Archived: Morecambe Bay Care Home

Updated 14 February 2018

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.

The inspection team consisted of two adult social care inspectors 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. The expert by experience who attended the inspection had experience of dementia and older peoples’ care. The inspection team also consisted of two pharmacist inspectors.

Prior to our inspection we reviewed all the information we held about the service. This included notifications the registered provider had sent us and their action plan from the last inspection. We also reviewed information provided by the safeguarding authorities. This enabled us to plan our inspection effectively. We noted concerns had been raised regarding the availability of staff at Morecambe Bay Care Home. Therefore, we included this within our inspection.

As part of the inspection visit we walked around the home and spent time in each of the self-contained areas where people lived. This enabled us to observe the care and support people experienced and the interactions between staff and people who lived at Morecambe Bay Care Home.

We spoke with eleven people who lived at the home and eight relatives. We spoke with a range of staff at the home. This included the regional manager, the clinical manager and the registered manager. We also spoke with two resident experience leads and twenty one staff who worked at the home. This included qualified nurses, care staff and the chef.

During the inspection visit we viewed a range of documentation. This included seven care records and a sample of medicine administration records (MARs). We also looked at quality audits, staff duty rotas, records of staff hours worked and two staff personnel files.

Updated 14 February 2018

Morecambe Bay Care Home consists of four self-contained areas, catering for a range of people with differing abilities. The service caters for people with disabilities, older people with nursing care needs and older people with residential care needs. At the time of the inspection there were 70 people who lived at Morecambe Bay Care Home.

We carried out a focussed inspection of this service on 01 and 08 September 2016. The first day was unannounced. At this inspection a breach of legal requirements was found. We found people did not always receive their medicines safely. We took enforcement action as a result of our findings and served a warning notice to the registered provider. This required the registered provider to reach the requirements of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 by the 05 December 2016.

After the focussed inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach. They provided us with an action plan which indicated legal requirements would be met by 31 January 2017.

We undertook this comprehensive inspection on the 02 and 03 May 2017 and the first day was unannounced. We carried out this inspection to check that they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last focussed inspection, by selecting the 'all reports' link for Morecambe Bay Care Home on our website at www.cqc.org.uk.

There was a manager in place who was registered with the Care Quality Commission. 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.

During this inspection we found people who used the service were not fully protected against the risks associated with the administration, use and management of medicines. People did not always receive their medicines and creams at the times they needed them or in a safe way. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment).

Risks to people who lived at the home were not consistently managed. We found risks were not always assessed and people were placed at risk of avoidable harm. We also found care and treatment was not always delivered in a way which minimised risk. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safe care and treatment).

People were not assured they would receive care and support from staff who had received appropriate training and development. Staff told us they needed training to enable them to respond to peoples’ needs. We observed staff were sometimes unable to offer support due to lack of training. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing).

People told us they sometimes had to wait for staff to help them. One person told us, “I wish they would come quicker.” We observed staff were not always effectively deployed. We found people were left unsupported in a lounge, with no access to call bells and no staff present to ask for help. In addition staff and visitors told us they felt leadership on one of the units at the home was poor. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Staffing).

Person centred care was not always delivered. We observed one person at the home did not have their verbal request for a specific meal met. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Person – centred care).

We found people were not protected from abuse and improper treatment. Systems in place were not consistently operated to ensure investigations were carried out and people were protected from abuse and avoidable harm. We found a person was being unlawfully deprived of their liberty. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Safeguarding service users from abuse and proper treatment).

We found quality monitoring systems were not always operated effectively to ensure risks were identified and mitigated, documentation was up to date and accurate and the quality of the service improved. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance).

We viewed care documentation and found this was not always accurate, complete and reflective of peoples’ needs. We noted gaps in records and one person did not have a care plan in place to address their needs. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Good governance).

Under Section 28 of the Health and Social Care Act 2008 we varied condition 2 of the service providers registration. Full information about CQC's regulatory response can be found at the back of the full version of the report.

We observed the lunchtime meal being provided. We saw this was not a positive experience for everyone who lived at the home. We observed one person being helped to eat and saw staff left them on two occasions to support another person. This meant the person’s meal was interrupted. People who lived at the home gave us mixed feedback regarding the quality of the food provided. One person told us they did not enjoy the meals provided. A further person described the food as, “nice.”

People and visitors told us staff were caring. One visitor commented, “They treat [my family member] with respect and they are caring.” We observed staff as they supported people. We saw some positive interactions between people who lived at the home and staff. However, we also saw staff did not always promote interaction between themselves and people who lived at Morecambe Bay Care Home.

We reviewed staff files and found there were processes that ensured staff were suitably recruited. Staff we spoke with confirmed checks had been carried out prior to starting work at the home.

During the inspection we saw people took part in group activities which were meaningful to them. We observed people enjoyed the activities provided and were smiling and laughing as they took part. We saw a board was displayed within the home advertising the activities programme in place.

We viewed documentation which showed people were supported to see other health professionals if the need arose. We saw referrals were made to doctors and specialist health teams if this was required.

There was a complaints policy in place to enable complaints to be made if this was required. We viewed the homes complaint file and saw if a complaint was made, this was responded to.

People could access advocacy services if this was required. The clinical manager informed us this would be arranged at peoples’ request.

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.

During the inspection we became aware of specific incidents at the home. We are considering our response to these.