30 January 2019
During a routine inspection
Why we inspected: This inspection was prompted by a serious incident and information of concerns we received.
People’s experience of using this service: During the inspection, we identified many concerns relating to people’s safety. This included the service not having appropriate fire evacuation equipment in place. Also, a lack of training and guidance for staff on how to support people in the event of a fire. There were insufficient staffing levels during the day and at night which all put people at significant risk of harm.
We found the premises and equipment used to support people were not safe or clean. Issues relating to the environment, which we identified at our last inspection, had not been addressed. This included carpeting and flooring being very dirty and smelling of urine. Furniture including beds, armchairs, tables and dining room chairs were dirty and stained. Bedding and towels were very worn, some had holes and were stained. Mattresses were stained, smelled strongly of urine and were wet.
Staffing levels had not been calculated in line with people’s needs. This meant staff struggled to meet people’s needs. Poor standards of care were observed; people had dirty fingernails and some people had food stains on their clothing.
Medicines were not managed safely. Staff did not always have guidance to ensure they administered ‘as required’ medicines to people. Medicines were not stored safely and stock levels of medication were not recorded. Topical cream administration records were not always completed by staff.
Risks to people were not always properly assessed. This included moving and handling, nutritional needs, use of equipment and falls risks. The management team had failed to address this which meant people were at risk of harm.
Assessments of people’s needs were not up to date which resulted in people’s needs not being met.
Systems were not in place to monitor accidents and incidents.
Staff demonstrated a limited understanding of safeguarding and records showed they had not received appropriate training in this area. During our inspection, we reported our concerns to the local safeguarding team. This means external professionals will look into our concerns.
The provider did not always maintain appropriate records relating to the requirements of the Mental Capacity Act 2005 (MCA). There was a failure to properly oversee and make applications for authorisations under the Deprivation of Liberty Safeguards (DoLS). People had not been included in decisions about their care.
People living with dementia did not have their care provided in line with best practice. This impacted on their quality of life and wellbeing. We have made a recommendation about this. People spent lengthy periods of time in the communal area; in the same chairs, only moving to attend for their meals in the adjoining room or to use the toilet.
An activity staff member was in post, but they had not received any training on how to plan and facilitate meaningful activities for people. Activities were often attended by the same people leaving others unstimulated.
People’s nutritional needs were not always met and advice from health care professionals was not always followed. This put people at risk of receiving inappropriate and unsafe care.
Staff did not always receive an induction, or complete mandatory training to ensure they had the skills they required for their roles. Staff did not always receive supervision and appraisal of their performance.
In August 2018, the registered provider went into administration. The administrators had employed a care company to run the home while a buyer was sought and had oversight of their management.
The governance of the service was poor. The provider had an awareness of the issues we identified, but had not mitigated risks within the provision associated with issues we found.
After the first day of the inspection, we requested an urgent action plan from the provider to tell us how they would address the concerns we found. They responded with a plan which gave timescales for the completion of works. We visited the service again to follow this up and found that not all of the actions had been completed. We found there were no plans in place as to how these would be met. We continued to monitor the service regarding the improvements they were making.
Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 4 April 2018). This service has been rated Requires Improvement at the last three inspections.
Enforcement: 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.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.