This inspection took place on 11 and 13 July 2016 and was unannounced.We previously inspected the service on 29 July 2015 and at that time we found the registered provider was not meeting the regulations relating to management of medicines. We asked the registered provider to make improvements. On this visit we checked to see if improvements had been made.
The service provides residential care for up to 25 people, some of whom are living with dementia. At the time of our inspection there were 19 people using the service, one of whom was a temporary admission.
The service is required to have a registered manager. 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 registered manager had left the service on 4 April 2016 and a new manager had come into post on 11 April 2016. They had applied to register with CQC but at the time of this inspection the application had not been finalised. The new manager of the service is no longer in post.
Some people who lived at Stockingate residential home told us they felt safe and three people we spoke with had concerns about safety.
Our inspection on 29 July 2015 found the registered provider was not meeting the regulations relating to the management of medicines because medicine to be returned to the pharmacy was not secured; so on this inspection we checked to see if improvements had been made.
We found medicines were not always managed in safe way for people and people were not always able to access as ‘required’ (PRN) medicines at night as there were no medicines trained staff on night duty. This was a breach of regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe management of medicines.
Staff had an understanding of how to safeguard adults from abuse and who to contact if they suspected any abuse, however the manager of the service had not acted on safeguarding concerns raised by people who used the service, staff and relatives. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Individual risk assessments were not always comprehensive and up to date to reflect risks to people and measures were not always in place to reduce the risks. Risk assessments were not always updated or followed to ensure people’s safety when eating. This was raised at our last two inspections as a concern. This was a breach of Regulation 12 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found people were not always protected against the risks of unsafe or unsuitable premises because the necessary safety checks were not being regularly completed and emergency plans were not in place. This was a breach of regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Sufficient suitably trained staff were not deployed to meet the assessed needs of people who used the service. This was a breach of regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We looked at the recruitment records of four members of staff. We found all the necessary checks had not been carried out for three of these before commencing employment with the home. This was a breach of Regulation 19 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
We found poor practice in the prevention and control of infections, which meant people were not protected against the spread of infection. This was a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Staff had not always received training to enable them to provide effective support to people who used the service, for example most staff were not up to date with or had not received training in managing behaviour that challenges or fire safety training. This was a breach of regulation 18 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
People’s capacity was not always considered when decisions needed to be made to ensure their rights were protected in line with legislation, for example when using a door sensor. This was a breach of regulation 11(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, need for consent.
People who used the service told us there was little choice of meals, and drinks were not always available. We found the risk of weight loss was not always managed well. This was a breach of regulation 14 of the Health and Social Care Act Regulated Activities Regulations 2014
A range of healthcare professionals were involved in people’s care as the need arose, however one person did not receive the health care they required in line with their care plan.
We observed staff interacting with people in a caring, friendly manner. Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported, however we saw on one occasional a person’s dignity was not protected with prompt personal care.
The choices of people who used the service were not always respected.
People did not always receive care that was planned to meet their assessed needs and there was a lack of meaningful activities for a number of people who lived at the home. These issues were a breach of Regulation 9 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Relatives told us they knew how to complain, however they told us the manager had not act on complaints. We saw no complaints had been recorded since the new manager had commenced employment with the service. This was a breach of regulation16 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Some relatives we spoke with felt consistent management had not been in place in recent months which impacted on support for their relatives.
We found the registered provider had not notified CQC of a number of safeguarding incident in line with legislation. This was a breach of Regulation 18 (2) (e) of the Care Quality commission (Registration) Regulations 2009 (Part 4).
Staff told us they did not feel supported and the manager was not visible in the service.
Appropriate records were not always kept and shared with CQC accurately during the inspection process.
People were not always consulted in how the service was run, however occasional meetings were held with relatives and staff.
The registered provider had some audits in place, but this system was not robust enough to identify and address the multiple risks and problems we found. The above issues were a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance.
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.
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.