Background to this inspection
Updated
24 June 2022
The inspection
We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act under the domains of safe and well-led, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was undertaken by four inspectors 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 service.
Service and service type
County Homes is a care home. People in care homes receive accommodation with personal or nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
This 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. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the Local Authority who work with the service.We used all of this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with the manager, the regional manager, seven staff from the nursing and care team and the activities co-ordinator. We reviewed a range of records. This included six people's care records, a sample of medication records, four staff recruitment files and records relating to the management of the service.
We spoke seven people living in the home and four relatives to gain their feedback on the service and the care they received.
Updated
24 June 2022
About the service
County Homes provides accommodation for up to 90 people who need help with nursing or personal care. At the time of the inspection 68 people lived in the home. Most people living in the home required nursing care and most people lived with dementia.
People's experience of using this service
At this inspection we identified concerns with the management of risk, care planning, the delivery of care, the management of medicines and governance.
People’s care plans did not contain adequate details of their medical conditions and the clinical care they required, to keep them safe and well. Some people had mental health needs or high-risk medicines that had not been properly risk assessed or care planned to ensure staff knew how to mitigate risks and support them appropriately. We also found that people’s medical and health needs were not sufficiently monitored by nursing staff to ensure their health and wellbeing was being maintained or to identify possible early signs of ill-health. This placed people at risk of avoidable harm.
Record keeping overall, in respect of people’s care was poorly maintained and at times this made it difficult to keep track of people’s progress and well-being.
Medicines were not managed safely. Information about some people’s medicines was not accurate or up to date. This resulted in some people not receiving the medicines they needed. Some people did not always receive the correct dose of their medicine, or missed doses of their medicines without explanation. Medicines that needed to be given at specific times were not always given correctly and staff did not have adequate information them on how to administer covert medicines (medicines hidden in food or drink), safely. We had service wide concerns about the safety of medication management so we referred our concerns to the Local Authority Safeguarding Team to investigate. After the inspection, the provider submitted an action plan to CQC outlining the immediate improvements they intended to take with regards to medicines.
Accident and incidents and safeguarding allegations were not recorded accurately to enable the provider to be assured that people’s safety was being maintained and the risk of injury or abuse mitigated.
The provider had a range of audits in place to monitor the quality and safety of the service. These audits had identified similar concerns with care planning, medicines and the environment, yet there was little evidence that any action had been taken to address these concerns. This resulted in the same concerns being identified at this inspection.
There was a staff and resident COVID-19 testing programme in place and appropriate safety measures in place for visitors and new admissions to the service. There were also arrangements in place to ensure that infection control standards were maintained. However, on the day of the inspection, parts of the environment were malodorous and unpleasant to live in.
The provider had a system in place to determine safe staffing levels. People and their relatives told us staff were kind, caring and respectful. The majority of people we spoke with felt there were enough staff on duty to support people’s needs.
People received support from a range of health and social care professionals including dieticians; mental health teams; speech and language therapy and their local GP.
The culture of the service was open and transparent. The manager and regional manager engaged with the inspection positively and were committed to making any necessary improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 01 December 2021).
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding.
During this inspection, the provider was found to be in breach of regulations 12 (Safe care and treatment) and 17 (Good Governance). This resulted in a change to the provider’s overall rating which is now rated as ‘Requires improvement’.
During this inspection, we looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
At this inspection we found breaches of regulations 12 and 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to the failure to ensure people received safe care and treatment and a failure to ensure the service was always governed and managed adequately.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work with the local authority to monitor progress.