Archived: Apthorp Care Centre

Updated 13 July 2019

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 took place on 11 December 2018 and was unannounced.

The inspection was completed by two inspectors, an inspection manager, a specialist advisor with expertise in dementia care, an assistant inspector, an evidence review officer, a directorate support coordinator and two experts 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 experts had experience of caring for people living with dementia.

During the inspection we reviewed care files for 14 people who lived in the service, including needs assessments, care plans, records of care and medicines information. We reviewed ten staff files including training, supervision and recruitment records for five staff who had joined the service since our last inspection. We made detailed observations of the building and premises, as well as observations of the care and support provided to people. We spoke with 12 people and five relatives. We spoke with 13 members of staff including the regional director, the quality manager, the home manager, the administrator, two floor managers, two domestic staff and five care workers. We also reviewed various audits, meeting records and other documents relevant to the management of the service.

Before the inspection we reviewed information we already held about the service including information submitted as notifications. Notifications are information about events and incidents which providers are required to tell us about by law. We also reviewed the feedback we had received from members of the public and local authority and health care teams in the local area.

Updated 13 July 2019

This inspection took place on 11 December 2018 and was unannounced. At the previous inspection in October 2017 we had found continued breaches of regulations regarding staffing and governance. The provider had failed to address these breaches, and additional breaches of regulations relating to safe care and treatment, and person-centred care were identified during the inspection. The provider had failed to implement the improvement plan they sent to us after the last inspection.

Apthorp Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Apthop care centre accommodates up to 108 people in ten flats each of which have separate adapted facilities. At the time of our inspection two of these flats had been decommissioned and 73 people were living in the home, many of whom were living with dementia.

There was no registered manager in post. 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 manager had started working in the service in late October 2018.

The provider had failed to sustain and embed previous improvements made in the quality and safety of the service. Although their systems had identified the failings we found in personalisation, risk assessments, medicines management, record keeping and the safety of premises they had failed to take effective action to address these concerns. The provider’s improvement plan was not driving improvements. The systems for involving people, relatives and staff in developing the service were not working effectively. While staff were optimistic about the potential for the new manager to make improvements, people and relatives were unclear about the management structure in the home.

There were not enough staff deployed to meet people’s needs. People told us they had to wait to receive care, and we saw people’s dignity was compromised as there were not enough staff available to support them in a timely manner. Bathrooms were dirty and this exposed people to the risk of harm due to poor infection control practice. Risks to people were not always identified, and risk assessments were not always followed. Medicines were not managed in a safe way.

People’s needs had not been assessed in line with best practice and resulting care plans lacked detail. The impact of people’s health conditions on their care preferences was not recorded and people’s dietary preferences were not always respected. The service had applied to the local authority to deprive people of their liberty under the Mental Capacity Act (2005) but we saw staff put in place additional restrictions on people’s liberty. Some areas of the home were not environmentally suitable for people living with dementia.

People’s dignity was not always upheld and the inspection team had to intervene on two occasions to ensure people’s dignity was restored. Care plans did not explore how people’s religious beliefs and cultural background affected their preferences for care. The service did not explore the impact of people’s sexual or gender identity on their experience of care services.

Records did not consistently demonstrate people had received care as planned or in line with their preferences. People had not been supported to explore their wishes for the end of their lives.

Staff recorded and escalated safeguarding concerns to ensure people were protected from abuse. People told us they were supported to attend healthcare appointments when they needed.

People told us staff were kind and we saw some positive, compassionate interactions between staff and people. People told us their privacy was respected and they were able to spend time alone with their visitors. Staff told us they took steps to maintain people’s independence and skills.

People gave us mixed feedback about the activities on offer. Some people enjoyed them and found them engaging, but other people did not find anything on offer that was suitable for them.

Some people knew how to make complaints, and records showed the provider followed their complaints policy in responding to concerns raised. However, other people did not know how to make complaints, and did not feel complaints were responded to appropriately.

We identified breaches of five regulations relating to person-centre care, safe care and treatment, premises and equipment, staffing and governance. Full details of our regulatory response are added to reports after all legal appeals are exhausted.

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.