Archived: Candle Court Care Home

Updated 31 March 2017

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 is 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 12 December 2016 and was unannounced.

The inspection team consisted of three adult social care inspectors, one specialist professional advisor in dementia care, a pharmacist inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection we reviewed information we held about the service. This included information sent to us by the provider, about the staff and the people who used the service. This included notifications received from the service and other information of concern, including safeguarding notifications.

We observed care in communal areas to help us understand the experiences of people who could not talk with us. We talked to four people using the service, 14 relatives, and 15 staff including the newly appointed deputy manager and consultant, operations director, staff nurses, unit managers, care workers and activities coordinators. We reviewed care records and risk assessments for 11 people using the service. This included care plans in relation to people receiving constant one to one care. We also reviewed training records and staff personnel information for staff and reviewed medicine administration (MAR) records.

Updated 31 March 2017

We carried out an unannounced comprehensive inspection on 12 December 2016. At our last inspection in July 2016 we had concerns about people’s safety. We took enforcement action and the service was placed into special measures and an urgent Notice of Decision served against the provider to restrict admissions to the home.

Candle Court is a care home providing accommodation and care for up to 93 people, some of whom had dementia, physical disabilities and mental health needs. At the time of our inspection there were 65 people living at the service.

At the time of our inspection the service had not had a registered manager in post since February 2016. 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 our focused inspection in February 2016 we found the provider was not meeting the legal requirements for staff training which was ineffective and staff had not received regular supervision. People who lacked capacity to make decisions about their care and treatment did not have their mental capacity assessed by staff before making a decision to administer covert medicines (medicine hidden in food). A safeguarding incident had not been reported to the Commission or the local safeguarding authority and so people may not have always been protected from the risk of abuse. We asked the provider to make improvements and we received an action plan stating how they would meet these requirements.

At our last inspection in July 2016 we saw that the provider had made some improvements since our February 2016 inspection. We found the provider failed to meet the legal requirements for reporting and acting on safeguarding incidents and responding to unexplained injuries. In addition, the provider failed to assess risks to people’s safety, safely manage medicines, ensure that sufficient numbers of equipment used for transferring people were available, staffing levels were adequate to meet people’s needs, care records were accurate and up to date and quality assurance systems were effective. We took enforcement action against the registered provider. We imposed a condition on the provider to prevent them from admitting any new people to Candle Court without the prior written agreement from the Care Quality Commission. The provider was placed into special measures by CQC.

At our inspection on 12 December 2016, we found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found. We saw that some improvements had been made on the issues we reported on at our July 2016 inspection. The provider had met most of the actions pertaining to medicine management in their action plan. However, we found new concerns relating to medicine administration on the ground floor. This was confirmed by an external audit who noted more concerns about the management of medicines on the ground floor. We saw that medicine administration record (MAR) charts were not signed at the time medicines were administered and medicines were left in people’s rooms for care staff who were not trained to administer medicines. This put people at risk of receiving inappropriate or unsafe care and treatment.

We noted improvements in areas such as, staff support, care records for people receiving one to one care and PRN protocols, better facilities to store and charge moving and handling equipment. Staff told us they felt more supported and felt less rushed due to an increase in staffing levels. They felt senior management was approachable and more available to talk to about any concerns they had.

However, we found gaps in risk assessments for people with epilepsy, which we saw was acted on by staff on the day of our inspection. People’s individual needs were not always met by the service despite dependency levels being assessed and staffing levels increased. Records showed a high use of agency staff who often did not understand people’s needs. Accident and incident were not always recorded, therefore no evidence of learning from these. There were gaps in staff training in specialist areas, such as dementia and dealing with behaviours which challenge the service. People were not always treated with dignity and respect in one unit and care not always delivered in accordance with people’s plan of care.

The home was not dementia friendly and did not support people finding their way around or orientate to their surroundings.

Staff were positive about some of the changes/improvements but we saw that the leadership and management of the service was not consistent across the home. On the day of our inspection we saw that the unit lead on one floor was passionate about the way the unit ran. Activities required further improvement to ensure that people less able to participate in group activities were provided with activities to meet their needs. The environment was generally clean.

People felt staff were rushed and didn’t always have the time to provide them with the care they needed because they were always busy.

We found repeated breaches relating safe management of medicines and risks, care records, person centred care, respect and dignity, staffing and quality assurance and leadership.

You can see what action we asked the provider to take at the end of this report.