About the service Russell Court is a residential care home providing personal and nursing care up to 42 people. As part of the local area’s response to the COVID-19 pandemic, the service had agreed with a local hospital to reserve 21 of the care home beds for people recently discharged from hospital. People went into isolation in their rooms on arrival to the home, due to risks associated with COVID-19. Some people were recovering from COVID-19 and following a hospital stay.
There was a quick turnaround of people staying at the home, with some people staying for a short period of a number of days or weeks. On the first day of our inspection, the service was supporting 23 people and on the second day of our inspection six days later, the service was supporting 30 people. Two people lived at the home on a longer-term basis.
People were accommodated in one building that had been adapted to provide designated areas for people with and without COVID-19, to help reduce the spread of infection. People who joined the service with a positive COVID-19 test were cared for in a separate wing which was designated for people with COVID-19 to reside in. There were additional wings and areas of the home designated to care for people who did not have COVID-19.
People’s experience of using this service and what we found
We identified a breach in relation to safe care and treatment because people’s risks were poorly assessed and we found widespread, significant concerns as to how the service managed people’s medicines and the risks associated with COVID-19. Incidents were not learned from to help improve the safety of the service. Though we saw staff were aware of safeguarding concerns being referred to the local authority, not all staff had received safeguarding training and not all staff understood their responsibilities in protecting people from abuse. Feedback indicated there were enough staff to meet people’s needs and on the whole, recruitment processes were safe. We asked the provider to immediately address shortfalls where they posed risk of harm to people. Although the provider gave us assurances they would do so after the first day of our inspection, our second site visit six days later found continued shortfalls in this area and additional ways that people and staff were being exposed to risk of significant harm. The provider could not demonstrate that people’s risks were consistently well managed. However, we saw some examples of how people’s risks and needs were responded to appropriately.
We identified a second breach of the regulations due to the provider’s poor systems and oversight of the quality and safety of the service. Despite the provider’s role in the local response to the pandemic and supporting people with COVID-19, they had not ensured their service was fit for purpose to safely meet people’s needs and manage infection risks. We needed to ask for immediate concerns around infection control to be addressed. We saw additional widespread concerns in relation to care planning to meet people’s individual needs and wishes. At the time of the inspection, relatives described the service’s communication as poor and we found there were no systems in use to effectively gather feedback to improve the quality of the service or to help inform person-centred care. The provider understood their regulatory requirements. The provider acknowledged our concerns and after our inspection, decided to suspend further admissions to the home whilst they addressed concerns with input and support from the local authority.
Staff told us they felt supported and welcomed recent improvements to the home. However, the provider’s training plans had not been maintained to ensure all staff received the training and supervision required for their roles. Poor quality care records, combined with staff training gaps, did not give us assurance that people’s needs could be effectively met at all times. Care staff and nurses described good communication with one another, for example to escalate if someone became unwell, and staff did show understanding of action they should take if people’s needs changed.
People were supported to have maximum choice and control of their lives and staff were supporting people in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support best practice and the new manager had identified further improvements were required in this area.
Feedback we received indicated people were offered enough to eat and drink, though systems did not ensure people’s feedback and preferences were always captured. We saw concerns as to how people’s dietary needs were responded to and prompted for improvements to be made to how this was monitored. Relatives and staff spoke positively about the premises.
We saw caring and warm staff interactions towards people, which was reflected in compliments the service received. Improvements were required to ensure people’s dignity and respect were always promoted, though staff gave us examples of how they tried to achieve this. Care planning processes did not always ensure people were well treated or to involve people in discussions about their care as far as possible. This meant people’s needs around equality and diversity, and gaining more independence, were not always explored as far as possible.
People were generally satisfied with the service provided yet their focus was on recovering and returning home. We found not enough was done to ensure people’s individual needs were understood and met as far as possible, and we found multiple examples of inconsistencies and insufficient guidance within people’s care records. This included key risks and decisions and put people at risk of poor care and experiences, and limited information within people’s end of life care plans. This was recognised by the provider and we were told immediate improvements were underway.
An activity coordinator had been recruited to help improve access to activities, due in part to the majority of people self-isolating at the time of the inspection. We were told most people had their own pastimes and ways of keeping in touch with loved ones, however the service had not ensured this was a consistent experience for all.
Complaints processes were not used effectively to help improve the quality of the service. Feedback we received indicated people and relatives were not all familiar with the complaints process.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 23 March 2020 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns we received from the local authority about how people’s needs were being met. A decision was made for us to inspect and examine those risks. We also 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 coronavirus and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the full report for more information. You can see what action we have asked the provider to take at the end of this full report. We raised our concerns with the provider through our inspection and enforcement processes and received assurance that the concerns were acknowledged, and improvements were underway.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment and good governance. 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 continue to monitor information we receive about the service moving forwards until we return to visit as per our re-inspection programme. This includes working with the local authority to monitor progress. If we receive any concerning information we may inspect sooner.
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 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.