Background to this inspection
Updated
12 July 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was completed by 3 inspectors and 1 Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
John Masefield House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. John Masefield is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We reviewed the action plan the provider had sent after the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 14 people who used the service and 9 relatives about their experience of the care provided. We spoke with 10 members of staff including, the operations manager, registered manager, nurses, team leaders, support workers and the chef.
We reviewed a range of records. This included 9 people's care records and multiple medication records. We looked at 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
Updated
12 July 2023
About the service
John Masefield House is a residential care home providing accommodation for persons who require nursing and personal care for up to 22 people in a single storey building. The service provides support to adults with a physical disability. At the time of our inspection there were 19 people living at the home.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
At the time of the inspection, the location did not care for or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
People’s experience of using this service and what we found
Right Support
Staff did not always have the information required to provide safe and effective care. Care plans and risk assessments did not always contain relevant, up to date information within them.
People were supported safely with most medicines. Topical medicines such as creams were not always applied as directed.
People were supported by staff who had been safely recruited. The provider completed police checks and gained references for staff prior to them starting work.
Staff received an induction before working with people.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Right Care
Risks to people had not always been mitigated. We found concerns with risk associated with health conditions, including risks from pressure damage, choking and moving and handling.
Not all staff had received the appropriate training to understand people's individual needs, such as people with a learning disability and/or autistic people.
Right Culture
The leadership and management of the service had been inconsistent with frequent changes leading to inconsistency in support and practices in the home. People and their relatives were concerned about this and the impact on those living in the home.
Systems and processes were not always effective in ensuring the registered manager and provider had effective oversight of the service.
Systems were in place to gain feedback from people, relatives, and staff.
The provider responded to requests for information during the inspection and implemented measures where concerns had been identified to improve the safety and quality of the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 1 September 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection. The inspection was also prompted in part due to concerns received about the management of the service.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for John Masefield House on our website at www.cqc.org.uk.
Enforcement and recommendation
We have identified breaches in relation to safe care and treatment, person centred care, staffing and good governance at this inspection.
We have made a recommendation about specific training requirements.
Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will ask for an action plan and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Special Measures
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 act 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 to 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.