The Close

Updated 23 March 2022

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.

On 10 January 2022 we carried out a targeted inspection looking at the infection prevention and control measures the provider had in place. This included reviewing how the provider was meeting COVID-19 vaccination requirements, as they had informed us that some staff had not been vaccinated and they were continuing to employ them. During the targeted inspection we confirmed that unvaccinated staff were working, and we identified a further concern relating to risk management. For this reason, we took the decision to broaden the scope of our inspection and we returned for a second day on 24 January 2022 to carry out a focussed inspection looking at the Safe and Well-Led key questions.

Inspection team

The inspection on 10 January 2022 was carried out by one inspector and two inspectors carried out the second day on 24 January 2022.

Service and service type

The Close is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Notice of inspection

This inspection was unannounced on 10 January, but we gave the provider one day’s notice of the second day of inspection.

What we did before the inspection

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 also contacted the local authority quality team and asked for feedback about their recent inspection of the service.

We used all this information to plan our inspection.

During the inspection

We were unable to speak with any people who used the service. The service was experiencing an outbreak of COVID-19 at the time of our inspection and most residents were isolating in their own rooms. In addition, some people were living with dementia and were unable to speak with us easily. We spoke with three relatives to gain feedback on their family member’s care. We also spoke with four members of the care staff, three members of the domestic staff, the activities co-ordinator, the chef, the registered manager and the provider.

We reviewed a range of records. This included four people’s care plans and three people’s medication administration records. We looked at one person’s recruitment and induction folder. We also reviewed a variety of other records and audits relating to the safety and quality of the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found. This included looking at training data, COVID-19 testing records for staff and rotas.

Updated 23 March 2022

About the service

The Close is a residential care home which was providing accommodation and personal care to 25 people at the time of the inspection. The service can support up to 30 people. The service accommodates people in an adapted period building, with some accommodation being in a newer wing on the ground floor. There are communal spaces and secure gardens for people to enjoy.

People’s experience of using this service and what we found

One risk relating to broken electronic keypads on external doors and doors to stairways, had not been fully assessed and robustly reduced. Information about this risk had not been effectively communicated to all staff. This placed people at potential risk of harm in the event of a fire.

Other risks were assessed, and clear actions were in place to reduce them. Medicines were well managed. Staff had a good understanding of safeguarding procedures and knew how to report abuse should they suspect it. There were enough staff to meet people’s needs. Four staff were working without the required vaccinations for COVID-19. The provider had shared this information with the Care Quality Commission prior to our inspection and had a plan in place to address this. Staff were safely recruited, well trained and received a good induction.

Oversight of the service was mostly very good. There were effective audits in place to monitor quality and safety. The provider acknowledged that they should have had better communication with staff to share information about the broken keypads. They have since put new communication systems in place.

This service was placed in Special Measures in 2017 and has, over time, been working hard to bring about the required improvements. We noted significant improvements. However, we identified a continued breach of regulation 12 (safe care and treatment) relating to fire safety. We also identified a breach of Regulation 12(3), but the Government has announced its intention to change the legal requirement for vaccination in care homes.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 4 September 2019.)

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 regulation 12 (safe care and treatment) but had made improvements and was no longer in breach of regulation 17 (good governance). An additional breach of regulation 12 (3) has been identified following this inspection.

This service has been in Special Measures since 11 October 2017. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

The inspection was prompted in part by information received from the provider which stated that staff were continuing to work despite being unvaccinated for COVID-19 infection. A decision was made for us to inspect and examine any risks this may pose.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

We inspected and found there was a concern with an aspect of fire safety so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well-Led.

We have found evidence that the provider needed to make improvements relating to fire safety. They immediately put plans in place to reduce the risks we identified relating to fire safety and ensure future risks were reduced. The provider had already taken action to reduce risks posed by unvaccinated staff. Please see the safe section of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Close on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to fire safety and failure to meet COVID-19 vaccination requirements at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will 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.