Background to this inspection
Updated
27 April 2017
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 visit took place on the 29 March 2017 and was unannounced. The inspection visit was carried out by two 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. We checked the information we held about the service and the provider. This included notifications the provider had sent to us about significant events at the service and information of concern we had received from the public. We used this to formulate our inspection plan.
The provider had completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We considered this information when we were planning the inspection.
We spent time observing care and support in the communal area. We observed how staff interacted with people who used the service. We spoke with five people who used the service, nine relatives, eight members of care staff and two registered nurses. We also spoke with the manager and the area manager. We did this to gain people's views about the care and to check that standards of care were being met.
We looked at the care records for 11 people. We checked that the care they received matched the information in their records. We also looked at records relating to the management of the service, including quality checks and the staffing rota.
Updated
27 April 2017
We inspected this service on 29 March 2017. This was an unannounced inspection. Our last inspection took place in February 2016 and we found there were not enough staff to meet people’s needs in a timely manner and people had to wait for support. We also found medicines were not always managed in a safe way. At this inspection we found the provider had not made the necessary improvements
The service was registered to provide nursing for up to 37 people. At the time of our inspection 33 people were using 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, it 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 service did not have a registered manager. 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.
There were not enough staff to offer support to people in a timely manner. The lack of staff within the home meant people had to wait for personal care, meals and medicines. As the rota was left uncovered we could not be assured there were the recommended amount of staff available for people. The provider used a dependency tool to work out staffing levels however we could not be assured this was accurate as it did not always reflect people’s individual needs.
People did not receive medicines as prescribed because we found medicines from previous days in blister packs. When people were prescribed medicines for agitation we did not see any evidence that people had been agitated when these medicines had been administered. When people needed pain relief they did not always receive this in a timely manner.
People were at risk as there were not enough staff to keep them safe. Injuries had occurred within the home due to the lack of staff available. Risks to people were not managed in a safe way. We saw no evidence after incidents had occurred that action had been taken to reduce the risk reoccurring. Staff did not demonstrate an understanding of safeguarding and so we could not be sure people were protected from potential abuse. When potential safeguarding incidents had been recorded we did not see these had been reported in line with the provider’s procedures.
People did not always receive adequate fluids to remain hydrated. Drinks were often left out of reach for people. When people needed support to eat and drink they had to wait due to the lack of staff within the home. We had to alert staff when people had not been offered anything to eat or drink. People were put at risk as they received foods that were not in line with recommendations made by health professionals.
People were not treated in a dignified way as staff were rushing to complete tasks. People were not offered choices and staff did not have time to encourage them to be independent. Staff felt the induction and training they received was inadequate to equip them with the skills they needed to support people effectively. People did not always receive individualised care or appropriate support when needed. People felt there could be more to do and relatives felt the home lack stimulation for people.
Capacity assessments were not always in place and we could not be assured how decisions had been made. Not all restrictions that had been put on people had been considered. Staff did not demonstrate an understanding of capacity and gaining consent from people.
There was a lack of leadership and we were concerned about the culture within the home. Staff did not feel listed to and when they raised concerns no action was taken. Staff told us they felt bullied and intimidated. Relatives also raised concerns about the lack of leadership and management of the home.
The systems that were in place were not always effective in identifying concerns. When action was needed to reduce risks reoccurring we did not see this had been taken. We could not be assured the provider understood their registration with us and significant events which occurred in the home had not been reported to us.
People and relatives were happy with the staff. And the provider ensured staffs suitability to work within the home. Visitors felt welcomed and were free to visit anytime.
During the inspection we contacted senior managers to raise our concerns. We did not leave the inspection until we were assured measures had been put into place to keep people safe. We asked the provider to produce an urgent action plan within 72 hours of the inspection and we are liaising with them in relation to this.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.