8, 9, 15, 16 July 2014
During an inspection looking at part of the service
Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
A lack of clear and up to date information in care plans and a lack of knowledge and understanding of some staff placed people at risk of unsafe or inappropriate care.
Recruitment processes were poor. The record of staff interviews undertaken was lacking in detail and did not explore areas of concern raised by previous employers or checks carried out through the disclosure and barring service (DBS). The documents we saw have given us concern about the level of scrutiny the provider took in determining people's identity and their suitability to work with vulnerable people.
Owing to the serious shortfall identified at the inspection and the inability of the service to attract high calibre nursing staff we took immediate action to prevent the home from providing nursing care.
People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to safely manage them.
We checked the medicine administration records (MAR) together with receipt records and these showed us that people were not always receiving their medicines correctly. For three people we found more of the medicine was remaining than the administration records indicated, meaning that some doses of medicine recorded as given either had not been given, or were given at an incorrect dose
The provider failed to ensure appropriate maintenance of the building and utility services this placed people who use the service, staff and visitors at potential risk of harm.
Is the service effective?
We looked at care plans and found inconsistencies in the quality of information available to explain how each person needed to be safely supported by the staff. We saw evidence that staff failed to check care plans and carry out interventions to provide the correct care.
People were not always consulted before they received any care or treatment and the provider did not take into account their wishes.
Is the service caring?
We saw written from one relative who described staff as being 'friendly' and 'brilliant despite not always being able to understand the language'. During our inspection relatives variously described staff to us as "wonderful" and "amazing." However, although we saw some positive interactions between staff and people who lived at the service we also saw other interactions which caused us continuing concern. We observed for example, that some staff demonstrated a lack of insight into the complex needs of people living with dementia and we saw instances where appropriate and timely support was not provided by either qualified nurses or care staff to alleviate people's anxiety and distress. We also had to intervene to make sure some people were given the appropriate support and assistance at mealtimes.
Is the service responsive?
We saw examples where staff failed to recognise to urgent situations for example one person who suffered two nosebleeds that necessitated an ambulance being called on each occasion. Health care professionals from other agencies also in the home at the time assisted the ambulance crew and instructed staff on what they had to do to make sure protective aprons and gloves were brought to the room.
We observed a people having difficulties eating their meals. Staff failed to respond and support people appropriately.
Is the service well-led?
Effective management systems were not in place to promote people's safety and welfare. This meant that the managers and staff could not monitor and learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations.
The registered manager had failed to anticipate and understand the possible outcomes of their decisions and actions on people's lives and take appropriate action.