Background to this inspection
Updated
22 June 2016
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 was 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 31 January and 04 February 2016 and was unannounced. The inspection team consisted of two inspectors and a specialist advisor in nursing care. Before the inspection we checked the information we held about the service and provider. This included the notifications that the provider had sent to us about incidents at the service and information we had received from the public. We used this information to formulate our inspection plan. We spoke with eight people who used the service. We spoke with the relatives of four people to gain feedback about the quality of care. We also spoke with six members of care staff, the assistant manager and the regional operations manager.
We used the Short Observational Framework for Inspection (SOFI) in two areas of the home. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spent significant time observing the care provided to people in the home throughout our visit.
We looked at the care records of six people to see if their records were accurate and up to date. We also looked at records relating to the management of the service. These included a medicines audit, staff rotas and training records.
Updated
22 June 2016
This inspection took place on the 29 January and the 04 February 2016. It was unannounced. The service was previously inspected on the 25 March 2014. At that inspection the provider was in breach of the Regulation in relation to the administration of medicines. Medicines were found to be administered appropriately at this inspection.
The service provides nursing care to 37 people. Most of the people using the service had complex needs these included people who were living with dementia and physical disabilities.
The service is required to 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. At the time of this inspection there was no registered manager in the service.
At this inspection we found the registered person had not ensured people were supported by staff who understood the right of people to have their dignity and independence promoted. There was not enough staff to meet people’s needs in a timely manner. There were long delays in answering call bells.
The registered person’s arrangements to assess and monitor the quality and safety of services and to assess monitor and mitigate the risks relating to people’s health, safety and welfare were not always operated effectively. The provider did not have an effective quality assurance system in place that identified and addressed shortfalls in the service. The provider had identified some shortfalls but had not addressed them in a timely manner.
The provider did not ensure people received a service that was designed to meet their individual needs and wishes in relation to how they wished to live. People were not offered the opportunity to pursue hobbies and interests. This led to people becoming bored and unstimulated.
Most of the staff understood and complied with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards. However, none of the staff we spoke with understood the implications for people who were living under different sections of the Mental Health Act 1983.
People were given the opportunity to plan their meals and had a choice of nutritious food and drink throughout the day. Most people were happy with the food. People’s medicines were administered safely and people were supported to access other healthcare professionals to maintain their physical health and well-being. We saw that there were thorough recruitment processes in place and these were applied before staff started to work with people. Visitors were welcomed to the home at all times.
We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.