Archived: Quarry Bank Residential Home

People’s experience of using this service:

People did not receive a service that provided them with safe, effective, compassionate and high-quality care. Care and support was not tailored to meet people’s specific needs.

Risk management was ineffective and placed people at risk of harm. Staff were not recruited safely or trained appropriately.

People’s human rights were not always upheld as the principles of the Mental Capacity Act 2005 were not adhered to. People were not empowered to make choices and have control over their care. People were not provided with support that was personalised to them. Staff did not always gain consent from people before delivering support and people’s privacy and dignity was not always upheld.

The service was not well led and there was an ineffective quality assurance system in place. During this inspection we found multiple failings at the service and risks to people had not been mitigated. We identified eight breaches of regulation. Seven of these were persistent breaches which were found at the last two inspections, which demonstrates learning and improvement had not taken place.

Rating at last inspection: The service was last rated as Inadequate (published 7 November 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: At the last inspection the service was rated ‘Inadequate.’ At this inspection the rating remained the same. Therefore, the service remains in ‘special measures.’ Services in special measures will be kept under review and, if we have not already taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

Enforcement: We issued a notice of decision to cancel registration and the service is now closed.

Full information about CQC’s regulatory response can be found at the back of this report.

At the last inspection on 13 July 2017, we rated the service as ‘Requires Improvement’ and we asked the provider to take action to make improvements in relation to safe care and good governance. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good. During this inspection we found improvements had not been made and there were shortfalls in other areas which resulted in breaches to five regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Quarry Bank Residential 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 personal care and accommodation for up to 23 older people, including those living with dementia. At the time of our inspection there were 19 people living at the home.

The service is required to have a registered manager in post. A registered manager is a person who has registered with 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 there was no registered manager in place. The provider had contacted CQC to inform us that the registered manager had taken some time off work and there was an acting manager in post.

Serious infection control concerns were identified and measures were not sufficient to prevent the risk to people of infections spreading. The service was poorly maintained and action was required to ensure people lived in an environment that safely met their needs. Measures required to reduce the risk of harm to people were not always in place. We were concerned about the provision of fire safety within the building as staff had not completed a fire drill, some staff did not know where the evacuation point was and the personal emergency evacuation plan (PEEP) did not reflect all people currently within the service.

The provider and management team had completed minimal checks on the quality of care provided. When governance systems were in place, they failed to record actions or drive forward improvements. The checks had not picked up on the shortfalls identified during the inspection.

Medicine procedures and systems were not robust, staff were not trained or had their competency check to ensure safe practices were in place. Improvements were required in relation to protocols and risk assessments relating to medicines to ensure that medicine practices were safe.

Staff were not sufficiently trained or supported to enable them to fully understand their role. Staff had a basic understanding of how to safeguard people from abuse. We have made a recommendation about improving the meal time experience for people.

Care records failed to demonstrate that the principles of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) had been applied. A lack of monitoring of DoLS applications resulted in no valid DoLS being in place for people who required them. The service had not completed any best interest’s meetings when making decisions for those people who lacked capacity.

People’s nutrition and hydration needs were catered for however, people’s provision of choice needed to be improved at meal times.

Some staff demonstrated knowledge of people and this helped them to provide some person-centred care. However, staff were heavily reliant on the support of the acting manager at times when people could be distressed.

Care plan’s 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 reviewed or monitored for trends and reoccurrences. Lessons learnt 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. There was limited access to activities within the home for people who would also benefit from access to a safe and secure garden.

Recruitment processes were in place but these needed to be more robust. We made a recommendation about ensuring safe recruitment practices were followed.

Relatives we spoke with provided mixed feedback about the service. Professionals gave positive feedback about the care that staff provided to people.

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 multiple concerns and are considering our regulatory response. 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.

Quarry Bank is a care home that accommodates up to 23 older people, some of whom may be living with dementia. The home is situated in a residential area of Hessle, a small town in East Yorkshire. Bedrooms are located on the ground, first and second floors and there is a passenger lift to reach the first and second floors. On the day of the inspection there were 20 people living at the home, including one person having respite care.

At the last inspection in June 2016 we were concerned that care workers had to use restraint to prevent one person from harming themselves, and they had not completed training on the use of restraint. We were also concerned that there was a lack of evidence to record the action taken following people’s falls and that safeguarding incidents had been reported appropriately. We issued a requirement in respect of Regulation 12 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we saw that, although staff had not completed training on the use of restraint, there was no-one living at the home who required physical restraint by staff to protect them from the risk of harm. We observed staff using distraction techniques to manage people’s anxieties and behaviours. The recording of falls was more robust and the records of any safeguarding concerns showed the action that had been taken by staff. The provider was no longer in breach of this regulation.

At the previous inspection we also had concerns about the low level of reporting to CQC using the submission of notifications, and the lack of audits to evidence that the quality of the service provided was being monitored. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we saw that notifications were being submitted to CQC as required by regulation. Although we considered that the provider was no longer in breach of this regulation, we continued to have concerns about the effectiveness of quality audits. Some areas of the service were not being audited, and the audits that did take place required more detail about the action taken to address any identified shortfalls. We have made a recommendation about this in the report.

On 13 July 2017 we identified concerns about the prevention and control of infection. We identified some unpleasant odours and found some equipment that was not clean. The systems currently in place did not fully protect people from the risk of infection. This was a breach of Regulation 12 (1) (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment.

The provider is required to display their inspection rating following a CQC inspection. The rating for the inspection conducted in May 2016 was not clearly displayed within the service. The failure to display the rating was a breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Sufficient numbers of staff were employed to make sure people received the support they needed, and those staff had been safely recruited. Staff received training on the topics considered essential by the provider.

People told us they were happy with the choice of meals provided at the home. People’s nutritional needs were recorded and their food and fluid intake was being monitored when this was an identified area of concern.

Care plans described the person and the level of support they required. There were some anomalies in recording, although none of these had affected the care the person had received.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible.

Risks to people were assessed and reduced where possible. Staff received training on safeguarding adults from abuse. They were confident when describing different types of abuse they may become aware of and the action they would take to protect people from harm. People told us they felt safe living at the home.

Staff were kind, caring and patient. They encouraged people to be as independent as possible and respected their privacy and dignity. Activities took place but these were minimal.

Staff told us they were well supported through supervision and staff meetings.

There was a complaints policy and procedure in place. Relatives were asked to complete satisfaction surveys. We considered that more effort could be made to give people who lived at the home the opportunity to express their views about the service they received.

There was a manager in post. They had been registered as the manager for a long time and this provided consistency for people who lived at the home and staff. Staff and relatives reported that the home was well managed.

The home is registered to provide accommodation and care for up to 23 older people, including people who are living with dementia. On the day of the inspection there were 22 people living at the home, including three people receiving respite care. The home is situated in the town of Hessle, in the East Riding of Yorkshire and it is also close to the city of Hull. There are two lounge areas, a dining room and an attached garden. The first and second floors of the home are accessed by a passenger lift.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission 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.

On the day of the inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed using the home’s recruitment and selection policies. This ensured only staff considered suitable to work with vulnerable people were employed at Quarry Bank.

The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm. However, we noted that although staff appeared to deal effectively with people who displayed behaviours that challenged, they had not received appropriate training. This was a breach of Regulation 12 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Quality audits had been undertaken by the registered provider but these were minimal and did not monitor medication, infection control or accidents. Although the audits included recommendations, there was no information to record whether these recommendations had been being carried out. This was a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Commission had not been notified of some significant events as required by legislation. These included situations that had required a person to be restrained by staff and when Deprivation of Liberty Safeguard (DoLS) applications had been authorised. This was a breach of Regulation 18 of the Registration Regulations 2009.

We checked medication systems and saw that medicines were stored, administered and disposed of safely. Staff who had responsibility for the administration of medication had received appropriate training.

People who lived at the home and relatives told us that staff were caring and that they respected people’s privacy and dignity. We saw that there were positive relationships between people who lived at the home, relatives and staff.

People told us that they were very happy with the food provided and we observed that people’s individual food and drink requirements were met.

There had been no complaints made to the home during the previous twelve months but people told us that they were confident any concerns expressed or complaints made would be listened to and acted on. There were systems in place to record any complaints made. There were also systems in place to seek feedback from health and social care professionals, and family and friends.

Staff, relatives and a social care professional told us that the home was well managed. Staff told us that they were well supported by the registered provider and registered manager, and felt that they were valued.

You can see what action we told the provider to take at the back of the full version of the report.

We spent an hour observing daily life within one of the lounges in the home and in the dining room. We spoke with two people who used the service and held brief conversations with three others. We spoke with staff and the manager about the care and wellbeing of people who used the service. We also gathered evidence of people's experiences of the service by reviewing care records and quality assurance documentation.

We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people's choices and decisions. Care records were up to date.

People we spoke with said they preferred the staff to give them their medication and that they usually received this on time and when they needed it. We found there were safe and effective medicine practices being followed within the service.

Staff had received appropriate professional development and training to ensure they could meet the needs of the people who used the service.

The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary.