The Care Quality Commission (CQC) has taken action to protect people living at Levanto Residential Care Home in Paignton, Devon, following inspections in June.
Levanto Residential Care Home is a residential care home providing personal care to up to 20 older people some living with dementia.
CQC carried out an unannounced comprehensive inspection due to concerns received about the safety and quality of care people received. This included safeguarding, complaints, staffing, infection control, nutrition, record keeping and the leadership of the service.
Following the inspection, the overall rating for the service deteriorated from good to inadequate and it was placed in special measures. Safe, effective, caring, responsive, safe, and well-led have moved down from good to inadequate.
During the inspection CQC raised concerns with the local authority safeguarding team in relation to 11 people, and about the service as a whole. Inspectors also shared concerns with the police and other agencies. The local authority responded by initiating a large-scale safeguarding adults enquiry.
Deanna Westwood, CQC director of operations, said:
“What we found at Levanto Residential Care Home were people living in unacceptable conditions and staff working in a toxic culture.
“It was distressing the way people were made to feel in a place that was supposed to be their home. We saw some staff who were physically and verbally abusive to people. Our team witnessed a person stand up repeatedly only to be told to sit down every time, and on three occasions they were physically pushed back into their chair with force. We also heard the unkind way that some staff spoke about people, telling our inspectors that people were ‘naughty’ and ‘nasty’. Relatives also told us staff had shouted at their loved ones, who had also told them staff weren’t very nice to them.
“Staff locked peoples' bedroom doors during the days, decided where people could spend their time and they weren’t given a choice of food at mealtimes. Staff made decisions for them with no consideration to what people wanted.
“These vulnerable people were relying on all staff members to act as their advocates, to help them live their best lives and it is unacceptable the people they relied on were treating them this way.
“Some staff did try to speak up but, weren’t listened to by management. Incidents weren’t investigated thoroughly, and confidentiality wasn’t maintained. One staff member told us they had confidentially raised concerns about a colleague with the registered manager who then told their colleague what they had said. This led to an argument where the colleague shouted and swore at them in front of people living at the service. This made them fearful of raising any further concerns.
“I want to praise those staff who were then brave enough to come forward to tell us anonymously what was happening, despite being made to feel intimidated. confidential concerns were shared with staff members rather than being addressed which enabled them to indulge in further intimidating behaviour. Management need to address this toxic, bullying, culture immediately.
“We’re deeply concerned that if this behaviour towards people was happening when we were on the premises, it may have been worse when we weren’t there. Because of this we’ve raised safeguarding alerts about individual people living in the service and the service as a whole. We’ve also shared our concerns with the police and other agencies. During the course of this inspection, several staff members disclosed they had witnessed staff inflict physical and verbal abuse upon people
“We are aware the local authority is now carrying out a large-scale safeguarding adults enquiry.
“People’s safety was a serious concern. We found a staff member with a negative reference working there, where no discussion had taken place to address any issues, and there was no evidence that in some case DBS checks had been carried out.
“People were losing a lot of weight with one person losing over 40kg in the past two years, which was almost half their body weight and another 8.7kg in the past six months. The lack of escalation to health professionals was putting people at risk of malnutrition.
“Following on from this inspection we received further safeguarding concerns and returned to Levanto Residential Care Home in July, we will publish our findings once we have completed our publication process and are actively considering what further action we may want to take as a result of that inspection. In the meantime, we will continue to monitor the service closely.”
Inspectors found the following during this inspection:
- Processes in place did not protect people from abuse. Several staff members had raised concerns about abusive and neglectful practice with the registered manager, verbally, in writing, and by whistleblowing to CQC. The registered manager failed to effectively investigate these concerns, and dismissed them as 'staff falling out', despite some of the concerns alleging physical and emotional abuse
- The service did not identify or recognise where people were subject to abusive or degrading treatment or where incidents between people were a safeguarding concern
- The service did not work in partnership with organisations. In some cases, staff worked in direct opposition to the advice given by healthcare professionals
- Staff spoke unkindly about people. One staff member told inspectors a person living with dementia was "naughty" and referred to them as "the nasty little one". A second staff member said this person was, "A nasty little [gender]"
- One person's care plan said their fluid intake should be restricted for medical reasons. Despite this being clearly recorded in both their care plan and hospital discharge record, staff did not monitor their fluid
- Several staff members told inspectors that one person choked and coughed when drinking. Their care plan did not contain any information about thickening their fluids to reduce the risk of choking or aspirating. When inspectors asked staff if they thickened this person's drinks, some said they did, and others didn't. Health professionals told CQC the person had been assessed as requiring thickened drinks in September 2020. However, the service had never ordered the prescribed thickener from the pharmacy
- The risk of the spread of infection was not well managed because good infection control practice was not being followed. Staff had not completed any training in relation to Covid-19. People were being supported to have visitors and inspectors observed people visiting during the inspection. This had not, however, been communicated to all family members and one person's relative said they were frustrated they could not visit
- Inspectors observed two people in their bedrooms for long periods of time with no drinks within reach
- Peoples' care plans were task focussed and contained limited information about peoples' personal preferences. People and their families were not supported to be involved in their care planning or express their views. One family member said, "One carer told me off for giving my relative chocolate marzipan. I thought that it was rude and that she was treating me like a child"
- Inspectors observed one staff member return from assisting a person in the toilet still wearing their gloves. They proceeded to assist the person to transfer without removing them
- Inspectors had previously raised concerns with the registered manager/provider but, the registered manager focussed on trying to identify who had contacted CQC and assumed complaints were malicious. Responses included, "We had been trying to wrack our brains as to who would be so nasty as to make the complaint." In response to one concern the registered manager said, "Any in-house complaint would be investigated by management." At this inspection it was found this not to be the case.