This inspection took place on 20 and 21 July 2016 and was unannounced. The service is a care home that provides personal care and accommodation for up to 42 older people. There were 39 people using the service at the time of our inspection. There was a registered manager in place. 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. We last inspected this service in July 2013 and found no concerns. We identified concerns at this inspection in relation to staffing, which included recruitment processes, training, deployment and staff interaction with people who used the service. We identified concerns with the leadership and culture of the service and found that people were not always protected by processes and safe staff practice.
Although staff had received guidance in relation to safeguarding processes, they did not always protect people from harm. Risks were not always managed effectively to help people maintain their health and a high number of incidents had occurred at the home, which records showed had not been analysed for themes or trends to learn from and to prevent further incidents.
People received their medicine safely, yet they did not always receive their medicines in a way that maintained their dignity. Although audits had identified some inaccurate medicines recording, this issue had not been rectified and put people at risk of not receiving their medicines as prescribed. Records showed that staff had not received training or updated guidance in relation to medicine administration.
Feedback showed that there had not always been enough staff to meet people’s basic needs at all times and our observations confirmed this. People were not always protected by safe staff recruitment practices. Records were not robust to support the running of the service or to assist in keeping people safe.
Staff had not received all training for their roles and our observations confirmed that they were not consistently equipped with the knowledge and skills to meet people’s needs. Where some staff were aware of appropriate and safe practices, they failed to consistently apply these to protect people from harm.
The service did not act in line with the principles of the Mental Capacity Act. Some people were restricted by staff practices at times and we saw that this caused them distress. People were not always supported to make decisions and their consent and choices were not consistently sought or respected.
People did not always have access to sufficient nutrition and hydration to help them to stay safe and well and healthcare professionals had raised concerns about this. There were ineffective processes in place to ensure that people were always supported by competent staff in a way that reflected their needs, or that concerns that people had not eaten were recognised or addressed.
Most relatives told us that staff met people’s needs, yet feedback suggested that this was inconsistent and we saw that some staff did not understand people’s needs. People had access to healthcare support as required for their needs and healthcare professionals told us that staff referred people promptly for support.
Staff were not consistently caring and failed to develop meaningful relationships with people and involve them in their care. Staff did not consistently express compassion or concern for people and did not always seek to act on their wishes. There were not robust systems in place to ensure that staff were aware of people’s interests and preferences. Staff failed to consistently treat people with dignity and respect.
Care was not always responsive to all people’s needs in a way that enabled them to have a good quality of life. Care plan reviews were not always completed in a timely way or to ensure that care reflected people’s needs and preferences. There was a complaints process in place, yet concerns were not always dealt with openly and had not been used to drive improvement in the service.
We identified concerns with leadership of the home. There was a failure to maintain oversight of the service or effectively resolve concerns to ensure that people were always kept safe and always supported by staff who were competent and respectful. Processes at the home were not robust to protect people and ensure that their needs were met.
People’s feedback was not consistently acted on in an open way and the registered provider and registered manager had not always acted transparently or fulfilled the requirements of their role. Staff were not always set clear direction in their roles and concerns in relation to the culture of the service and approach of staff were not addressed. The registered manager was not always approachable and feedback suggested that this had reflected into staff practice.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
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.