Background to this inspection
Updated
3 June 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This was an unannounced inspection which took place on 27 April 2017. The inspection team consisted of three inspectors and a nurse specialist.
We received anonymous concerns prior to the inspection about the quality of care that people received. Before the inspection we reviewed the information we had about the service. This included information sent to us by the provider, about the staff and the people who used the service. We reviewed notifications sent to us about significant events at the service. A notification is information about important events which the provider is required to tell us about by law.
During the visit we spoke with the registered manager and the provider, five people, six members of staff and two visitors. We looked at a sample of four people’s care records, medicine administration records and supervision records for staff. We looked at records that related to the management of the service which included minutes of staff meetings and audits of the service.
After the inspection we spoke with one health care professional and one relative of a person that lived in the service.
Updated
3 June 2017
This inspection was carried out on 27 April 2017. Chaldon Rise Nursing provides long term care and support for up to 34 older people some of whom have dementia, a mental health diagnosis, physical disability or learning disability. Short term placements are offered to provide respite care. At the time of our inspection there were 25 people living at the service.
There was a registered manager in post and present on the day of the inspection. 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.
At the previous inspection we identified a breach in regulation 11. People’s consent was not always being gained before care was delivered. The provider sent us an action planned to say that this had been addressed however on this inspection we still found concerns.
People's consent was not always being gained in relation to the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS). These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect them from harm. Assessments had not been completed specific to the decision that needed to be made around people's capacity. DoLS applications had been submitted to the local authority where it may have been appropriate however people’s capacity had not been assessed before they were submitted.
There were not always enough staff deployed in the service provide safe care to people. There was not enough information to guide staff in how to reduce the risks to people. Incidents and accidents were not always followed up and actions were not always put in place to reduce the risk of incidents. Despite people stating that they felt safe they were not always protected from the risk of abuse. Safe recruitment practices were not always followed. The cleanliness of the premises and equipment was not well maintained which put people at risk.
People were not always receiving care from staff that were competent, skilled and experienced. There was a risk that people were receiving care from staff who were had not had training to meet the needs of people living with dementia, mental health and other health care needs. Staff competencies were not assessed as they did not always have appropriate supervision or appraisals.
People were not always provided with choices that met their reasonable preferences at meal times. People were not always treated with dignity and respect in relation to the care that they received. We did see times when staff were caring and considerate to people. People told us that staff were kind towards them.
The provider was not always responsive to people's needs. There was a lack of pre-admission assessments before people moved in which should have identified that the service could not meet their needs. There were also other people at the service whose needs could not be met. There was a lack of detailed information in some people's care plans around the support they needed. However in other care plans there was guidance for staff and staff received the appropriate care in relation to this.
There were not enough activities on offer specific to the needs of people. There were periods of time where people had no meaningful engagement with staff. People did not always have the opportunity to go out.
There were not effective systems in place to assess and monitor the quality of the service. Although an audit had been undertaken this had not been used to improve the quality of care for people. People were not given opportunities to be involved the in the running of the service or provide feedback to improve the quality of care.
People's medicines were being managed in a safe way however staff had not always been competency assessed in medicine management.
Personal evacuation plans were in place for every person who lived at the service and staff had received fire safety training. People at risk of dehydration or malnutrition had systems in place to support them however records that related to recording what people had eaten and drunk were not always maintained. People had access to health care professionals to support them with their health needs.
There was a complaints procedure in place. Where complaints had been received these were investigated thoroughly.
Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The provider had informed the CQC of significant events.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service therefore has been placed in 'Special measures'.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.
This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.