This unannounced inspection took place on the 1 and 2 March 2016. Nazareth House Northampton provides accommodation for up to 50 people who require residential care for a range of personal care needs. There were 42 people in residence during this inspection.The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were not protected against the risks of avoidable harm and abuse. Some staff were not aware of their responsibilities with regards to safeguarding people who lived at the home. The provider had not ensured that assessments of risk and associated risk management plans were up to date and accurately reflected people's circumstances. This left people vulnerable to significant risks to their health and wellbeing.
The provider had failed to deploy sufficient numbers of staff in order to meet the needs of people who used the service and failed to demonstrate a systematic approach in determining the number of staff required. People were not cared for by staff that had the knowledge, skills, experience and support to carry out their roles. Staff did not receive appropriate supervision, appraisal or training to enable them to fulfil their responsibilities.
The provider failed to protect people who used the service against the risks associated with the safe management of medicines. Medication was not administered as per instructions; errors were identified on Medication Administration Charts (MAR) and MAR records could not be relied on as an accurate account of the medicines administered to people. Medicines were not kept securely.
People living at the home did not always consent to their care and treatment. Mental capacity assessments were not carried out for the people living in the service to measure whether they were able to make their own decisions. Staff did not have a good working knowledge of the Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005.
There was poor monitoring of peoples nutritional and hydration needs which put people at risk. Records could not be relied upon as an accurate account of people’s food and fluid intake. There was lack of monitoring and oversight of people who were at risk of not eating or drinking enough.
People were not always given the opportunity to have stimulation or follow their hobbies and interests. The newly appointed activities coordinator was very proactive but was unable to provide a stimulating environment for all people living at the home without the support and input from other staff members.
Some staff had a caring approach to the people they cared for but there were significant shortfalls in the caring attitudes and approaches of other staff due to low numbers of staff. There was a task focussed culture at the home, positive, caring relationships between staff and people who lived at the home had not been developed.
People were not always treated with dignity and respect. There was limited interaction or conversation with people during personal care or when supporting people with other activities. People were not spoken about in a dignified or respectful manner and people were not listened to.
People were supported by staff who did not have guidance on people's current needs and how they should be supported. Care plans did not reflect people’s current or changing needs and many had not been reviewed or updated. People were at risk of inappropriate care.
Although assessment, auditing and monitoring of the service took place, this was limited, insufficient and not designed in a way to address existing shortfalls and make improvements. As a result, people’s safety and the service they received was compromised.
The provider had not ensured that there were clear lines of responsibility and accountability at all levels. Leadership was poor and staff were not fully aware of what was expected of them.
The provider had not changed their practice in relation to issues raised in complaints and actions had not been identified to prevent similar concerns being raised.
The home had been without a registered manager in post for eight months and this lack of leadership had significantly impacted on the quality of care that people had received. At the time of our inspection a manager had been appointed and an application for the registered manager position had been submitted to the Care Quality Commission.
We found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
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.