Background to this inspection
Updated
5 February 2015
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 was 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 28 October 2014 and was unannounced.
Our inspection team consisted of two inspectors 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. The expert by experience had experience of older people and people living with dementia.
Before the inspection, the provider was sent a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider did not submit a completed PIR to us despite confirming they had received the request.
We checked the information we held about the service and the provider. This included the notifications that the provider had sent to us about incidents at the service and information we had received from the public and the local authority. We used this information to formulate our inspection plan.
We spoke with six people who used the service and two relatives. We did this to gain people’s views about the care. We also spoke with three members of care staff, the activity coordinator, the deputy manager and the registered manager. This was to check that standards of care were being met.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We looked at 11 people’s care records to see if their records were accurate and up to date. We also looked at records relating to the management of the service. These included audits, health and safety checks, staff rotas, training records, three staff recruitment files and minutes of meetings.
Updated
5 February 2015
We inspected this service on 28 October 2014. The service was registered to provide accommodation and personal care for up to 22 people. People who use the service have physical health and/or mental health needs, such as dementia.
At the time of our inspection accommodation and care was provided to 17 people.
The service had a registered manager in post. 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 and associated Regulations about how the service is run.
At the last inspection on 14 April 2014 we asked the provider to make improvements. These were in relation to the content and accuracy of the information contained in people’s care records, how the quality of care was assessed and monitored and how the staff’s professional development needs were monitored and managed.
During this inspection we found that the registered manager and provider had failed to make the required improvements. This meant the provider had continued to not meet the standards required to meet people’s care and welfare needs.
We also identified additional areas of unsafe, ineffective and unresponsive care. This was because the service was not well led. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and The Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.
Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. This meant people were not always kept safe and their welfare and wellbeing was not consistently promoted.
There were insufficient numbers of staff to keep people safe and provide the right care at the right time. This also meant that people’s individual care preferences and needs were not always met.
Records relating to people’s care were not always accurate, up to date or readily accessible in the event of an emergency situation. This meant people were at risk of receiving unsuitable or unsafe care. Records in relation to the management of the home did not always contain information relating to criminal checks completed on the staff. This meant people could not be assured they were being cared for by suitable staff.
The provider did not monitor the staff’s performance or learning needs. This meant people could not be assured that they were receiving care from staff who were appropriately skilled.
People were at risk of dehydration and malnutrition were not always monitored to ensure they ate and drank sufficiently. When people lost significant amounts of weight the registered manager could not show us that professional advice had been sought. This meant that people’s risks of malnutrition and dehydration were not always managed.
Some people who used the service were unable to make certain decisions about their care. The registered manager and provider could not show us that under these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. This meant people could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves.
When staff had the time they supported people with care and compassion and respect. However, we saw that sometimes people were not treated with the care, compassion and respect they should have received.
People’s feedback about the care was sought, but the systems in place to analyse feedback needed to be improved so that feedback could be consistently listened to and acted upon.
The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.
The registered manager did not inform us of incidents that occurred at the service and pre-inspection information was not completed at our request. This meant we were unaware of incidents that had occurred within the home.
Medicines were given to people in a safe manner. People’s privacy was promoted and people understood the complaints process and the deputy and registered manager’s told us how they would respond to a complaint in accordance with the provider’s policy.