19 April 2023
During an inspection looking at part of the service
The service is a detached property in its own grounds. It has two floors with access to the upper floor via stairs, chair lift or a passenger lift. Seventeen rooms have en-suite facilities and there are shared bathrooms, shower facilities and toilets. Shared living areas include two lounges and an open plan dining room with seating areas. There is a rear garden and patio area with seating.
People’s experience of using this service and what we found
The inspection was prompted following concerns we received about the changes of management of the service and the impact on the care people received. At the time of the inspection, the manager had been in post for a month and was not registered with the Care Quality Commission (CQC). The manager had submitted their application with CQC but had agreed to defer it whilst they gained further experience at the service.
There had been a number of manager changes over the last 2 years at the service. Feedback from staff, and from the review of records and care documentation evidenced there was poor oversight of the service which was affecting aspects of the operation of the service. Audits to oversee the service were not always fully effective in identifying areas for improvement.
Relatives were also concerned about the impact of the management changes on the service. Relatives commented “The day-to-day care of my mother has generally remained good however due to the frequent changes in manager I feel there has been a lack of continuity.”
Care plans and risk assessments had been reviewed but when peoples care needs had changed, they were not always updated promptly on the person’s care plan or risk assessment. This could lead to people receiving inconsistent care.
Some people could find it difficult to express themselves or manage their emotions. This could lead to distressed behaviour which could put them, or others at risk. People's care plans did not always inform, direct or guide staff in the actions to take when people were becoming anxious and how to support them. As staff had no guidance when a person became anxious, this meant that there was no consistent understanding or approach in how to support people.
The medicines system was not robust. The recording of medicines received at the service and administered were not consistently completed. This could lead to potential errors. Some people were prescribed medicines to be taken when required, there was a lack of guidance when this medicine should be administered. Staff did not record the reason for giving a when required medicine or whether it was effective.
Staff told us there were not enough staff on duty to undertake all duties. The provider did not have a dependency tool to calculate the staffing levels needed to support people’s care needs. However people told us that staff responded in a timely manner when they called for assistance.
People using the service and their relatives told us they felt they were cared for by the core staff team who were skilled, caring and respectful. We observed many kind and caring interactions between staff and people. Staff spent time chatting with people and knew the people they supported well.
Due to the changes in leadership this had impacted on the level of staff support and some training.
The provider had effective safeguarding systems in place and all staff had a good understanding of what to do to help ensure people were protected from the risk of harm or abuse.
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.
The food provided by the service was enjoyed by people.
People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately
Staff were motivated and fully focused on ensuring people's needs were met.
Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection:
The last rating for this service was Good (published 29 November 2018).
Why we inspected
We were prompted to carry out this inspection due to concerns we received about the lack of leadership and 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 COVID-19 and other infection outbreaks effectively.
Enforcement
We found 2 breaches of regulation in relation to staffing, medicines and lack of leadership and oversight of the service at this inspection.
Please see the action we have told the provider to take at the end of the full version of this report.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.