John Masefield House - Care Home with Nursing Physical Disabilities

John Masefield House is a residential care home providing accommodation for persons who require nursing and personal care for up to 22 people in a single storey building. The service provides support to adults with a physical disability. At the time of our inspection there were 19 people living at the home.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

At the time of the inspection, the location did not care for or support anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

People’s experience of using this service and what we found

Right Support

Staff did not always have the information required to provide safe and effective care. Care plans and risk assessments did not always contain relevant, up to date information within them.

People were supported safely with most medicines. Topical medicines such as creams were not always applied as directed.

People were supported by staff who had been safely recruited. The provider completed police checks and gained references for staff prior to them starting work.

Staff received an induction before working with people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

Risks to people had not always been mitigated. We found concerns with risk associated with health conditions, including risks from pressure damage, choking and moving and handling.

Not all staff had received the appropriate training to understand people's individual needs, such as people with a learning disability and/or autistic people.

Right Culture

The leadership and management of the service had been inconsistent with frequent changes leading to inconsistency in support and practices in the home. People and their relatives were concerned about this and the impact on those living in the home.

Systems and processes were not always effective in ensuring the registered manager and provider had effective oversight of the service.

Systems were in place to gain feedback from people, relatives, and staff.

The provider responded to requests for information during the inspection and implemented measures where concerns had been identified to improve the safety and quality of the service.

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 (published 1 September 2022) and there were 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 we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The inspection was also prompted in part due to concerns received about the management of the service.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for John Masefield House on our website at www.cqc.org.uk.

Enforcement and recommendation

We have identified breaches in relation to safe care and treatment, person centred care, staffing and good governance at this inspection.

We have made a recommendation about specific training requirements.

Please see the action we have told the provider to take at the end of this report. 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

We will ask for an action plan and meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

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 act 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 to 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.

John Masefield House is a residential care home providing accommodation for persons who require nursing and personal care for up to 22 people in a single storey building. The service provides support to adults with a physical disability. At the time of our inspection there were 18 people living at the home.

People’s experience of using this service and what we found

There had been improvements since the last inspection. However, we found further improvement was required in areas of the service including person centered care and records.

Information in people’s care records on how people communicated needed more detail. The records did not always contain descriptions of how people may be communicating when they were not able to verbalise.

Where people wanted to participate in social activities or other interests, support was not always in place to enable people to engage in these activities or to go out and enjoy a full and meaningful life.

We mostly observed respectful interactions with staff and people throughout the inspection. However, we observed that some agency staff did not always interact appropriately with people when supporting them. People and relatives commented on the high use of agency staff having an impact on the quality of care. The management team were doing all they could to recruit permanent members of staff.

There were systems in place to monitor the safety and quality of the service. However, there were still shortfalls in ensuring all documentation was accurate and up to date across people’s care records. Some people's records still contained conflicting information leading to uncertainty about what people’s up to date care and support needs were. These risks were mitigated as staff had a good knowledge of the people they were supporting.

Improvements were required in the cleanliness of the home. At the time of the inspection there was a vacancy for a member of cleaning staff. The management were endeavouring to fill this role to reduce the burden on care staff having to undertake cleaning duties.

The manager had instigated systems and processes to keep an overview of incidents and accidents and take actions to minimise these happening again.

The manager and provider had taken action to reduce risks in relation to the premises, such as fire risks and maintenance of equipment and environment.

Staff supported people with their medicines and kept people safe from risk of harm.

We received consistent positive feedback about the manager from people and their relatives and how communication and relationships with the service had improved under the manager’s leadership. Staff reported they felt very supported by the current manager and felt the culture of the service had improved.

People’s access to health care support had improved. There was a visiting physiotherapist who reported that staff were responsive in carrying out the necessary exercises with people. The manager told us that a physiotherapy assistant had been recruited and was due to start at the service.

People and/or their legal representatives had been supported to discuss the risks and benefits of particular decisions, such as whether they would prefer to be resuscitated in the event of a cardiac event

The provider had developed a system of ensuring all complaints were dealt with in line with their policy and procedures. For example, outcomes were recorded in response to complaints received or any evaluation to evidence any actions required as a result.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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 (published 3 March 2022) and there were breaches of regulation. We imposed conditions on the provider’s registration to submit regular information to tell us what action they were taking to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of all of these regulations. The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last four consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 and 16 November 2021. Breaches of legal requirements were found. We imposed conditions on the provider's registration to regularly inform the CQC how they were progressing with improving the service in respect of Regulation 9 Person centred care; Regulation 12 Safe care and treatment; Regulation 16 Receiving and acting on complaints and Regulation 17 Good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this focused inspection to check they had made the required improvements and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make continued improvements.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for John Masefield House 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 monitor the service and will take further action if needed.

We have identified continued breaches in relation to person centred care (regulation 9) and good governance (regulation 17).

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

John Masefield House is a residential care home providing personal and nursing care for up to 22 physically disabled adults. There were 19 people living at the service at the time of the inspection.

People’s experience of using this service and what we found

The provider had not evidenced their understanding of ensuring quality performance, risks and regulatory requirements were in place. The provider had not evidenced continuous learning from previous inspections to improve and sustain care delivery. Systems were not always in place or effective to ensure all documentation was accurate and up to date. Quality assurance arrangements were not in place to monitor and improve the service. People’s records contained conflicting information leading to uncertainty about the accuracy and relevance of the information.

There was no registered manager in post at the time of the inspection. At the last comprehensive inspection in October 2020 we reported that there had been several managers since the provider registered in August 2019, which had resulted in poor and conflicting management. There was a new manager in place who intended to apply to register with the Care Quality Commission.

The provider had not ensured that all risk had been assessed, monitored or managed effectively to ensure people were safe. We found long standing actions in respect of potential fire risks. Staff were not fully up to date in aspects of safety training in respect of moving and handling and fire training. People’s records did not accurately reflect professional guidance in areas such as thickened fluids and use of equipment for their condition. We found systems to keep an overview of incidents and accidents were incomplete and not reviewed to see if there were any patterns and what had been put in place to minimise these happening again. The provider had not ensured the safety of all equipment such as medical equipment and vehicle maintenance.

Staff said they did not feel engaged with, or supported by the provider. Inconsistent leadership was impacting on the culture at the service. There were concerns that staffing levels were being affected by staff resigning which meant there was a risk of people being impacted by a lack of consistent, experienced and knowledgeable staff.

People were not always supported to access all healthcare services they had been assessed as requiring. For example, there had been a long period of absence of physiotherapy support in the home.

The provider had not always enabled and supported people to discuss the risks and benefits of particular decisions. Information on how to fully communicate with people who were non-verbal was limited.

People had not been supported to follow interests and take part in activities that were important to them. Staff reported feeling overwhelmed with the amount of tasks and there were no specific staff to support people in meaningful activities.

Complaints were not always responded to in line with the provider’s policy and procedures. We found no outcomes recorded in response to complaints received or any evaluation to evidence any actions required as a result.

We observed warm and respectful interactions with staff and people throughout the inspection. Staff, relatives and residents all gave positive feedback about the new manager but expressed concern about the long-term position due to high turnover of previous managers.

Medicines were managed safely and we noted the home had a good standard of cleanliness with staff adhering to infection prevention and control policies and procedures.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 4 March 2021). The service remains rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and consistency of management. A decision was made for us to inspect and examine those risks.

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.

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 have identified breaches in relation to safe care and treatment, providing person centred care, receiving and acting upon complaints and governance of the service. 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for John Masefield House on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

John Masefield House - Care Home with Nursing Physical Disabilities is a residential care home providing personal and nursing care to 19 people at the time of the inspection.

John Masefield House - Care Home with Nursing Physical Disabilities accommodates up to 22 people in one adapted building. The service specialises in supporting people with a range of physical disabilities.

People’s experience of using this service and what we found

Improvements had been made to the management of the service. Effective systems had been introduced to enable the provider to monitor and improve the service. Feedback about the home manager and the improvements they had made were positive.

Communication had improved to ensure people, relatives and staff were kept informed of the progress the service was making and were involved.

There was a person-centred culture that put people at the centre of all the service did. This was promoted by the home manager and had a positive impact on staff morale. Staff felt valued and listened to.

Risk assessment processes had improved. Care plans contained detailed risk assessments and management plans which ensured people received safe care. Medicines were managed safely by trained, competent staff.

Systems had been introduced which ensure the safety of equipment and the environment. There was a refurbishment plan in place to improve the environment for people.

There were sufficient staff to meet people’s needs and the provider continued to actively recruit to vacant posts.

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 inadequate (published 3 December 2020) and there were multiple breaches of regulation. We issued warning notices in relation to Regulation 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 3 December 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 coronavirus and other infection outbreaks effectively.

We carried out an announced comprehensive inspection of this service on 22 October 2020. Breaches of legal requirements were found. The provider was issued with warning notices relating to safe care and treatment and good governance.

We undertook this focused inspection to check they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for John Masefield House - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk.

John Masefield House is a residential care home providing personal and nursing care for up to 22 physically disabled adults. There were 22 people living at the service at the time of the inspection.

People’s experience of using this service and what we found

The service was not well-led. The provider did not have effective systems in place to monitor and improve the service. There had been significant changes in the management of the service which had resulted in poor leadership and oversight. Everyone was complimentary about the new home manager and the positive changes that had already been made as a result of them joining the service.

Risks to people were not always assessed and managed to ensure action was taken to mitigate risks. This included risks associated with the use of equipment, eating and drinking and diagnosed health conditions. We were not assured that the provider had implemented effective infection control systems to ensure people and others were protected from the risks associated with COVID-19. Systems in place did not ensure the safe management of medicines. Health and safety measures in place in the environment did not always ensure people were safe.

There were sufficient staff to meet people’s needs. However, the service relied on a significant amount of agency staff which impacted on people’s care.

Relatives did not always feel that communication through the COVID-19 pandemic had been effective and told us arrangements to keep relatives in touch with loved ones had been sporadic.

People did not always receive food and drink to meet their needs. We received mixed feedback about the quality of food. However, we received positive feedback about the new chef who had recently joined the service.

Care plans were not always up to date and contained conflicting information relating to people’s care needs and how these should be met. However, care plans did include person-centred information that enabled staff to know people well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Where people were supported by staff who knew them well, people were treated with dignity and respected as unique individuals. However, some staff did not always treat people with respect. People were involved in decisions about their care and supported to access advocacy services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 6 August 2019 and this is the first inspection.

The last rating for the service under the previous provider was requires improvement published on 10 July 2018.

Why we inspected

The inspection was prompted in part due to concerns received about lack of equipment, impacting on people’s quality of care and lack of leadership and provider oversight of the service. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, and well-led sections of this full report.

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 risks to people’s safety and the effectiveness of management systems to keep people safe.

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

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

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.