25 August and 7 October 2015
During a routine inspection
We carried out an unannounced focussed inspection on 25 August 2015 in relation to information of concern we had received from other agencies; their concerns were that the service did not have adequate management. The manager subsequently appointed a consultancy company to oversee the management of the service. We continued to monitor the service and allowed time for the consultancy to establish their role in the home. We revisited the home to carry out a full comprehensive inspection on 7 October 2015.
This inspection follows our comprehensive inspection in February 2015 where we found the service Required Improvement in all areas. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Red House Nursing Home on our website at www.cqc.org.uk
The Red House Nursing Home provides accommodation for people requiring personal care and nursing care. The service can accommodate up to 25 people. At the time of our inspection there were 15 people using the service, of which nine required nursing care. The service provides nursing care to people that are living with dementia and enduring mental health and physical conditions.
There was a registered manager in post. 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.
There was a lack of consistent managerial and clinical leadership and oversight of the quality and safety of the care being provided.
The Registered Manager had been repeatedly absent from the home over the last few months due to understandable circumstances. They had not made provision for the day to day management of the home in their absence leaving staff at the home without clinical leadership and managerial guidance. This had led to a failure of all the systems that were designed to keep people safe. Records relating to all areas of the business were in disarray. People were at risk of missing health appointments as they did not always receive their correspondence.
The appointment of the consultants came at a time when most of the staff that knew people and understood their needs had left the service. The consultants had been given the managerial role without the adequate finances for repairs or control of the duty rota. Improvements to the service were starting to take effect, however we found areas for improvement that had not yet been identified.
The provider had failed to ensure that the home was maintained in a condition which protected the health and safety of people living in the home. Timely repairs had not been carried out even though they had been brought to the attention of the provider. People were at risk of infections as the mattresses that were not clean had not been replaced.
People had not always been properly assessed for their suitability to live at the home, as people had been admitted to the home without adequate staff skills or experience to meet their needs, in particular those with complex behaviour or mental health needs. There was a lack of stability of the staff group which had impacted on people receiving a continuity of care. Staff had not been supported to carry out their roles as they had not received adequate supervision.
People’s risks were not always being reviewed and plans to mitigate the risks were not recorded, leaving people without plans to prevent pressure ulcers or falls. People did not receive consistent care because the systems in place to assess their needs and to ensure that care was provided in line with their needs and preferences were disjointed.
People were at risk of not eating and drinking enough to maintain their health and well-being as staff did not carry out accurate risk assessments or refer people to health professionals in a timely way. Staff did not provide an environment that would promote eating or provide foods that were suitable for people’s needs or follow medical advice for fluid regimes.
People were at risk of being cared for by people who had not undergone the appropriate checks as the records were not able to demonstrate that the registered manager had carried these out. Not all staff had undergone checks with the Disclosure and Barring Service (DBS) in relation to their employment at the service. Not all staff had recruitment records that demonstrated their suitability to provide care.
People could not rely on staff responding to their complaints as staff did not adhere to their policy and the provider did not respond to people’s complaints.
We identified that the provider was in breach of seven of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3). We have commenced the process of cancelling the registration of the provider and Registered Manager.