27 June 2017
During a routine inspection
We carried out this unannounced inspection on 27 June 2017. At our previous inspection on 24 March 2015 they were rated Good.
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.
The service had a registered manager in post, however; they had not been at the service for a number of months. Another manager had taken over the service, however; the registered manager had not cancelled their registration and the new manager had not applied to register with us. 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, their relatives and staff members had been through a period of consultation regarding the future of the service, led by the provider. A number of options had been discussed through meetings and other information provided. The consultation period had completed when we carried out our visit, but the outcome of this was not yet known, and was due to be published in August 2017.
Incidents and accidents were recorded by the service however; incidents of potential abuse were not always treated as safeguarding concerns which meant that external organisations were not informed of these concerns. We also saw that risk assessments were not always up to date and reflective of recent developments or changes in people's conditions. Where repeated incidents occurred, such as falls, risk assessments did not reflect that this had happened. Staff members supported people to take their medicines, however; the systems for recording this were not robust and we saw that this led to errors in the way the administration of medicines was recorded.
Staff members sought people's consent before providing them with care, however; consent was not documented in people's care plans and the service was not acting in accordance with the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Staff were not supported with regular supervision or appraisal, however; they did receive training to provide them with the skills they needed to perform their roles.
People and their family members were not always involved in making decisions about their care or support arrangements. Care plans were in place but they were not always person-centred. They were reviewed on a regular basis but without the input of the individual or their relatives. People were not regularly active or stimulated whilst living at the service. There were some activities at the service but these were not always reflective of people's individual preference or interests.
Quality assurance systems were in place at the service, however; they were not effective in assessing, monitoring and improving the quality of care provided. Checks and audits were carried out but were not done so regularly and were not used to help the service develop or improve.
Staffing levels at the service were sufficient to meet people's care needs and there were robust recruitment practices in place to ensure that staff were of good character to perform their roles. Staff members were kind and compassionate in their interactions with people and worked to create a positive and relaxed atmosphere at the service. People's privacy and dignity were promoted and they were provided with information about the service and what they could expect from members of staff.
People were provided with support where necessary to maintain a healthy and balanced diet. They were provide with choices about meals and drinks and were encouraged to eat as healthily as possible. We also found that people were supported to maintain good health and had access to a range of different healthcare professionals when needed.
There was a positive and open culture at the service. Staff were motivated to meet people's needs and believed in the ethos of the service. People's feedback about their care was welcomed and compliments and complaints were responded to. Feedback surveys were used to gather people's opinions and were analysed on an annual basis.
We identified a number of breaches of legal requirements during this inspection. 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.