care including the following:-

  • The National Institute for Care Excellence (NICE) ‘Dementia Supporting people with dementia and their carer’s in health and social care 2006;

  • Alzheimer’s Society Fact Sheet 2013. Staying Involved and Active

  • The Health and Social Care Act 2008; Code of Practice on the prevention and control of infections and related guidance’ and

  • The NICE guidelines ‘Pressure ulcers: prevention and management of pressure ulcers 2014’

The provider had failed to take account of this guidance.

We found peoples care and welfare needs were not properly met at this home. People who had dementia care needs did not have them properly met. For example people who displayed behaviours which challenged staff or other service users because of their dementia type illness were not supported by staff in a consistent or well-planned way. Detailed intervention plans for when people became agitated were not in place and best practice guidelines to help avoid these circumstances were not considered. Medicines that had a sedative effect on people were found to be used in some circumstances to manage people’s behaviours, without guidance or sufficient agreed practice to safeguard and protect service users’ rights.

People were at risk of poor nursing care at the home. Nurses did not demonstrate that they had an understanding of peoples nursing care needs or were taking actions to meet them. For example some people were at risk of pressure skin damage but had had their pressure relieving equipment removed. In some cases this had resulted in people developing pressure ulcers.

Some people required support with their diet so that they could remain as healthy as possible. Care planning for these people was not sufficiently detailed to protect them from being at risk and some staff supporting them lacked training and experience which also placed them at risk of harm.

There was a lack of effective person centred care for people who had dementia type illness or nursing care needs. The acting manager confirmed that no specific model of dementia care had been adopted by the provider, to guide and inform best practice for example social, psychological, or a person centred approaches. This demonstrated that the provider had failed to follow good practice guidelines issued by NICE.

We found that no therapeutic activities took place which would provide interest or stimulation and help promote positive behaviour and improve service users’ wellbeing

Where people living at the home had been shown or suspected to have been subject to abuse, these had not been reported to the local safeguarding authority for consideration of investigation or to CQC for statutory notification that such an incident had occurred.

We found that people were not protected from the risk of infection. Furniture, equipment and surroundings of bedrooms and communal areas were not properly cleaned and there was poor odour control. We found that in a significant number of areas of the home appropriate standards of cleanliness and hygiene were not maintained. This demonstrated that cleaning had not been carried out effectively other procedures used at the home placed service users at risk of infection.

The provider did not cooperate effectively in partnership with other providers to ensure the safety welfare and wellbeing of people at the home was upheld. Mistakes were made where people did not receive pain relief.

Medication was not administered properly so some people had their medication for serious illnesses delayed for significant periods whilst others received too much and subsequently displayed the symptoms of an overdose.

The home was not well run, operational procedures were disorganised and oversight by the provider was ineffective. The provider did not effectively assess and monitor the quality of the home to make sure it was safe, effective and meeting the homes ‘Statement of Purpose’. The homes monthly audits with senior managers had not taken place since January 2015.Other areas of monitoring such as the frequency of accidents and incidents and the measures to reduce risks to people living at the home could also not be found. Other monitoring of the home had not been effective. For example, at the previous inspection we issued a warning notice about the poor cleanliness and infection control. At this inspection we found the measures to ensure the home was effectively cleaned had been unsuccessful however no monitoring had taken place and no remedial action had been taken to ensure standards of hygiene followed the prevention and control of infections Code of Practice and related guidance.

We found that the provider failed to make improvements to the quality and safety of services for people at the home. The provider did not take action following a CQC inspection on 27, 28 October and 5 November 2014 where the home was found to be in breach of four regulations and people using the service were found to be at risk despite Warning Notices being issued. The provider did not act in a timely fashion to achieve compliance, meet service users’ needs and adequately protect them from receiving poor care. We found the provider remained in breach of regulations which resulted in further enforcement action to be considered.

We found there were multiple of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and under the Care Act 2014

You can see what action we took at the back of the full version of this report.

Inspection carried out on 27,28 October and 5 November 2014

During an inspection to make sure that the improvements required had been made

This inspection took place on 27 and 28 October and 5 November 2014 and was unannounced.

Redworth provides care and accommodation for up to 57 people. The home is divided into four separate units. On the first floor there are three units, the first for up to 22 people with dementia care needs (there were 18 people accommodated there during our inspection), the second for up to six people who have a learning disability (there was one person living there at the time of our inspection) and the third for up to four people with intermediate care needs, whereby they were accommodated whilst they recovered following a period of illness or injury (there were two people in receipt of intermediate care during our visit). On the ground floor there is one unit for 25 people with nursing or ‘residential’ needs some of whom also have dementia (there were sixteen people accommodated there during our inspection).

The home had a registered manager 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 a service is run.

We found Redworth to be inadequate in all areas we inspected. We looked at guidance for providers in dementia care including the following:-

  • The National Institute for Care Excellence (NICE) ‘Dementia Supporting people with dementia and their carer’s in health and social care 2006;

  • Alzheimer’s Society Fact Sheet 2013. Staying Involved and Active

  • The Health and Social Care Act 2008; Code of Practice on the prevention and control of infections and related guidance’ and

  • The NICE guidelines ‘Pressure ulcers: prevention and management of pressure ulcers 2014’

The provider had failed to take account of this guidance.

We found people had access to other health care professionals. However, guidance from them was not always acted upon. For example; in one instance another health and social care professional had provided the care workers with information about a person’s care needs and associated risks. There was no evidence either from observations made by us of care practice or from the care records examined that the recommendations made had been carried out.

We found the home was not clean. There was a strong unpleasant odour throughout the first floor of the home. We found a number of mattresses and chairs were dirty and stained placing people at risk of cross infection. The environment had not been adapted to meet the needs of people with dementia to help promote their independence and well-being.

We examined the medication records and found on one occasion one person had been given the wrong amount of their prescribed medication. We also found that other people had not been given their prescribed medication because there was none available in the home. This placed services users at serious risk of harm.

The person in charge could not provide us with evidence to demonstrate that all safeguarding incidents had been reported to the Local Safeguarding Authority or to the Commission.

Risks to people’s care and welfare were not managed safely. For example, people at high risk of malnutrition were at risk because food and fluid charts were not being used properly to make sure people were eating and drinking enough. The care plans we looked at did not reflect how to manage peoples’ diverse needs, for example, how to support people who may, as a result of their dementia, become agitated.

We found there were enough staff on duty to meet people’s needs. However, the provider could not demonstrate that all staff had been provided with specialist training to meet the needs of the people in their care.

People living on the ground floor of the home told us they were treated with dignity and encouraged to be independent. However, for people with more advanced dementia care needs, this was not case. For example, for two days we heard a service user crying out from their room and did not observe staff at any time to attend to this person’s obvious distress. Although there were activities taking place for people on the ground floor of the home this was not the case for people with more advanced dementia care needs living on the first floor of the home. We saw no activities taking place over the two days of our inspection and there was very little on the first floor for people to do. Our observations of care practices, particularly on the first floor of the home, and the care plans we looked at, demonstrated people’s needs were not catered for in an individualised way.

We discussed the quality assurance systems in place with the regional manager and deputy manager. We were told regular audits were carried out of the care home which included the number of accidents and safeguarding incidents each month. However, there was no evidence of any action being taken to prevent these from happening again. We saw the audits carried out had failed to identify poor standards of care within the care home.

We found a number of breaches of the Health and social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we took at the back of the full version of the report.

Inspection carried out on 18 June 2013

During a routine inspection

As part of this scheduled inspection we followed up on two compliance actions set at the previous inspection in November 2012. We found improvements had been made in both of these areas.

The acting manager told us they were in the process of applying to become the registered manager at Redworth.

People told us they had been asked for their permission prior to receiving care or treatment.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People said they were happy with the care and support they received at Redworth. One person told us "I like it here. I’ve been here 2 years; I don’t think I’ll move from here.” Another person said “I haven’t got a complaint in the world.”

There was enough equipment to promote the independence and comfort of people who used the service. The acting manager told us the provider had contracts in place for the regular servicing and maintenance of equipment within the home. We saw records of maintenance and safety checks for the equipment used in the home to support this. We also saw records of other routine maintenance checks carried out within the home.

There were sufficient staff employed and deployed at the home to meet peoples' needs.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Comments about the staff and people’s experience of them included “You can’t fault them” and “They can’t do enough for you really.”

Inspection carried out on 22 November 2012

During a routine inspection

We used a number of different methods, for example observing how people were cared for, to help us understand the experiences of people who used the services. This was because we were unable to get people’s direct comments about the care they received.

People were given appropriate information regarding their care or treatment. We saw adjustments had been made within the home to help uphold and maintain the dignity and independence of people with dementia type illnesses who lived there.

People’s needs were assessed and care and treatment was planned, however there was a risk it was not always delivered in line with their individual care plans due to the deployment of staff.

The provider had a safeguarding policy and procedure in place. All of the staff we spoke with during the inspection were familiar with safeguarding procedures and knew how to respond to any allegations of abuse.

We found there were not enough qualified, skilled and experienced staff to meet people’s needs at all times.

The provider had a complaints policy and procedure and was able to demonstrate complaints and concerns raised had been investigated and resolved, as far as possible, to the satisfaction of the complainants.

Inspection carried out on 11 January 2012

During an inspection in response to concerns

Most people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how staff supported people and this was positive and respectful. We did not see any of the people who lived in the separate learning disability unit as they were all out as part of their daily activities.

We spoke with five people. Everyone we talked to spoke highly of the service. They said:

“You get well looked after”,

“It’s good here”,

“They found my dressing gown and it had been gone about six months!”,

“I enjoyed my dinner”,

“They have good food here” and

“I’ve been here two years, I like it here”.

We heard staff talking to people using their preferred name and people being asked questions about what they would like.

We heard staff saying:

“How would you like your tea” and

“Your hair looks lovely”.