Background to this inspection
Updated
6 September 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
Two inspectors carried out the inspection.
Service and service type
The Elms @ Kimblesworth is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. 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. The manager had applied to CQC to become registered and was awaiting the outcome of their registered manager’s interview with our registration services.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We attended a local authority strategy meeting to review the findings of other professionals and hear about the work of the provider to improve the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service about their experience of the care provided. We spoke with nine members of staff including the area manager, the manager, the deputy manager, an agency nurse, senior care workers, care workers and the cook.
We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including quality audits, policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data. We spoke with three professionals responsible for conducting safeguarding investigations to find out the outcome of their enquiries.
Updated
6 September 2019
About the service
The Elms @ Kimblesworth is a care home which provides accommodation for people who require nursing and personal care. The service can provide care for up to 19 people. At the time of our inspection 14 people with mental health needs and learning disabilities were using the service. People with learning disabilities were therefore living in a home larger than current best practice guidance recommends.
The service has not been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. The principles and values ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People’s safety had been compromised. Three safeguarding concerns raised by professionals with the local authority had been investigated and substantiated. These concerns had included the safe use of medicines. Further concerns re the use of medicines were found during this inspection. People’s personal risks required updating to include more person-centred information. Accidents and incidents had not been reviewed in a timely manner. The manager was continuing to learn lessons and had shared some lessons learnt with staff in a staff meeting.
The provider did not have a suitable system in place to measure people’s dependency needs and enable them to decide how many staff should be on duty.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Staff training and support were not effective. Staff were carrying out physical health checks on people without having had appropriate training.
Staff had worked with other professionals to support people’s care needs. However, we found some opportunities had been missed where the involvement of other professionals may have benefitted people. Action had been taken when this had been pointed out to the manager.
Updated care plans required further improvement to enable staff to have sufficient information to meet people’s care needs. The service did not have in place accessible information for people.
End of life care was provided in accordance with people’s wishes. Where people had not wished to discuss their end of life care, staff had documented this. Staff were respectful and kind towards people. They respected people’s privacy and dignity. Their ability to provide appropriate care for people was reduced by not being suitably supported by the area manager and the provider.
Care in the home was not informed by national best practice guidance. There were three people who used the service with diagnosed learning disabilities. The service didn't apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People did not always have the appropriate support to give them choice and control. People’s independence was not always promoted. We made a recommendation about this.
Governance arrangements in the service was poor. Audits carried out in the service did not identify the deficits we found. Arrangements to support the manager develop in their role were not in place.
People and staff were not fully engaged in the service. We made a recommendation about this.
Joint working with other professionals had been undermined in some circumstances where staff had not seen the opportunity to seek advice or share information.
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 requires improvement (published 9 April 2019). The provider completed an action plan after the last inspection to show what they would do and by when they would improve. At this inspection sufficient improvement had not been made and the provider was still in breach of regulations. The service had deteriorated to inadequate.
Why we inspected
The inspection was prompted in part by safeguarding concerns and a notification of a specific incident, following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident. The information CQC received about the incidents indicated concerns about the management of unsafe medicines practices and falls.
Enforcement
We have identified breaches in relation to people receiving inappropriate care to keep them safe, medicines, staff implementing the Mental Capacity Act, staff training and good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.