Archived: Lower Farm Care Home with Nursing

At the time of the inspection there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

At the previous inspection in October 2015 we identified two breaches of the regulations. Improvements were needed to the quality assurance system and the care plans. The registered manager provided an action plan stating that they would take the action necessary to become compliant with the regulations by 29 February 2016. However, the system to monitor the quality of the care being provided and to drive improvement was still not effective and this impacted on all areas of the service. Work had commenced to improve the care plans so that staff had the information they required to meet people’s needs.

Risks had not always been managed to keep people as safe as possible. The necessary fire procedures were not in place to keep people safe in the event of a fire.

We could not be confident that people received their medication as the prescriber had intended. Staff competence to administer medication had not been undertaken. Current legislation was not being followed regarding the storage and recording of administration of medication. Medication audits were not being completed regularly to identify any areas for improvement.

Staff had been employed without the necessary checks being completed. Staff had not all completed the necessary training or competency assessments. This meant that people could be cared for by staff who did not have the right skills, knowledge or competency.

Staff were not always aware of the procedure to follow if they thought someone had been harmed in any way. This meant that concerns may not be investigated appropriately and the appropriate action may not be taken. There was ineffective monitoring of care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was not acting in accordance with the requirements of the MCA including the DoLS. The required assessments and decisions had not been completed to ensure that people continued to be able to make as many decisions as possible. Some people may have been unlawfully deprived of their liberty.

Adequate food and drink was provided. People had access to the relevant healthcare professionals.

There were not enough staff to ensure that people always received the care and support that they needed and in a timely manner.

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.

We found nine breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is now considering the appropriate regulatory response.

Our tour of the home demonstrated to us that the cleaning regime ensured that hygiene and infection prevention and control was completed to a good standard. We saw that the home followed Department of Health (DH) guidance for the safe and effective management and prevention of healthcare associated infections.

We found that the provider only employed staff after two suitable and acceptable references had been obtained. We saw that staff's previous employment history had been explored and a suitable explanation had been provided for any gaps that had been identified. People were assured that only staff who had been deemed fit and healthy and able to meet their care needs were employed at the service.

People we spoke with told us, "I know who to complain to if ever the need arose." The same people told us that they had never had cause to complain. Our review of the provider's complaint policy showed us that there were effective support systems in pace to support people if ever they needed to complain.

People's care plans were detailed and comprehensive and contained information that would allow any member of staff to care for that person in a way the person liked.

The provider had training, policies and procedures in place which ensured that vulnerable adults were protected from abuse. All of the staff who we spoke with were able to tell us where and how abuse should be reported.

We saw from the records that we reviewed that staff were supported to obtain further professional qualifications in health care. Staff also told us that the provider's training and induction processes were comprehensive.

The provider kept records for the appropriate amount of time, held them in a secure place and retained them as required by relevant legislation.