Archived: Cadbury Hall Care Home

Updated 31 October 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

This inspection was completed by two inspectors, a member of our medicines team, a specialist nurse adviser 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.

Service and service type:

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

The service had a manager registered with the CQC. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

The inspection was unannounced.

What we did before the inspection:

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed other information that we held about the service such as notifications. These are events that happen in the service that the provider is legally required to tell us about. We reviewed information we had received from members of the public and people using the service. We used all of this information to plan our inspection.

During the inspection:

We spoke with 10 people who lived at the service, five people’s relatives, and eight members of staff. This included the registered manager, regional manager, nursing and care staff. We reviewed a range of records. This included some people’s care records and multiple medication records. We also reviewed records relating to the management of the service such as incident and accident records, meeting minutes, training records, policies, audits and complaints.

After the inspection:

We received clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We contacted eight healthcare professionals who have had contact with the service to gain their views and received responses from four of them.

Updated 31 October 2019

About the service:

Yatton Hall Care Home provides accommodation with nursing and personal care for up to 48 people. When we visited, 37 people lived there.

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

During this inspection we found that people’s needs were not always met due to inadequate staffing levels. People, their relatives and staff said care needs were not always met and we made observations to support this. People’s medicines were not always managed safely, and this placed people at risk.

People’s risks were assessed and identified, and risk management plans were in place to reduce known risk. However, during a review of some people’s care records the service could not evidence care had been delivered in line with people’s assessed needs. We observed the service was clean, however observations of staff infection control practice place people at risk.

We reviewed the service practice in relation to the Mental Capacity Act 2005 (MCA). People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. This was not in line with the principles of the MCA. The registered manager did not have robust system to monitor Deprivation of Liberty Safeguards (DoLS) applications and authorisations meaning some people at the service may have been unlawfully deprived of their liberty. Legal conditions on DoLS authorisations had not been identified or met.

Staff were not always fully supported in their roles, and in addition to being below the providers training completion compliance level, staff had not received regular supervision and appraisal. We spoke with staff who confirmed they had not been receiving their supervision and staff new to care had not been appropriately supported in the early stages of their employment. People’s feedback was mixed in relation to the current standard of food at the service. We saw records relating to nutritional support were not always accurate.

People spoke positively of the staff and many commented on how they tried their best to provide the best possible care in challenging circumstances. However, during the inspection we made observations and received comments from people evidencing how their dignity had been compromised.

We found the service was not always fully responsive to people’s care needs. Whilst we found care was planned, people did not consistently receive care in line with their assessed needs. We found that people’s records were inconsistent and information about people preferences, past history, important relationships and religious and cultural beliefs were not always documented. Whilst this had not impacted anybody, it did not demonstrate a consistent person-centred approach.

There was an inconsistent approach to end of life care planning throughout the service. There was a system to investigate complaints, however it was not evident it had been consistently used and records were incomplete. The service had an activities provision. However, this had been impacted since the passenger lift became defective and people gave us information about how they had become socially isolated.

It was evident that the governance systems in operation at the service at both internal and provider level were currently ineffective. Internal auditing systems had not identified the breaches of regulation we found during the inspection. Provider level governance and auditing in August 2019 had not identified concerns affecting the health, safety and welfare of people at the service. The provider had failed to send a DoLS notification to the Care Quality Commission (CQC) as required by law.

Staff felt unsupported and some commented on not feeling appreciated or valued. People using the service gave mixed feedback about their involvement through continual engagement and meetings. Staff told us meetings were held and we saw supporting minutes.

Whilst it was evident people’s needs were not always met through inadequate staffing and management oversight, people and their relatives spoke positively about staff. There was awareness of staff effort in the face of adversity and people felt that staff were doing their best to support them. Staff we spoke with told us they worked well as a team together despite staffing issues.

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 Good (published September 2017)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety and will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Enforcement:

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.