28 and 29 January 2015.
During a routine inspection
This inspection took place on 28 and 29 January 2015. The inspection was unannounced.
We had found breaches in the Health and Social Act 2008 at the past two inspections of this service. We last inspected this service in April 2014. At that time we found improvements had been made but that the service remained in breach of the Health and Social Care Act 2008 and we found evidence that people’s needs were not consistently being met. We did not find that people’s care and welfare needs were being met, people were not being safe guarded from the risk of abuse, medicines were not being well managed, staff were not being adequately supported and the systems in place to assess and monitor the quality of the service were not effective.
Carpenter Place provides personal care and accommodation to up to 32 older people who may also have a learning disability, dementia or a physical disability. At the time of our inspection 32 people were living at the home. All of the people had small self-contained flats within the home and had access to shared lounges, dining rooms, and assisted bathrooms.
The service should have a registered manager in post. At the time of our inspection a manager had been recruited but was not on duty during the inspection. Following the inspection we were informed that the person had resigned from this position. The provider informed us of the interim management arrangements in place to cover this vacancy. 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 did not find that people were being adequately protected from the risk of abuse and the risk of harm. Our observations and feedback from people living and working at Carpenter Place did not provide evidence that people always had access to the staff support they needed to meet their needs or to stay safe.
People needed staff to manage their medicines. We found that the medicines were not always being administered as prescribed. One person whose care we followed in detail had not received the medicines they needed for four days as the supply had run out. This had resulted in the person experiencing an unpleasant symptom which could have been reduced or avoided if action had been taken by the provider.
People had been supported to see the doctor when they experienced ill health. Changes in people’s health and support needs were not always well documented and did not always result in a review of the person’s needs. People had not been offered opportunities to meet their wider healthcare needs such as eye care, dental care and foot care. People had not been supported to maintain their personal hygiene and care needs.
The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. We looked at the work undertaken by the service to ensure people had been assessed and the necessary applications made to the supervisory body. We found that numerous people were experiencing restrictions to their liberty but that these had not been identified as such and no applications had been made. Two applications had been made and neither staff, manager’s nor records were able to identify who these were for or what restrictions had been agreed for people. This showed the service was not complying with the requirements of the MCA 2005.
People told us that in recent months the food had improved, however we did not find that people always had a pleasant meal time experience. People were not always given the support they needed to eat. The organisation of the meal times meant people did not always get to enjoy hot food, and on occasions cutlery or comfortable seating was not available.
We saw many interactions between staff and people living at the home which were compassionate and caring. People gave us mixed feedback about the staff, some people told us staff were kind and did all they could to help them, others told us staff made them feel worthless and did not support them to meet their needs.
We found that some arrangements had been made to provide people with interesting things to do each day. Some people liked the arrangements and some people told us the activities were not suited to their interests and needs. People were encouraged to maintain their independence and to access the local community if they were able, and to maintain relationships with their family and friends.
There was a system to respond to concerns and complaints and we found this varied in effectiveness. Some people had raised concerns that had been investigated well, recorded and the matter of concern had been addressed and changes made. Other people had not experienced this and were frustrated that issues of concern had not been resolved.
The management and leadership of the home had not been effective and people did not consistently experience a safe, good quality service. There were audits and checks in place but these had failed to identify all of the issues of concern. The provider’s action planning in response to audits had failed to drive up standards and to secure the level of service that people needed or should have been able to expect.
You can see what action we told the provider to take at the back of the full version of the report.