This comprehensive inspection took place on 15, 16 and 23 June 2017 and was unannounced. At the last inspection on 21 May 2015, the service was rated ‘Good’.At this inspection we found a number of concerns and breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Eliza House provides accommodation and support with personal care for up to 26 people some of whom were living with dementia. At the time of our inspection there were 26 people using the service.
The service did not have a registered manager, however the manager in place who took up the position in November 2016 had submitted an application to the Care Quality Commission (CQC), to become the registered manager of this 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.
The manager completed a number of audits and checks to monitor the quality of the service. These included audits for medicine, care plans, fire checks, room checks, maintenance of the home and infection control. However, we found that these audits inadequate and failed to identify any of the issues that we identified as part of this inspection.
Health and safety, infection control and care plan audits were completed as per a tick box format and did not identify any of the issues we found. This included issues such as broken radiator covers, poor fabric and condition of the home, chemicals and toiletries left exposed in a bathroom and a broken bin which contained clinical waste.
Where external audits had been completed by the environmental health department for food hygiene ratings and the Clinical Commissioning Group (CCG) for medicines management, issues that had been highlighted had not been addressed. These issues remained and were identified again as part of this inspection.
The manager was unable to provide us with records in relation to staff supervision, appraisals, medicine competency assessments, safeguarding investigations, complaints, accidents and incidents and the results of previously completed satisfaction surveys as they were not available within the home.
Medicines were not managed safely. There were a number of concerns around the storage of controlled drugs, room temperature checks for the storage of medicines and incomplete paperwork confirming the safe and appropriate administration of covert medicines.
Scheduled activities did not always take place. People and relatives all told us that there was very little provision of activities taking place within the home and that activities listed on the activity timetable did not always take place. We saw very little interaction, activity or stimulation that was initiated by care staff that were on duty. People were taken to the lounge and positioned to watch television or listen to music. During the three inspection days, many people were seen to be in the same place throughout the day. People regularly gave feedback, ideas and suggestions at weekly residents meetings about activities that they would like to see organised. However, the home had failed to take action on this feedback.
Accidents and incidents were not recorded in a way which enabled the service to analyse and identify any trends or patterns so these could be reduced or mitigated against in order to keep people safe.
Where staff had completed training in topics such as medicine administration, we were unable to confirm that staff members competencies had been assessed once they had completed the training course to confirm that they were competent in the assessed area.
Care staff told us that they received regular supervision and felt supported in their role. Staff files contained supervision records that had been carried out since the new manager had been in post. However, we were unable to confirm whether staff had received regular supervisions since the last inspection. In addition there were no records of any completed appraisals for any staff members, some of whom had been employed by the service for a number of years.
Over the first two days of the inspection, the inspector and the expert by experience recorded a mixture of positive and negative observations of the lunchtime meal experience. Whilst it was observed that meals served were hot and people were seen to enjoy their meals and ate well, little consideration had been given to the setting and preparation of the dining room which would promote a positive mealtime experience.
Care plans did not always contain information about the person’s likes and dislikes, choices and preferences.
People and relatives told us that they knew who to speak with if they had any concerns or issues to raise. However, we found that no complaints had been recorded since the last inspection in 2015. The manager, who had been in post since November 2016, was unable to confirm if there had been any complaints and where these had been recorded prior to his arrival. The manager told us that they had not received any complaints since November 2016.
All staff demonstrated a good level of understanding of the Mental Capacity Act 2005 (MCA), Deprivation of Liberty Safeguards (DoLS) and seeking consent when supporting people with their care needs. We found that the service had appropriately submitted authorisation requests for people lacked capacity and who were possibly being deprived of their liberty. However, care plans did not always evidence that people or where appropriate their relatives had consented to the care and support they received.
Care staff demonstrated a good understanding of the terms safeguarding and whistleblowing and were able to describe the actions they would take if abuse was suspected.
Risks associated with people's care and support needs had been identified and these had been assessed, giving staff instructions and directions on how to safely manage those risks.
The provider demonstrated safe recruitment processes were in place to ensure that each person employed at the service was safe to work with vulnerable adults. This included criminal record checks, identification verification, visa verification and reference requests confirming staff conduct in previous employment.
Care plans contained records of all visits and appointments made by a variety of healthcare professionals such as GPs, dentists, chiropodists and district nurses. Details of the visit and any actions to be taken had been recorded.
Throughout the inspection we observed some positive and caring interactions between people and staff. People were observed to be treated with dignity and respect.
Care staff demonstrated a sound awareness of supporting people from different backgrounds, varying religious and cultural backgrounds and supporting people who may identify as being lesbian, gay, bi-sexual or transgender.
People and relatives knew the manager and felt confident in approaching them. Staff were equally positive about the manager and found to him to be a supportive and good manager.
At this inspection we found breaches of Regulation 9, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to unsafe medicine management, concerns related to health and safety, infection control and the condition of the fabric of the home, lack of activities, ineffective quality audit systems and lack of supervisions, appraisals and medicine competency assessments.
Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.