Background to this inspection
Updated
22 June 2019
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.
This inspection took place on 29 and 30 October 2018 and was unannounced. The inspection team consisted of one inspector, an assistant inspector, a Specialist Advisor and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Specialist Advisor was a qualified nurse with experience of working with older people and people who may exhibit behaviours that can challenge others.
As part of the inspection we reviewed the information we held about the service. We looked to see if statutory notifications had been sent by the provider. A statutory notification contains information about important events which the provider is required to send to us by law. We sought information and views from the local authority. We also reviewed information that had been sent to us by the public. We used this information to help us plan our inspection.
During the inspection we spoke with 11 people who used the service and four relatives. We spoke with the provider (who is also the registered manager) and 10 members of staff including, deputy managers, the cook and care staff. To help us understand the experiences of people we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people living at the service. We also carried out observations across the service regarding the quality of care people received. We reviewed records relating to people’s medicines, nine people’s care records and records relating to the management of the service; including recruitment records, complaints and quality assurance records.
Updated
22 June 2019
This inspection took place on 29 and 30 October 2018 and was unannounced. At the last inspection completed in April 2018 the service had been rated as ‘requires improvement’. The provider was not meeting the legal requirements regarding safe care, staffing levels, dignity and good governance. The service was in special measures. It first entered special measures following an inspection that ended on 11 September 2017. The service remained in special measures following the last inspection. At this inspection we found the provider had endeavoured to make some improvements, although these had failed to improve the quality of care provided. We saw overall the standards of quality had deteriorated. The provider remained in breach of some legal requirements and we identified further breaches of regulations.
Angel Court Residential Home 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. The service accommodates up to 30 older people. At the time of the inspection there were 19 people living at the service, most of whom were living with dementia.
A registered manager was 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.
The provider had not ensured that all incidents that may be considered as safeguarding concerns were identified, reported to the local safeguarding authority and investigated appropriately. People were not always protected from the risk of ongoing harm. Risks to people including those due to behaviours that can challenge, mobility and swallowing issues were not fully understood and managed safely.
People were supported by sufficient numbers of care staff although these staff were not always deployed effectively in order to ensure people’s needs were met. While some improvements had been made to medicines management systems, further improvements were still required. In particular around the management of creams and medicines that had been prescribed to treat those people with challenging behaviours.
People were not always supported by care staff who had been equipped with the skills and knowledge they required to support people safely and effectively. People’s consent to their care was not always obtained and steps were not taken in people’s best interests in line with the law where they lacked mental capacity. People’s basic nutritional needs were mostly met although improvements were still needed.
While care staff had good intentions, the care people received was not always caring. People’s dignity was not always upheld and people were not always treated with respect and empathy. People’s independence was not always fully promoted and they were not given maximum control over their choices and lives.
People did not always receive fully personalised care. They were not always involved in planning the care they received and care staff did not fully understand people’s needs. People did not have sufficient access to the leisure opportunities and they were not encouraged to pursue personal interests.
People were not encouraged to complain and share their views about the service in order to ensure improvements could be made.
People were not cared for by a staff team who were fully supported by the provider. People did not feel the culture within the service was open and that it was safe to speak out about concerns they had. People were not living in a service where a culture of continuous improvement was present. Further improvements were still needed to quality assurance and governance systems which remained ineffective.
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 provider was in breach of the regulations surrounding safe care, person-centred care, the need for consent, dignity and good governance. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.