Archived: Western Rise

Updated 13 October 2016

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 was 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. The planned inspection was bought forward because we had received concerns.

This inspection took place on 4 February 2016 and was unannounced. Two inspectors arrived at the home at 6.30am and were joined by another two inspectors at 9am. The inspectors were in the home until approximately 6.30pm.

Before the inspection we had received concerns relating to the health and welfare of people using the service. We reviewed information we held about the registered provider. This included information from previous inspections and notifications (about events and incidents in the home) sent to us by the provider.

We went into all rooms and areas in the home. We spoke, met with or saw everyone living at Western Rise. We spoke with the registered provider, the deputy manager, acting manager, all care and ancillary staff on duty, and with two visiting health care professionals.

We observed the interactions between staff and people living at the home and reviewed a number of records. The records we looked at included seven people’s care records, the provider’s quality assurance system, training, accident and incident reports, four staff recruitment records, records relating to medicine administration and staffing rotas.

Updated 13 October 2016

Western Rise is registered to provide accommodation with personal care for up to 37 people. People living at Western Rise had a range of needs. Some people were older, some younger, some were living with dementia and some needed help with their physical needs. The majority had mental health needs, some of which were complex. On the day of the inspection there were 28 people living there.

This inspection took place on 4 February 2016. We brought a planned inspection forward because we had received concerns about people’s health and welfare.

The service was last inspected on 9 January 2015, when it was rated as ‘Good’. Prior to this, the home had a history of not being able to maintain the standard of care provided to people.

This inspection took place as a result of concerns CQC received relating to the staff attitude, cleanliness and the care and welfare of people living at the service.

The registered manager for Western Rise had recently left. As a consequence there was no manager registered for the service. It is a condition of the registration for the service that a manager is registered. A registered manager is a person who has registered with the Care Quality Commission 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.

Alternative management arrangements had been made. These arrangements were not robust and risks and quality issues identified during this inspection had not been identified by the management team. Action had not been taken to ensure people received a safe, effective, responsive and caring service. Although staff were well intentioned, they were working without clear leadership, direction or co-ordination. Staff talked about tasks that needed to be done and kept records relating to these. However, no one staff member had overarching responsibility for ensuring that people’s needs were met, and met in a personalised way.

The majority of staff were not trained in safeguarding people and did not understand whistleblowing procedures. Staff had not escalated concerns to the registered provider when action had not been taken to ensure people were safe. Recruitment of staff was not robust enough to ensure people of good character were employed.

Risks to people’s physical and mental health were not assessed or understood. As a consequence people were at risk of developing pressure sores, of becoming unwell because staff did not know about risks associated with their fluid intake, and at risk of not getting their medicines. Some people had mental health issues which were distressing to the person, and this distress was not managed. This was also distressing for others around them, and this was not managed.

There were sufficient staff on duty during the day, although we have asked the registered provider to review the staffing between 0630 and 0800am. However, staff did not receive the training or support they needed to meet their responsibilities, and to support people effectively.

The home was not clean and not well maintained. There was a strong smell of urine throughout the home and some toilets were dirty. Carpets were stained and many had significant burn marks. Parts of the home smelt of smoke. Some people were smoking in their room. One of these people had been assessed as not being safe to smoke without supervision. However, this person was smoking on their own. Fire checks had not been carried out since October 2015 and some fire doors did not close. We have shared this information with the local fire authority.

People did not always have their choice promoted. Many people were deprived of their liberty but staff did not know who had legal authorisations in place, and who didn’t. The front door, porch door, door to the kitchen and door to the lower floor had key pad locks on them. Only staff knew the numbers to these doors. All staff carried a master key which they could use to go into all the bedrooms. Staff had a poor understanding of the Mental Capacity Act (2005) and when making decisions for people, were not doing this in accordance with this law.

Staff made referrals to health care professionals. However, they did not always follow the recommendations provided. For example, one person had been prescribed nutritional supplements and staff were not monitoring to ensure this person took these. This person was losing weight.

People did not always have their privacy and dignity promoted. We sat that one person was calling out whilst being hoisted in the middle of a busy lounge. Staff did not respond to this person’s distress, or make attempts to protect their dignity. Distressed people, or people making requests, were sometimes ignored. People were not supported to maintain their independence or to develop new skills, and were not involved in planning their care. They spent much of their time sitting in the home. Many people said they would like to go out or do something, but there were no opportunities for this. There was a card making activity during our inspection, but people living at Western Rise said this type of activity was unusual.

Care plans did not contain information for staff on how to prevent behaviours which might challenge, or any specific information on what might help a person to be reassured or engaged. Some people told us about the small things that made them happy, but that these weren’t available to them. These included going for a walk .

People’s monies were well managed and kept safely.

We found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one breach of the Care Quality Commission (Registration) Regulations 2009 (Part 4). We have also recommended the registered provider keep the staffing levels under review.

We have shared our concerns with commissioners, with the safeguarding team and with the local fire authority. People’s care needs are currently being reviewed by the local authority commissioners.

We are taking further action in relation to this provider and will report on this when it is completed. The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action.