Archived: Fourwinds Residential Care Home

Updated 6 February 2018

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 5 October 2017 and was unannounced. The 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.

Before the inspection, the provider completed a Provider Information Return. 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. We looked at action plans and notifications received by the Care Quality Commission which a provider is required to send us by law. Notifications are information we receive from the service when significant events happen, like a death or a serious injury. We reviewed information we had received from other sources including health and social care professionals.

During our inspection we spoke with 12 people living at the service, one person’s relative, the manager, the provider and five staff. We visited some people’s bedrooms, with their permission; we looked at care records and associated risk assessments for six people. We looked at management records including staff recruitment, training and support records, health and safety checks for the building, and staff meeting minutes. We looked at medicines records and observed people receiving their medicines.

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 last inspected Fourwinds Residential Care Home in March 2017 and rated the service Inadequate overall. We found that the provider was in breach of a number of regulations and we took enforcement action.

Updated 6 February 2018

This inspection was carried out on 5 October 2017 and was unannounced.

Fourwinds Residential Care Home provides accommodation and personal care for up to 35 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. The service has 31 single bedrooms and two double bedrooms that people could choose to share. There were 16 people living at the service at the time of our inspection.

At our inspections in May 2015, July 2016 and March 2017 we found the service was in continued breach of several regulations. We required the provider to make improvements and when they did not we placed the service into special measures and took enforcement action against the provider. This process has concluded and we cancelled the provider’s registration to provide accommodation and personal care to people at Fourwinds Residential Care Home.

A manager was working at the service. A registered manager had not been leading the service since May 2015. The manager had applied to be registered but withdrew their application following our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider and manager did not have oversight of the service and had not taken sufficient action since our last inspection to support staff to provide a consistently good service. The manager began working at the service in June 2017 and told us they had not been supported by the provider to fulfil the role and make the necessary improvements to the service. The provider however told us they had supported the manager, including employing consultants to support improvements.

The manager and staff did not understand the visions and values for the quality of the service provided. Checks on the quality of service provided continued to be ineffective and the shortfalls in the service we found at this inspection had not been identified. The views of people, their relatives and stakeholders had not been used to improve the service. Staff had not been asked for their views about the service or been involved in planning the necessary improvements.

At our previous inspections we required the provider to make improvements to staffing levels. Staffing levels had increased, however; staff were not consistently deployed at the right times to meet people’s needs. People who needed support to tell staff about their needs and wishes, because they could not communicate using speech, received little support and attention from staff. People told us they had to wait for the support they needed at times.

Staff had not completed all the basic training they needed to provide safe and effective care to people despite the provider purchasing a training package. They did not regularly meet with the manager to discuss their role and practice. Staff told us they did not feel supported and were not confident to raise concerns with the manager.

Staff knew the signs of possible abuse but were not confident to raise concerns they had with the manager. They were still not confident to raise any concerns with the provider as they felt they would not take any action.

Previously we required the provider to make improvements to the way risks to people were managed. Action had not been taken to manage all risks and people continued to be at risk of choking or developing skin damage. An analysis of accidents had not been used to identify any changes in people’s needs and then plan care to reduce risks to them. Improvements to the way medicines were managed had not been sustained and people were at risk from poor medicines management.

Food was not always prepared to meet people’s needs, including people at risk of choking. Menus did not offer people a balanced diet. People were not involved in planning the meals provided at the service. People were not supported to stay as well as possible.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS authorisations had been granted for five people who lacked capacity to consent and were restricted. Imposed restrictions on people had not been reviewed to ensure they were kept to a minimum. We observed one person asking to go out being stopped from doing so by staff and staff were not working within the framework of the person’s DoLS to support them to go out.

Staff did not follow the principles of the Mental Capacity Act 2005 and people were not supported to make decisions. Assessments of people’s ability to make day to day decisions had not been completed and guidance had not been provided to staff about how to support people to make decisions.

People and their relatives continued not to be involved in planning their care. People’s care plans had not been regularly reviewed to identify any changes in their needs. Care plans had not been up dated when people’s needs changed and up to date guidance was not available to staff about people’s needs.

Although people and their relatives told us that staff were caring, people were not always treated with respect. Staff continued not to listen and respond to people’s requests, including requests for drinks. Activities some people took part in had improved however other people continued not to be supported to take part in any social activities. People told us they had privacy.

A new complaints process had been introduced. However, some people told us they were not confident to raise concerns they had with the manager and the provider.

Records about the care people received continued to be inaccurate and incomplete. Dates had not been fully recorded so staff and health care professionals could refer to the most up to date information. People’s personal information was now stored safely.

The provider had not notified us of four notifiable events so we could check that appropriate action had been taken. The CQC performance rating was now displayed at the service, as required.

When staff were employed by the service, all the required recruitment checks had been completed, including obtaining a full employment history. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Improvements had been made to the environment, some areas had been redecorated and some new furniture purchased.

The overall rating for this service has been ‘Inadequate’ for more than 12 months and service was in ‘Special measures’. We kept the service under review and took action in line with our enforcement procedures. We cancelled the provider’s registration for the service and the service has closed.