Archived: Quality Care Management Limited

Updated 17 June 2023

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 Health and Social Care Act 2008.

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 conducted by four inspectors.

Service and service type

Quality Care Management Limited is a 'care home'. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Quality Care Management Limited is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

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 the information, we had received about the service, including previous inspection reports and notifications. Notifications are information about specific important events the service is legally required to send to us. We also used information gathered as part of the monitoring activity that commenced on 28 February 2022 and was completed on 16 March 2022 to help and inform our judgements.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with five people who used the service and used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We received feedback from four family members and three external professionals.

We spoke with 12 members of staff including the registered manager, the providers representative, the deputy for the nominated individual, nurses, care staff, laundry staff, catering staff and the activities coordinator.

We reviewed care plans for seven people and records of care provided for 11 people. We looked at staff files in relation to recruitment and records relating to staff training. A variety of records relating to the management of the service, including audits, policies and procedures were also reviewed.

Updated 17 June 2023

About the service

Quality Care Management Limited is a care home which provides personal and nursing care for up to 38 people, aged 55 and over. Most people living at the service are living with dementia or another cognitive impairment. At the time of the inspection the service was supporting 30 people.

The care home accommodates people in one adapted building.

People’s experience of using this service and what we found

At this comprehensive inspection we found five breaches of regulations. There were systemic failings identified during this inspection that demonstrated a significant deterioration in the quality and safety of the service since its last focused and comprehensive inspections.

The provider failed to ensure effective oversight of service provision. Quality and safety monitoring systems were ineffective in identifying and directing the service to act upon and mitigate risks to people who used the service and ensure the quality of service provision.

People were at risk of neglect and unsafe or inappropriate care or treatment. We observed staff ignoring people and poor moving and handling practices.

People were not always treated with dignity and respect; some people told us staff were not always kind to them. Although family members were positive about the service, we observed occasions when staff treated people without compassion and kindness.

Staff said they knew how to prevent and report abuse. We were concerned however, that staff practice which amounted to omissions of care had not been considered as neglect.

There were not enough sufficiently skilled staff to meet people's needs. There was a high reliance on agency staff; we observed the staff on duty lacked the skills and knowledge to care for the people living at the home. People therefore did not receive person centred care.

Not all staff had received all necessary training and there were no formal supervision processes occurring. We were not assured of quality of training received given the widespread failings found at this inspection.

Medicines were not always administered as prescribed and there was a lack of guidance for staff in respect of topical creams. Infection prevention and control measures were not always followed by staff.

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. The principles of the Mental Capacity Act 2005 were not being applied in respect of best interest decisions to provide care or use restrictive practices.

Staff, people and visitors gave varied feedback about the service. Our observations of how care was provided to people were reflective of the varied feedback.

We found errors and discrepancies that had not been identified by the quality assurance systems in place. Care plans and risk assessments had not been updated, were not consistently person centred and lacked detailed guidance for staff to ensure people received care in a person centred and safe way. Risk assessments that related to people’s health, safety and the environment did not ensure all risks were effectively assessed.

Staff were positive about the management team. The provider had appropriate staff recruitment procedures. The management team sought advice and guidance from external professionals where required.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last inspection (report published 23 October 2020) was a focused inspection covering safe and well-led. Although these key questions were rated good the overall rating remained Requires Improvement as the ratings from the previous inspection (published 17 October 2019) for the remaining key questions were used to calculate the overall rating for the service. This service has been rated requires improvement for the last seven consecutive inspections.

At this comprehensive inspection the service has been rated inadequate.

At our last focused inspection in September 2020 we recommended the registered person consider contingency arrangements to ensure records can be maintained during difficult times. At this inspection we found that some care plans and risk assessments had not been updated to fully reflect people’s changing needs.

In July 2019 we also recommended the registered person seek advice from a reputable source to ensure the application of the Mental Capacity Act 2005 is applied and recorded consistently and accurately. At this inspection we have found continuing concerns with the application of the MCA.

In July 2019 we also recommended the provider seek advice and guidance from a reputable source about creating a stimulating environment for people who are living with dementia. At this inspection we found further work to ensure the environment is suitable and stimulating for people living with dementia was required.

At our last comprehensive inspection in July 2019 we recommended the registered person review the deployment of staff to ensure this met the needs of people, especially those who were unable to use a call bell. We did not find any concerns with the deployment of staff at this inspection.

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed, to seek assurance about this decision and to identify learning about the DMA process.

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 found evidence the provider needs to make improvements. Please see the relevant key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Quality Care Management limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in risk assessment, medicines management, infection control, staff training, the Mental Capacity Act 2005, treating people with dignity and respect and quality assurance at this inspection.

We have cancelled the provider's registration.