West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors and a passenger lift is provided. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has landscaped gardens and there is a car park to the front of the property. This inspection took place on 2 and 3 February 2016 and was unannounced on the first day. At the time of the inspection 25 people were living in the home. The service was last inspected in September 2014 and no breaches of legal requirements were identified.
There was no registered manager at the time of the inspection. 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. The provider had appointed a new manager, who had started work a few days before Christmas. The manager told us they were preparing to apply to become registered.
We received mixed feedback from people living in the home and their visiting relatives, although most of the feedback was very complimentary regarding how nice the staff were, and about the care that people received. We found several areas for concern, as some risks to people’s health, safety and welfare were not appropriately managed. This included poor cleanliness and infection prevention and control in the home. The environment was not in a good state of repair or well decorated in some areas, and that there were physical hazards, such as trip hazards and security risks. Therefore, people were not always cared for in a hygienic and safe environment.
We saw that people’s health care needs were not always accurately assessed and risks, such as risks associated with use of the stairs and the use of bedrails were not always recognised. In some cases, support and advice had not been sought from healthcare professionals. In one case the person’s care plan was not being followed. This meant that people’s care was not well planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met. Additionally, the records staff kept about the care they delivered to people were not checked, leaving people at risk of not having their current, individual needs met.
There were few activities. The level of staffing support available did not adequately provide for people’s social and intellectual needs, and allow people sufficient freedom to go out into their local community.
Staff told us they received training, which helped them to carry out their role. However, not all staff had a good understanding of the Mental Capacity Act 2005. There were a number of people who lived in the home who were living with dementia, but not all staff had a good understanding of working positively with people living with dementia. Staff confirmed that they received supervision sessions with their manager.
The Mental Capacity Act (2005) (MCA) has been introduced as extra safeguards, in law, to protect people’s rights and make sure that the care or treatment they receive is in their best interests. The service was not meeting the requirements of the MCA (2005) for people who may lack capacity to make decisions. For example, people’s mental capacity was not assessed when particular decisions had been made. Additionally, some decisions made did not support people’s rights.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the necessary DoLS applications had been made.
There were 14 people living with dementia who lived in the home, and although some work had been done to make sure the environment was dementia friendly, it was not made wholly suitable for their needs.
People were not always offered choices or encouraged to be as independent as possible. For example, people told us they had very little input into the planning of activities, and there was limited choice in relation to meals and mealtimes.
Although people we spoke with told us the food was nice, suitable arrangements were not always in place to support people to maintain a healthy intake of food and drink. We saw that the management of nutrition was not always effective in making sure that people’s nutritional needs were identified, and that they were provided with individual diets that met their needs.
We saw that overall, medicines were ordered and disposed of safely, and administered to people by staff trained to do so. However, the storage temperature was not monitored for all of the medicines kept in the home. There was no guidance for staff about how people might express pain, when their communication had been affected by living with dementia, or under what circumstances staff should administer pain relief to them.
For the most part, positive caring relationships were developed with people who used the service. Staff spoke to people respectfully, and in a gentle and caring way. However, we did see instances when people’s privacy and dignity were not protected.
The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety and in some instances, had failed to provide appropriate care to maintain people’s safety.
Audits were completed to monitor the quality and safety of the service provided to people. However, some of these audits had not been effective, and no action plans were in place to make sure any issues identified were followed up and improvements made.
People told us their views and opinions were taken in to consideration and people felt involved in suggestions and ideas about the home. However, we found that where people had asked for things to be improved, there was no indication that action had been taken to address them.
We found five breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider, and will report on this at a later date.
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.