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Archived: St Mary's Inadequate

Reports


Inspection carried out on 27 July 2017

During a routine inspection

We undertook an unannounced inspection of this service on 27 July and 2 and 9 August 2017.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a garden to the rear of the property. At the time of inspection there were 21 people living at the service.

This service did not have a registered manager in post. The previous registered manager left the service in April 2016. At the previous inspection the provider told us that they were in the process of appointing a new manager but this had not been done. A registered manager from the provider’s other location was supporting the service two days a week and there were two deputy managers in day to day charge of the service. The two deputy managers supported three inspectors during the first day of the inspection. A registered manager is a person who is 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 last inspected this service in January 2017. We found significant shortfalls and the service had an overall rating of requires improvement with an inadequate rating in the well led domain. The service had been rated ‘inadequate’ overall at our inspection in August 2016 and been placed in special measures. As the provider remained in breach of the regulations and there was a lack of leadership the service remained in special measures which required the provider to make improvements. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us information and records about actions taken to make improvements following our previous inspection.

At this inspection improvements had not been made and the provider had not complied with all of the requirement notices issued at the previous inspection in January 2017 and further breaches of the regulations were found at this inspection.

The provider had failed to comply with a condition we had applied to their registration requiring them to appoint a registered manager. Although some efforts had been made to register a manager and an application had been sent to CQC this was subsequently withdrawn.

The systems in place to audit the quality of the service were not effective. The provider had not ensured that the requirement notices issued at the previous inspection were complied with. There remained continuous breaches of 5 regulations and 6 further breaches of regulations were identified at this inspection.

Whistle blowers had contacted the Care Quality Commission to inform us that staff were getting people up in the dementia unit from 5 am onwards. We arrived at 7 am; four people were up in the dementia unit and two people were up in the residential unit. Action had not been taken to address this concern and to make sure people had the choice of when they wanted to get up.

People were not protected from harm as the provider had failed to take action to ensure people were safe and report safeguarding issues to the local authority.

Risks to people’s health when they fell were not being mitigated and there continued to be a lack of risk assessments to guide staff how to support people safely. People were at risk of choking however, detailed risk assessments were not in place to ensure that staff had information to support people with their meals and drinks.

People sometimes displayed behaviour that challenged and were at risk of harming themselves or others. The deputy manager had implemente

Inspection carried out on 3 October 2017

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

This inspection was carried out on 03 and 04 October 2017 and was unannounced.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover, with limited parking. Residential accommodation is situated over four floors which includes a separate dementia unit. The service also has its own chapel and a well maintained garden to the rear of the property. At the time of the inspection there were 15 people living at the service.

The service had not had a registered manager in post since April 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last inspected this service in July 2017. We found significant shortfalls and the service had an overall rating of Inadequate. CQC took urgent enforcement action to prevent the provider admitting any new people and to request regular action plans and updates about the required improvements. The provider failed to comply with this action and did not send action plans as requested. CQC has taken further action that we will publish in due course.

We received a number of concerns from whistle-blowers and others about people’s safety, care and well-being. As a result we undertook this focused inspection to look into those concerns.

Staff did not have a full awareness of the Mental Capacity Act and Deprivation of Liberty Safeguards as they had not recognised when people's liberty had been restricted. Action had not been taken since the last inspection to make sure people were not unlawfully restricted.

People’s health care needs were not consistently and effectively monitored to make sure they received specialist support when they needed it. When people had lost a large amount of weight they were not consistently referred to the relevant healthcare professionals to ensure people were receiving the professional advice they needed.

Staff had not received regular effective training, supervision and appraisals to support them in their role. The induction was not modelled on current recommended guidance. Agency staff who were used to cover shifts at short notice did not receive an induction into the service. Staff competency was not checked to make sure they were providing safe and effective care.

People were not always supported to have enough to eat and drink and to maintain a balanced diet. People were not involved in deciding what foods were on the menu. There was a lack of basic provisions to enable people to have choices about their meals. There was a lack of fresh vegetables. The stock of produce and ingredients in the stores, fridges and freezers was very low.

The provider had not appointed a registered manager to improve the leadership of the service. A consultant had been employed since August 2017 and they were supporting a trainee manager and a deputy manager. There was a lack of leadership and poor governance systems placing people at continued risk of receiving poor care.

The provider had not taken appropriate action to ensure the service was compliant with the regulations. The provider had not notified the local authority or CQC about two safeguarding incidents which had occurred.

Staff raised concerns with the management team throughout the inspection that they had not been paid correctly. Some staff had not turned up for their shift because they had not been paid. People, their relatives and staff views were not taken into account to continuously improve the service.

The systems for monitoring and checking the quality of care provided were not effective as the shortfalls found at this inspection had not been identified and actioned. Records were not cons

Inspection carried out on 10 January 2017

During a routine inspection

We undertook an unannounced inspection of this service on 10 and 11 January 2017

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a garden to the rear of the property. At the time of inspection there were 22 people living at the service.

This service did not have a registered manager in post. The previous registered manager left the service in April 2016. At the previous inspection the provider told us that they were in the process of appointing a new manager but this had not been done. A registered manager from the provider’s other location was supporting the service two days a week and there were two deputy managers in place. One deputy manager supported the inspectors on the first day of the inspection and the registered provider, and registered manager from the other location, together with the deputy manager assisted the inspector on the second day of the inspection. A registered manager is a person who is 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 last inspected this service in August 2016. We found significant shortfalls and the service was rated inadequate overall and placed into special measures. The provider had not complied with the warning notices issued at the previous inspection in February 2016 when the service was rated.

The provider had failed to comply with a condition we had applied to their registration requiring them to appoint a registered manager. There was a lack of risk assessments to guide staff how to mitigate risks when supporting people with their behaviour. There was a lack of hoists to ensure people were being moved safely. Suitable arrangements were not in place in the event of an emergency such as fire. People were not receiving their medicines safely and medicines were not being stored at the correct temperatures.

The provider had not acted in a timely manner to ensure the premises were as safe as possible. Applications to apply for authorisations to deprive people of their liberty in line with the Mental Capacity Act had not been applied for. Detailed assessments were not always thorough to ensure people’s care needs were identified and fully met. People were not being supported to follow their interests and take part in social activities of their choice. The registered provider had failed to take appropriate action to mitigate risks and improve the quality and safety of services. Records were not completed or accurate.

We took enforcement action, placed the service into special measures and required the provider to make improvements. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us information and records about actions taken to make improvements following our previous inspection. At this inspection we found that improvements had been made in many areas, however there remained areas where further improvements were required.

At this inspection the provider had failed to appoint a registered manager. Although the provider wrote to CQC in September 2016 to tell us their intention was for the registered manager of their other location to apply to be the registered manager of St Mary’s, no application had been received. The registered provider told us that they were continuing to advertise for the role but to date did not have any suitable candidates.

The systems in place to audit the quality of the service were not eff

Inspection carried out on 15 August 2016

During a routine inspection

We undertook an unannounced inspection of this service on 12 and 13 August 2016.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a well maintained garden to the rear of the property.

This service did not have a registered manager in post. The previous registered manager left the service in April 2016. The deputy manager has been acting manager since that time and assisted with the inspection. A registered manager is a person who is 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 inspection there were 22 people living at the service.

At the previous unannounced, comprehensive inspection of this service on 10 and 11 February 2016, a warning notice was served together with three requirement notices. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Although some improvements had been made the provider had not fully complied with the issues raised in the warning notice and one of the requirement notices. These shortfalls will be outlined in the report, together with the improvements made to the service.

There were areas of the premises that were still in need of repair. There was ongoing re-decoration and a plan in place, but progress was slow. Thermostatic valves or a system to regulate the water temperature had been installed, however; bathrooms had not been fitted with restrictors to make sure the risk of scalding was reduced.

The provider had carried out a legionella test which confirmed the water system was safe to use. The two electric pumps in the garden to manage waste water had been repaired and were working. Some windows had also been repaired, but others still remained closed and could not be opened as they needed new sashes to enable them to open safely. There were no timescales as to when this outstanding work would be carried out.

The uneven floor on the third floor had been repaired and new flooring was in the process of being fitted. The first floor shower room was still out of action. The first floor bathroom seat had been replaced and was in working order.

Checks on the fire system had been made on a regular basis and fire drills had been completed, but staff attending these drills had not been recorded to ensure that all staff were included and were fully aware of fire procedures. The personal evacuation plans for each person had been reviewed but there was no information on people’s behaviour or mobility to show how they could be supported to evacuate the premises in the event of a fire.

Equipment to support people with their mobility had been serviced to ensure that it was safe to use. However, during the previous inspection staff had identified that the service required an additional hoist. Staff asked the provider to purchase a new hoist in 2015 but this request had not been actioned at the time of the inspection The provider visited the service weekly and was aware of these issues, but progress to improve the environment and equipment was slow.

There were eight people who needed assistance to move with a hoist and several people who were using bed rails to reduce the risk of falls. The acting manager told us that they had not been assessed by health care professional to ensure the right equipment was in place and people were being moved as safely as possible.

Inspection carried out on 10 February 2016

During a routine inspection

We undertook an unannounced inspection of this service on 10 and 11 February 2016.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a well maintained garden to the rear of the property.

This service had a registered manager in post. A registered manager is a person who is 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 inspection there were 23 people living at the service.

The premises was in need of repair and redecoration, and in some areas required action to be taken immediately to ensure that people were safe living at the service. Thermostatic valves or a system to regulate the water temperature was not in place to reduce the risk of scalding, and the electrical wiring safety certificate had expired. It was also identified on the previous legionella test in October 2015 that there was an issue with the water, which had not been monitored or risk assessed. There were two electric pumps in the garden to manage waste water and these had stopped working. Some windows had been repaired but there were others which could not be opened.

Equipment to support people with their mobility had been serviced to ensure that it was safe to use, and plans were in place in the event of an emergency. However, staff had identified that people required access to an additional hoist. The provider was requested to purchase a new hoist, but this request had not been actioned at the time of the inspection.

The majority of these issues had been highlighted in the quality assurance checks made by the registered manager, but the provider had not acted in a timely manner to improve the service, and make sure the premises were safe for people to live in.

Although people’s rooms were checked to look for health and safety issues, there were no environmental risk assessments in place to make sure all areas of the service were as safe as possible. There was an uneven floor on the third floor in need of repair, and there was no risk assessment in place to ensure staff and people were aware of this hazard.

The first floor shower room was leaking and was out of action, together with the first floor bathroom, as the bath seat had broken.

Checks on the fire system had been made on a regular basis and fire drills had been completed, but staff attending these drills had not been recorded to ensure that all staff were included, to ensure they had a clear understanding of what action to take in the event of a fire.

Accidents and incidents were recorded and appropriate action had been taken to look for patterns or trends, to prevent further occurrences.

There were not always enough staff deployed to ensure that people received care and support in an effective and timely manner. People told us they had to wait for staff to respond to their call bells.

Recruitment processes did not fully meet the requirements of the regulations because prospective staff’s conduct at their previous employment had not been verified, and there were gaps in employment histories, which had not been discussed.

Staff told us that they were provided with training but records showed updates of training were overdue for some staff. This could place people at risk of experiencing support that was not current or best practice. The registered manager had carried out an audit of the training required to ensure that staff received the relevant training, and was in the process of arranging for the shortfalls to be addressed.

Staff received individual

Inspection carried out on 21 February 2014

During a routine inspection

Our inspection of 24 September 2013 found that improvements were needed to ensure that people were being appropriately supported with their nutrition and hydration. We also found that some staff members did not have the skills and competencies to fully meet people’s needs. There were shortfalls in the staff training programme to make sure staff had the skills to deliver care and treatment safely and to an appropriate standard.

During this inspection we found that improvements had been made and the provider was compliant.

We spoke with the manager and three senior staff and two other members of staff. We also spoke with ten people using the service and one relative. We found that overall people were satisfied with the service. A relative commented: “The care is generally good, the staff are very caring”.

We found that since the last inspection the staff training programme including induction training had been reviewed and implemented. The training plan was on-going and staff had completed training in moving and handling and various other core subjects. Staff had been supervised and appraised to make sure they had the opportunity to develop their skills to carry out their role.

We found that the chairs in the dementia unit were soiled especially on the arm rests. We were told by the manager that the provider had agreed to replace the chairs and this would be done in the near future.

At the time of our inspection the provider did not have a registered manager in post.

Inspection carried out on 24 September 2013

During a routine inspection

People told us they were mostly satisfied with their care. They said: “I suppose I am satisfied”. “The care is passable". "The care is satisfactory”. Relatives said that they found the staff obliging and professional. Some staff felt the atmosphere at the service was friendly and they would recommend the service.

People told us that the quality of food varied and they felt it had improved during the last few weeks. We found that some people were not being routinely asked their choice and they were not involved in menu planning. We observed that people were not receiving drinks throughout the day to make sure they had enough to drink and did not become dehydrated.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

People and staff told us that the staffing levels in the service could be improved. They said there were times when the service was short staffed and they had to wait for staff to answer their calls for support. We found that there was a training programme in place but some training needed to be updated and there was a lack of induction training for new staff.

Inspection carried out on 18 April 2013

During a routine inspection

We made an unannounced visit to the service and spoke with people who used the service, the manager and to staff members. There were 34 people using the service and we met and spoke with some of them and with some visiting relatives. Everyone we spoke with said that they were satisfied with the service being provided.

People told us they were happy with their care and supported. They said that the staff were kind and caring. People said “I can do what I like here; the staff are good and help me with what I need". People’s health needs were supported and the service worked closely with other health and social care professionals to maintain and improve people’s health and well being.

There were systems in place to check that the service was being effectively managed. People told us that did not have any complaints but would speak to a member of staff if they had any concerns.

Inspection carried out on 7, 11 March 2013

During a routine inspection

We found that the provider had not made the improvements required from our inspection of 8 August 2012. The timescales in the action plan dated 28 September 2012 had not been met. The service had made some improvements to people's personalised records as ten of the thirty six care plans had been re-written and updated. There were shortfalls in the quality assurance system and some records were inaccurate, missing and not stored securely. Further improvements were therefore required before compliance will be achieved.

People told us that residents meetings had not been held and they had not received a survey to ask them their views about the service. They said they did not have any complaints and were satisfied with the care being provided.

People told us the staff were polite, friendly and caring. They said that that sometimes they had to wait to get the support that they needed from staff.

People said: "One day the staff were so busy I did not get my breakfast till 09.45". "I can not speak highly enough about the staff, but there is really too much for them to do", People said the staff worked really hard but felt there was not always enough staff on duty. Staff told us that at times they were very busy and they could do with more staff on duty. They said the provider had agreed that staffing levels would increase to address the shortfalls.

Inspection carried out on 8 August 2012

During a routine inspection

Some of the people living in the home were unable to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us

A few people told us that they liked the home and the staff were polite and respectful.

Relatives were satisfied with the service and would recommend the home. They said that the staff were polite, respectful and caring and there was usually enough staff.

There were mixed views from the staff with regard to the staffing levels. Some felt there was not enough staff on duty at certain times while others thought they could cope but they were always busy.

Relatives told us that they were involved with the care of their relative, however care plans did not reflect the individual and personalised care being provided and did not show how risk would be managed.