Background to this inspection
Updated
29 January 2022
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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
Welcome House – The Cedars is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. 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 Care Quality Commission. 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. The registered manager was absent during the inspection, so the inspection was supported by a registered manager from one of the provider’s other care homes. We refer to them as ‘the manager’ through this report.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We asked the local Healthwatch if they had received feedback about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with three people who used the service about their experience of the care provided. We spoke with five members of staff including the operations manager, the manager, a senior care worker and two care staff.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at two staff files in relation to staff competency and supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at staff rotas, training data, staff and resident meetings and quality assurance records. We continued to speak with local authority staff. We made a referral to the Kent fire and rescue service.
Updated
29 January 2022
About the service
Welcome House – The Cedars is a residential care home providing personal care to nine people with mental health needs at the time of the inspection. The service can support up to 26 people.
People’s experience of using this service and what we found
People were not always safe at Welcome House – The Cedars. Individual risks had not been identified or clear guidance recorded to help to keep people safe. The premises and outside environment posed risks that had not been identified or action taken to keep people safe. The service was not clean and infection control procedures to mitigate against COVID-19 had not been managed within government guidance.
Accidents and incidents were not investigated and analysed to make sure lessons could be learnt and action taken to prevent further occurrences. People were not protected from harm or abuse as incidents were not always recorded or investigated. People’s prescribed medicines had not been managed well as clear guidance for staff was not available to keep people safe.
People did not receive the individual support needed as staffing levels did not allow time. Staff were completing all cleaning, cooking and gardening tasks as well as their care and support responsibilities as staff were not employed in these roles. Some staff were working long hours without a rest break which put people at risk of unsafe care.
People did not receive care and support that was individual and responsive to their needs.
The systems in place to audit the safety and quality of the service were not robust or sufficient to alert the provider to concerns and issues within the service. Timely action had not been taken to address issues that had been identified within audits. Monitoring systems had not picked up areas which were identified during the inspection. The provider had not acted to ensure they had sufficient oversight of the service, placing people at risk.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (report published 23 January 2020) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
The inspection was prompted in part due to concerns about the management of the service and concerns received from service users about their care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Welcome House – The Cedars on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to: the management of individual and environmental risk, learning lessons from accidents and incidents, medicines management, safeguarding people from abuse, management of infection control, safe staffing levels, providing person centred care, CQC were not always notified of significant events and having systems and processes to effectively assess, monitor and improve the quality and safety of the service at this inspection.
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.
Follow up
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.