About the service Geraint House is a residential care service providing personal care and accommodation to up to 11 people with mental health needs. At the time of our inspection there were 10 people using the service. Each person has a private bedroom with shared washroom and kitchen facilities separated across three floors. The care home has a dinning room, two lounges and a garden to the rear of the property.
People’s experience of using this service and what we found
People were not being supported to have their ‘as required’ prescribed medicines safely. The provider failed to ensure people were protected from harm or abuse and there was a lack of robust safeguarding systems in place. Risk was not adequately identified or monitored, resulting in unsafe fire evacuations and people’s individual needs not being met. Staff were not always recruited safely and lacked knowledge and training regarding specific health needs. The environment was worn and dirty. Infection prevention and control was poorly managed, and people were not kept safe from increased risk of contracting health infections such as COVID-19
People’s needs were poorly assessed and did not inform their care plan. Care plans for newly admitted people were not robust. The provider failed to ensure staff were trained and competent to fulfil their roles. Deprivation of Liberty Safeguards were poorly managed and did not inform people’s care plans. People’s dietary needs were not always considered or met. The provider worked alongside external professionals; however, health information was not always used to ensure peoples’ needs were met.
The provider had a significant lack of robust governance oversight and quality assurance systems in place to ensure quality of service. Care plan reviews were of poor quality and ineffective at improving care. The provider failed to adequately respond to concerns raised with them by the inspector during the inspection. People and staff had limited ability to provide feedback and input to the running of the service due to Meetings not always being held regularly in line with organisational policy. The provider failed to consistently notify the local authority and CQC when incidents or allegations of abuse were disclosed.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 14 February 2020).
Why we inspected
We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control (IPC) and staff COVID-19 vaccinations as a condition of deployment. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.
We inspected and found there was a concern with IPC risks and the use of potentially restrictive practices, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Effective and Well-led.
The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Geraint House on our website at www.cqc.org.uk.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We identified breeches in respect of people’s consent to receive care, their safe care and treatment, safeguarding people from abuse and improper treatment, the premises and equipment, the provider’s governance arrangements and staffing.
Please see the action we have told the provider to take at the end of this report.
We have sent the provider three warning notices to request improvements are made.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the provider’s 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.