Background to this inspection
Updated
19 January 2019
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 is 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.
This inspection took place on 16, 17 October and 13 November 2018 and was unannounced. We completed the third day of inspection as we received further concerns following our initial visit about the quality of care provided and staffing levels within the service. The inspection team consisted of three inspectors, an assistant inspector and an 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.
As part of the inspection we reviewed the information we held about the service. We looked to see if statutory notifications had been sent by the provider. A statutory notification contains information about important events which the provider is required to send to us by law. We sought information and views from the local authority. We also reviewed information that had been sent to us by the public. We used this information to help us plan our inspection.
During the inspection we spoke with 11 people who used the service and four relatives. We spoke with the registered manager who is also the provider. A new manager was in post during the first two days of the inspection who we spoke with. They were no longer in post when we returned for our final day of inspection. We spoke with two health and social care professionals and 17 members of staff including the cook, care staff and two senior care staff who were acting deputy managers. We carried out observations across the service regarding the quality of care people received. We reviewed records relating to people’s medicines, 13 people’s care records and records relating to the management of the service; including recruitment records, complaints and quality assurance records.
Updated
19 January 2019
This inspection took place on 16, 17 October and 13 November 2018. At the last inspection completed in June 2018 we found the service was rated as ‘requires improvement’. They were not meeting the regulation around effectively managing and governing the service. The service left special measures due to the improvements identified during that inspection. At this inspection we found the provider had failed to sustain and continue making improvements. The quality and safety of care provided to people had deteriorated significantly. They continued to fail to meet the regulation around effectively managing and governing the service and we identified further breaches of regulation. The service re-entered special measures.
Angel Court Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 25 older people. At the time of the inspection there were 23 people living at the service, many of whom were living with dementia.
People were not protected from the ongoing risk of potential abuse. The provider had failed to ensure robust systems were in place to identify potential abuse, ensure it was reported and investigate the concerns. The provider had failed to ensure robust plans were in place to protect people from further harm. People were also exposed to the risk of harm due to the provider’s failure to ensure their risk management processes were robust. People did not always receive topical creams as prescribed. People were also not protected by effective processes to control the risk of infection.
People were not supported by sufficient numbers of suitably trained, experienced care staff. The provider had failed to ensure training and supervision was effective and equipped staff with the skills they required to support people.
People’s human rights were not upheld by the effective use of the Mental Capacity Act 2005. People’s day to day health needs were not always met and instructions given by healthcare professionals were not always followed. People’s nutritional needs were not always fully understood and monitored by care staff.
People were not supported in a caring, dignified and respectful way. People’s independence was not always promoted. Effective systems were not in place to ensure people were communicated with effectively and given maximum choice and control.
People were not always fully involved in the development of their care plans. People’s needs were not always fully assessed and care delivered was not always in line with individual needs. People were not given access to sufficient activities and leisure opportunities tailored around their unique preferences.
People were not being supported in a service run by a provider who was keen to improve the quality of service provided to them. People were not protected by robust governance and quality assurance systems. The provider continually failed to identify the areas of improvement required within the service. The provider did not proactively seek feedback from a range of sources with a view to identifying where improvements could be made and constructively use this feedback to improve the quality of care provided. The provider failed to recognise and take responsibility for the failings within the service.
The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of 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.
The provider was in breach of the regulations surrounding person-centred care, dignity and respect, the need for consent, safe care and treatment, staffing, effective governance and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the 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.