This inspection took place on 4 November 2015 and was unannounced. Watford House is registered to provide accommodation and personal care for up to 43 people. Some of whom were living with dementia. At the time of this inspection 36 people used the service. The last inspection was completed in March 2014 and was compliant with the Regulations we looked at. These included Regulation 9 care and welfare of people, Regulation 14 nutritional requirements, Regulation 12 infection control, Regulation 18 staffing and Regulation 17 records.
Since the last inspection there had been a change in the management arrangements of the service in that the registered manager had resigned the position. A person had been recruited for the manager’s position but has not been registered with us. They told us an application to register would be submitted shortly. 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.
Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. People were not always kept safe and their welfare and wellbeing was not consistently promoted because risk assessment and care plans were not consistently followed.
Medication systems, administration and storage were unsafe. People were at risk of not receiving their prescribed medication when they needed it or in the correct way.
Some staff were unsure of the actions they needed to take if they had concerns regarding people’s safety. Incidents were not identified as potential abuse; they were not reported or investigated.
Staff did not receive the required training or supervision they needed to support people with their care needs. Infection control was compromised by staff working practices. Some equipment was unsuitable and incorrectly used and areas within the environment were unhygienic which posed a risk of harm for people.
CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLs) and to report on what we find. There were restrictions of movement in place as people could not access all areas within the home with ease.
People had access to healthcare professionals but did not always receive medical support and interventions in a timely way to ensure their health and well-being was upheld.
People’s care was not personalised and did not reflect their individual needs and preferences. Recreational and leisure activities were arranged throughout the week. Some people were given the opportunity to participate in the group activities if they wished to do so. However most people spent long periods of time with little or no stimulation. People were not treated with the dignity and respect.
The provider did not have effective systems in place to assess, monitor and improve the quality of care. Poor care was not being identified and rectified by the provider.
The provider did not inform us of reportable incidents that occurred at the service. This meant we were unaware of incidents, for example injuries and safeguarding concerns that had occurred within the home.
People were aware of the complaints procedure and knew how and to whom they could raise their concerns. Staffing levels were sufficient to provide basic care and support to people.
The provider had a recruitment process in place. Staff were only employed after all essential pre-employment safety checks had been satisfactorily completed.
We found several breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of The Care Quality Commission (Registration) Regulations 2009.
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.
You can see what action we told the provider to take at the back of the full version of the report.