This inspection took place on 2, 3 and 4 June 2015 and was unannounced. At our last inspection in August 2014 we found the provider was not compliant with the requirements of the law with regards to safeguarding people from abuse, management of medicines, assessing and monitoring the quality of service provision and records. The provider had submitted an action plan regarding the actions they would take to improve. We saw that some areas had improved, for example, there were now risk assessments present for the kitchen. Insufficient improvements had been made overall and some areas had not be adequately addressed.
Hilton Rose Retirement Home is a residential home that provides accommodation for up to 25 older people who require personal care. At the time of our inspection 25 people were living at the home. The majority of people currently living at the service have dementia. There is currently 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.
During our inspection, we found that people’s medicine was not always received as directed by their doctor. We found errors with the administration and recording of medicines and we observed unsafe practices when staff were giving people their medicine.
People were not always receiving appropriate support due to insufficient staffing levels at certain points during the day. We observed people waiting for support and sometimes attempting to complete tasks independently that they required support with due to the lack of available staff.
People were not protected from abuse due to unsafe recruitment practices. We saw the absence of background checks such as DBS certificates and references.
We found inadequate risk management within the service. This included call bells that allow for people to call for support being out of people’s reach, inadequate risk assessments and people being supported to move in a way that could cause an injury.
Staff could explain what abuse was which showed they could recognise signs of potential harm. Staff could describe how they would report abuse and told us that they would be happy to whistle blow if they were required to.
We found issues with hygiene within the home during our inspection. These issues included a smell of urine in certain areas, unclean communal areas and poor hygiene practices of some people living at the home following visits to the toilet with insufficient support.
We found that people’s capacity had not been assessed in line with the required legislation and people were not consenting to the support they received. We saw that where people’s liberty was being restricted in order to protect their safety and well-being, appropriate applications had been submitted to the local authority in most cases.
We saw that people were not always supported to effectively maintain their health. People had regular access to the GP, optician and chiropodist although most people within the service had not seen a dentist for several years. We did not see evidence that people with diabetes had seen a chiropodist recently. We found examples where instructions from external healthcare professionals had not been identified and implemented.
We saw that staff were given opportunities to complete further qualifications such as a diploma in health and social care or in dementia. We also saw that training had not always been completed in the areas that staff were working. Staff told us that they felt supported in their role and had regular one to one meetings with their manager.
People told us that they enjoyed the food they ate and adaptations had been made to meals for special dietary requirements such as diabetes.
We saw people’s privacy and dignity being compromised during our visit. In particular with people visiting the toilet with doors open and being left with aprons on and food down them for a lengthy period of time.
We saw that there were dementia friendly aids present within the service such as handrails and adaptive toilet seats to assist people with their independence. However, certain things were observed that would disorientate someone with dementia, such as clocks showing the incorrect time.
People were not actively involved in making decisions about their care and the development of their care plan. We observed staff involved in positive, caring interactions with people. We also saw situations where staff made decisions without consulting people, for example changing TV channels in communal areas.
We saw that the care people received and their care plans were not always updated in line with their changing needs. Staff told us that they felt care plans were up to date which demonstrated that staff may not always be aware of people’s current needs. People were not encouraged to pursue a range of leisure opportunities.
Feedback surveys were completed to obtain people’s views on the service. Staff told us that they always obtain feedback from people when they support them, either verbally or by monitoring their reactions and enjoyment.
We found that there were insufficient audits and quality assurance processes in place. We saw that audits that were in place didn’t always identify issues and concerns.
Staff felt that the management team were approachable and they were happy with the level of involvement both they and the people living at the service received.
We found areas in which the provider was not meeting the requirements of the law. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this provider is ‘inadequate’. This means that is 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 the providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measure will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.