Archived: Smallcombe House

Updated 12 December 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.

The inspection was prompted by information of an incident of alleged serious abuse involving a person using the service. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk and of other incidents where people may have experienced harm. This inspection examined those risks.

At the inspection we knew of one incident being investigated by the police and an ongoing investigation by the local authority into safeguarding practices at the service. The local authority investigations included individual incidents as well as looking at the whole service. These investigations had not yet been concluded by the local authority.

The inspection team consisted of two inspectors on all three days and an expert by experience on our second day of inspection, 30 July 2018. 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 we reviewed information from the local authority, the provider’s plan identifying how they planned to improve the service following our inspection of March 2018, and other information we had about the service including statutory notifications. Notifications are information about specific events that the service is legally required to send us.

We spoke with seven people living at the service, two relatives and nine staff members, this included senior staff, two members of the provider’s senior management team and the registered manager. We also spoke with three health/social care professionals. We reviewed eleven people’s care and support records and three staff files. We also looked at records relating to the management of the service such as incident and accident records, meeting minutes, recruitment and training records, policies, audits and complaints.

Some people at the service may not be able to tell us about their experiences. We used a number of different methods such as undertaking observations to help us understand people’s experiences of the home. As part of our observations we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the needs of people who could not speak with us.

Updated 12 December 2018

The inspection took place on 23,30 July 2018 and 07 August 2018 and was unannounced on all three days. At our last inspection in March 2018 we found the service was in breach of one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to Regulation 17, good governance. We had found there were still shortfalls around accurate and consistent record keeping, medicines and effective systems to monitor and review the quality of the service. In addition we had made a recommendation around supporting people with their nutritional needs. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Smallcombe House, on our website at www.cqc.org.uk.

This inspection was prompted by information of an incident of alleged serious abuse involving a person using the service. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

Smallcombe House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Smallcombe House accommodates up to 32 people across three floors, one of which contains the foyer, communal lounge, dining room and offices. At the time of our visit there were 24 people living at the service.

There was 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 2008 and associated Regulations about how the service is run.

People told us they generally felt safe at the service. Their feedback was mixed, with both positive and negative responses to our enquiries about their experiences of care.

We found the service to be inadequate in safe, effective, caring, responsive and well-led. At our inspection in March 2018 the service was Requires Improvement in all five domains with one breach of regulations regarding the quality of record-keeping. The provider had sent CQC an action plan, but we found that none of the actions had been completed and the service had deteriorated. At this inspection we found the provider was in breach of an additional nine regulations.

People did not receive a caring service. We found institutional practices delivered by poorly trained and insufficient staff. During the first two days of our inspection we observed only one out of three care staff engaged with people in a warm and friendly manner.

The service was not clean, there was a strong unpleasant odour in the communal lounge and in some people’s bedrooms. Furniture in the lounge was worn and dirty with visible stains. Equipment used to support people had not been cleaned. We found toiletries left in bathrooms alongside prescribed creams for people which constituted a risk of cross infection. Communal toilets on the ground floor were not cleaned frequently enough. This lack of cleanliness did not support people’s dignity. We raised this at our inspection on 23 July 2018, however action was not taken until after our second visit on 30 July 2018. We again visited on 07 August 2018 and found that the odour, whilst not being completely absent, had reduced and all furniture in the lounge had been steam cleaned. The service was generally cleaner overall, however we identified two people’s rooms which needed further cleaning.

People were supported to sit in the lounge during the day, however we observed little interaction or stimulation for people. The majority of people appeared asleep or withdrawn. We observed, on the first two days of our inspection, that some staff communicated with people in a brusque and task focussed manner. On the third day we observed some staff were communicating appropriately and engaging with people.

There were not enough competent staff at the service to support people safely. The service used high numbers of agency staff. Agency staff received minimal information about people and were given a list of tasks to carry out. There was no information provided about people’s preferences. The provider had sent an action plan to CQC on 06 August 2018 which stated this information had been updated. When we inspected on 07 August, we found this information had not been fully updated.

People’s care records were not up to date and daily records were disorganised, making it difficult to understand people’s current needs. Accidents and incidents were not recorded clearly and were not followed up according to the provider’s policies on reporting incidents and safeguarding.

The management of the service was ineffective. Since the inspection in March 2018 the quality of the service had deteriorated significantly. Systems in place to monitor the quality and effectiveness of the service had not been used effectively. None of the shortfalls found in the inspection of March 2018 had been addressed. We found further shortfalls on 23 July 2018 and fed these back. No action was taken. We again inspected on 30 July 2018 and following this requested an immediate action plan from the provider. We carried out a further follow up visit to check on the safety of the service on 07 August 2018.

We found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to

reports after any representations and appeals have been concluded.