This inspection took place over two days and was unannounced on the 1 June 2017, and announced on the 2 June 2017. The last inspection was completed in May 2015 and was awarded a rating of ‘good’.Eccleston Court is registered to provide nursing and personal care for up to 54 people with physical health needs, or people living with dementia. At the time of the inspection there were 45 people using the service. The service consists of two units, one of which provides nursing support to people who primarily have a physical health need and another that provides nursing support to people living with dementia.
At the time of the inspection there was no registered manager in post within the service. The previous registered manager had left in December 2016. A new manager had started within the service, just prior to the inspection in May 2017.
During the inspection we identified breaches of Regulations 10, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We are taking a number of appropriate actions to protect the people who are living in the service.
People within the service were not always safe. It was standard practice for sluice rooms in one unit to be left unlocked which placed people at risk of harm through coming into contact with hazardous materials. Fluid thickener was kept unsecured in people’s bedrooms, which can pose a risk of death if ingested inappropriately. Cupboards containing cleaning materials and alcohol had been left unlocked in the kitchenette in one unit, and staff did not know where the keys were to secure these. An oven was being used to cook people’s food in a communal area, and adequate action had not been taken to address the risks around this following a ‘near miss’ incident that had occurred a short time prior to the inspection visit. This showed poor risk awareness.
People were not always treated with dignity and respect. Staff did not always work in a person-centred way, and we observed examples where people living with a sensory impairment were treated in an undignified manner. People’s family members did not always feel welcome within the service, and some of them commented that they felt there may be reprisals from making a complaint. Staff took their breaks in communal areas; these areas were meant for people using the service, which gave the environment a feel of being oriented to meet the needs of staff rather than the people they cared for.
Staff did not have up-to-date training in areas needed for them to carry out their role effectively, and supervisions and appraisals had not been completed. Staff did not always demonstrate a good knowledge around health and safety, or person-centred care which demonstrated a lack of training in these areas.
Care records did not always contain accurate and up-to-date information about people’s needs, which meant that relevant information was not available to staff around how to support people. Staff did not always fill in daily monitoring charts correctly. For example one person’s nutritional monitoring chart incorrectly recorded that a person had eaten their porridge, however we observed that they had, in fact not eaten this.
People’s confidentiality was not protected. Staff spoke without discretion about people’s needs in communal areas, and personal information was not stored securely. Staff confirmed that handovers took place in a communal area, during which personal information about people’s needs was openly discussed.
Audits were not being completed by the service. For example, an analysis of information relating to care records, accidents and incidents, pressure wounds had not been undertaken which meant that trends and patterns could not be identified. The registered provider had completed a quality monitoring visit, which had identified areas that required improvement. However, we found that this process had not picked up on other issues. We also found that whilst action had been taken to address some of the issues identified, other areas remained unaddressed, for example staff training.
The registered provider had failed to take the required action in relation to a safeguarding concern as required by the local authority. This had been a recurring safeguarding concern relating to one person, which had occurred four times since December 2015. This showed that lessons had not been learnt, and demonstrated that the registered provider had failed to comply with the local authority’s safeguarding procedure.
People commented that they enjoyed the food that was available. We observed mixed examples of good and poor practice by staff during meal times. In one unit staff were attentive to people’s needs during meal times. However in the other unit staff were having discussions between themselves, and ignored the needs of one person with a sensory impairment. Catering staff did not have a good knowledge of people’s dietary needs, and had failed to ensure diabetic options were available for people’s desert.
Mental capacity assessments had been completed for some people and not others. Where people required their medication to be administered without their knowledge, a mental capacity assessment had not been completed and a best interests decision made. We have made a recommendation to the registered provider around ensuring they are compliant with requirements of the Mental Capacity Act 20015.
People received their medication as prescribed. The registered provider had successfully identified some issues around medication and made efforts to make improvements. We checked a sample of seven people’s medication and found the stock levels to be correct.
Activities and entertainment were provided to people to help keep them entertained. There were two activities co-ordinators in place to support people, and we observed examples of them doing arts and crafts and spending time with people on a one-to-one basis. However family members of those people living with dementia commented that they did not feel there was sufficient social stimulation for their relatives and that they spent a lot of time in bed.
We observed some examples of good practice amongst staff, where they were attentive and supportive of people. One member of staff showed us that they, along with a colleague made small gifts for the family members of people who had passed away within the service. This demonstrated an example of compassion by some members of staff.
The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
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.