Archived: Cerne Abbas

Updated 2 December 2014

The inspection was carried out by one inspector and a specialist advisor who had experience of clinical health care needs. At the time of the inspection there were 38 people living at Cerne Abbas.

We reviewed the Provider Information Record (PIR) and previous inspection reports before the inspection. The PIR was information given to us by the provider. This enabled us to ensure we were addressing potential areas of concern. We spoke with professionals at the local authority such as the commissioners of care at the home and members of the Care Commission group.

During the day we spoke with seven people who used the service, five relatives, one senior representative of the provider, three senior members of staff and seven members of care staff.

We looked around the premises and observed care practices throughout the inspection. We reviewed seven people’s care records and followed their care. This is ‘pathway tracking’ that aims to ensure people were receiving the care required. We also reviewed records held by the home relating to the running of the home such as environmental risk assessments, fire officer’s reports and quality assurance monitoring audits.

Due to people’s enduring mental health illness some people could not inform us how they experienced care at the service. We therefore carried out a Short Observational Framework Inspection (SOFI) over the lunch time period. SOFI is a tool to help us assess the care of people who are unable to tell us verbally about the care they receive. The SOFI was difficult to fully utilise due to the other concerns within the home. Observations, where they took place, were from both the SOFI and general observations.

This report was written during the testing phase of our new approach to regulating adult social care services. After this testing phase, inspection of consent to care and treatment, restraint, and practice under the Mental Capacity Act 2005 (MCA) was moved from the key question ‘Is the service safe?’ to ‘Is the service effective? The ratings for this location were awarded in October 2014. They can be directly compared with any other service we have rated since then, including in relation to consent, restraint, and the MCA under the ‘Effective’ section. Our written findings in relation to these topics, however, can be read in the ‘Is the service safe’ sections of this report.

Updated 2 December 2014

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

Cerne Abbas provides nursing care and accommodation for up to 56 people. At the time of the inspection there were 38 people living at the home. Since the inspection the home has now closed. The people living at the home were older people. People had mental health needs, complex health care needs or were living with dementia.

At our last inspection in 2013 we did not identify any concerns with the care provided to people who lived at the home.

The unannounced inspection was carried out over two days. At the time of the inspection there was not a registered manager in post. The register manager left in January 2013. Since that time there have been three acting managers but none had gone through the registration process. The current manager has submitted an application to become the registered manager which is being considered.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

On the first day of the inspection there was a planned power cut at the home that lasted for seven hours. Whilst the electricity company had given ample notice of this the staff were not prepared.  The lack of forward planning put people at risk of harm. The manager was on holiday, the senior member of staff designated to manage the home was not at the premises for the first two hours meaning there was no effective leadership. There were no extra staff on duty to support people during this time, no risk assessment or action plan to ensure people’s needs were met in a safe manner.  

On the second day of the inspection a project manager appointed by the provider as their representatives was present at the home.

On both inspection days we observed there was no  activity for people to do, those who could, walked around, those who could not remained in bed or were left unsupported by staff in communal areas where they just sat. The interaction between staff and people living at the home was mainly around the staff tasks, such as assisting with personal care and support needs or assisting people to eat. We observed some people were left isolated as they could not call for help or company. One person who did ask for assistance was not provided with this for 15 minutes. One member of staff acknowledged their request but did not act.  This meant staff did not support people in a caring and compassionate way.  

The home was poorly maintained and put people at risk of harm.  We observed areas of the home were not clean. Due to the lack of maintenance the home could not be effectively cleaned. This meant people were at risk of health acquired infections. For example, in some areas of the home there was no hot water. Specialised equipment used was in poor condition. The senior representative from the provider told us there were plans to refurbish parts of the building but they did not know when. The relatives we spoke with were aware of this.  

People’s care records outlined their needs and the risks they faced. These were not being consistently followed by staff. This meant people’s needs were not being consistently met in the way they needed or wished.  

There was insufficient evidence in people’s care records that people had been consulted about their daily routines.  For example, people were not consulted about what time they liked to get up in the morning. This meant people were not offered a choice about their personal preferences to receive care and support at the time of their choosing.

People’s care plans had been identified as needing development. We found where improvements had been made to the care plans, staff were not following them. This meant people’s care was not being delivered in accordance with their care plans.

People’s rights to privacy and dignity were not always respected. We noted people had their door leading to communal corridors left open. In one instance, we observed from the corridor a person receiving personal care. This meant staff did not treat people with respect.  

The home was in the process of a recruitment drive. The relatives and staff we spoke with shared their concerns about the lack of permanent staff and the impact this could have on people. We noted there were periods of time during the inspection where there was insufficient staff to meet peoples identified needs.  This meant people were at risk of not having their needs met consistently.  

There was a quality assurance audit at the home. This identified a number of areas that required improvement but there were weaknesses in the auditing systems.  

We found the home was not consistently meeting the requirements of the Deprivation of Liberty Safeguards (DOLS) with systems to protect people’s rights under the Mental Capacity Act 2005. (MCA) These systems were not being used as not all people living at the home had their capacity to make decisions considered.  This meant people’s individual rights were not being respected and adhered to.

We found numerous breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.