This inspection took place on the 10 and 11 December 2018. Both days were unannounced.Somerset House Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide nursing, personal care and accommodation for up to 44 older people, including those living with dementia. At the time of our inspection there were 40 people living at the home.
This was the first inspection of the service since the current provider took over in July 2018. We have found multiple breaches in regulation and the overall rating for the service is 'Inadequate'. The service is therefore in 'special measures'.
The inspection was partly prompted by an incident which had a serious impact on a person using the service. This indicated potential concerns about the management of risk in the service and the level of care provided to people. We did not look at the circumstances of the specific incident, as this may be subject to criminal investigation, but we looked at associated risks.
The service is required to 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. At the time of the inspection a manager was in place but had yet to register with CQC.
The service was chaotic and was not well-led. People’s care needs were not being met due to insufficient staffing numbers and unsupported staff. The service was heavily reliant on agency staff and the management team failed to provide any support or leadership to staff members who did not know the people or the service.
Recruitment processes in place were not safe and medicines procedures were not robust.
The management team had completed checks on the quality of care provided. However, a number of these checks had not picked up on the shortfalls identified during the inspection. We found that the management checks focused on paperwork and failed to recognise the lack of care being provided to people.
Staff were not sufficiently trained or supported to enable them to fully understand their role. Staff had not received sufficient training in specialist areas such as behaviours that can be challenging to others, moving and handling and restraint. This meant that staff were not skilled in ensuring that care was provided in a safe and least restrictive way.
People’s nutrition and hydration needs were not being catered for. People did not receive the support they required to eat and drink and their intake was not being monitored effectively. Actions were not taken when people required additional support or a referral to a health care practitioner.
Staff did not have knowledge of people which impacted on their ability to provide person-centred care. Staff were very task focused throughout the inspection which led to people’s care needs being neglected.
Care plans failed to reflect people’s current needs and risks. Poor behaviour management plans placed staff and people at risk within the service. Accidents and incidents were not recorded, reviewed or monitored for trends and reoccurrences. Lessons which could be learned from any incidents were not considered.
The meeting of people’s wider needs could be improved through the provision of more meaningful activities that are monitored and reviewed. We received mixed feedback from people regarding the provision of activities.
Care records demonstrated that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied. The manager was in the process of submitting all DoLS requests to the local authority as the current provider had been unable to locate copies of applications made under the previous provider.
Relatives we spoke with were not satisfied with the care that was being provided to their loved ones and felt the service was not well-led.
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.