Archived: 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.

We carried out an unannounced comprehensive inspection of this service on 29 February 2016 and 02 March 2016. At this inspection a breach of legal requirements was found. After the comprehensive inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this focused 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 comprehensive inspection, by selecting the 'all reports' link for Morecambe Bay Care Home on our website at www.cqc.org.uk

This focussed inspection took place on the 01 and 08 September 2016. The first day was unannounced. This means the registered provider did not know we were inspecting the home on this day.

At the time of the inspection there was a registered manager who was registered with the Care Quality Commission. Prior to the inspection we were informed by the registered provider that the registered manager had ceased employment at the home. We were also informed an acting manager who was familiar with the home would be overseeing the management of the service.

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.

At the comprehensive inspection of Morecambe Bay Care Home in February and March 2016. We identified a breach of Regulation 12, (Safe care and treatment) as medicines at the home were not managed safely.

We carried out this focussed inspection in September 2016 to check improvements had been made. During the focussed inspection we found people using 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 continued breach of Regulation 12 (Safe Care and treatment.)

You can see what action we told the provider to take at the back of the full version of the report.

We viewed care records to check the care and support people received. On the first day of the inspection we noted care records did not always contain accurate and sufficient information to ensure people's needs were met. We raised concerns with the acting manager. On the second day of the inspection we saw action had been taken to rectify this. We have made a recommendation regarding this.

We received mixed feedback about the service provided by Morecambe Bay Care Home. People told us they were happy living at Morecambe Bay Care Home and they found staff to be kind. People we spoke with described staff as, “lovely”, “caring”, and “brilliant”. However people also described staff as “busy.” And, “worn out.” They told us if they required support, staff came quickly as they could. On the day of the inspection we observed staff to be rushing between tasks.

We spoke with staff about staffing levels. Two staff raised concerns with the number of staff available to meet people’s needs. Staff told us if unplanned leave was taken the management at the home provided additional staff whenever possible; however there were occasions when this could not be provided. We have made a recommendation regarding this.

Morecambe Bay Care Home consists of four self-contained units, catering for a range of people with differing abilities. The service caters for people living with disabilities, older people with nursing care needs, older people living with dementia and people who require short term rehabilitation therapy. At the time of the inspection there were 70 people living at the home.

The last inspection of Morecambe Bay Care Home was carried out in September 2015 and the service was rated as ‘requires improvement’ overall, with ‘requires improvement’ ratings in two of the key questions and an ‘inadequate’ rating in place for 'is the service safe.’ The registered provider did not meet the requirements of the regulations during that inspection as breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We identified a breach in Regulation 12 (Safe care and treatment). We found medicines were not managed safely. We also identified a breach in Regulation 13 (Safeguarding service users from abuse and improper treatment.)

The home is managed by a registered manager. A registered manager has legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager sent us an action plan explaining what they were going to do to rectify these breaches. The action plan demonstrated that all legal requirements would be met by September 2015.

During this inspection in February and March 2016 we found improvements had been made in relation to safeguarding service users from abuse and improper treatment. We saw evidence safeguarding referrals were made to the safeguarding authorities as required.

We found some improvements had been made in the safe management of medicines, but some areas of medicines handling remained to be addressed. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014 (Safe care and treatment.) You can see the action we told the provider to take at the full version of the report.

People told us they were happy living at Morecambe Bay Care Home and the care met their individual needs. People told us they liked staff. One person described staff as “lovely.” We found staffing was arranged in advance to ensure sufficient staff were available to meet people’s needs. Staff we spoke with told us they were busy but they had sufficient time to support people safely.

There were systems in place to protect people at risk of harm and abuse. Staff were able to define abuse and the actions to take if they suspected people were being abused.

We found individual risk assessments were carried out and care plans were developed to document the measures required to reduce risk. Staff were knowledgeable of the measures in place and we observed these were followed these to ensure people’s safety was maintained.

We saw appropriate recruitment checks were carried out to ensure suitable people were employed to work at the home and there were sufficient staff to meet people’s needs. People told us staff were busy but they were supported in a prompt manner.

Staff received regular support from the management team to ensure training needs were identified. We found staff received appropriate training to enable them to meet peoples’ needs.

Processes were in place to ensure people’s freedom was not inappropriately restricted and staff told us they would report any concerns to the registered manager.

We found people were offered a variety of foods and people told us they liked the meals at Morecambe Bay Care Home.

People were referred to other health professionals for further advice and support when assessed needs indicated this was appropriate.

We saw staff treated people with respect and kindness and people told us they were involved in their care planning.

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s expressed wishes. During the inspection we saw people were supported to carry out activities which were meaningful to them.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home.

The registered provider monitored the quality of service by carrying out quality assurance checks and we found systems were in place to identify if improvements were required.

Communication at the home was not always effective. We noted occasions when information was not passed to members of the management team. We have made a recommendation regarding this.

People who lived at the home were offered the opportunity to participate in an annual survey. There was also an electronic and paper based system in place to enable people to give feedback. People also told us they could discuss their views with staff or the registered manager if they wished to do so. However one person and two relatives told us they felt there could be improvements made in the relationship they had with the management at the home. We have made a recommendation regarding this.

Most of the care files seen contained good information about the person's biography, physical, medical and personal support needs. However, we found some gaps in one person's file. We raised this with the clinical lead for the service, who agreed that further work needed to be undertaken by the staff to ensure that appropriate information was gathered about this person's care and support requirements. The service provider should access the advice of its specialist dementia care team in order to ensure best practice in dementia care is implemented within the home.

We found documentary evidence to show that the staffing structure consisted of a multi-disciplinary team of professionals. People who used the service, their representatives and staff were asked for their views about their care and treatment which were acted on. Records were kept securely and could be located promptly when needed.