Archived: Cowlersley Court Care Home

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cowlersley Court Care Home on our website at www.cqc.org.uk.

The service is required to have a registered manager; there was no registered manager at the time of our initial inspection or at this inspection. There was a manager who was responsible for the day to day running of the service. 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.

We found that safeguarding incidents had not been recognised or reported to the Care Quality Commission, although some of the concerns had been recognised by other health professionals who had visited the service.

The registered provider had done some work on the risk assessments which needed to be in place to reduce identified risks. These were in some cases not adequate and in other cases not completed.

Accidents and incidents were not being recorded adequately and in cases where these were referred to in daily care records no accident or incident forms were available, although the area manager told us they had been completed.

There were not enough staff on duty to meet people's needs. This was due to the people who used the service being spread out over the home which is large, which meant there were long periods where there were no staff in some areas.

We looked at the processes in place for the administration of medicines. We found that there had been some changes made, however these were not sufficient to ensure that people were receiving their medicines as prescribed.

The home was not always kept clean. We saw several examples of poor cleanliness which would contribute to the risk of any infections within the home spreading.

There was little evidence of leadership in the home. The manager was on leave at the time of our inspection, however there was no manager covering for their absence. The area manager attended the service during our inspection but spent most of their time in the office which is away from the main areas of the home.

Staff told us that the manager asked them 'how they could support them' and 'did not tell staff what needed to be done'.

The registered provider was not meeting the requirements of their registration with the Care Quality Commission as they were not notifying CQC of events which they had a duty to do.

There was some evidence of oversight from the wider management team as there had been a visit made by the area manager to the service in January 2016 and we saw that there had been a report completed of this visit. However the action plan for the identified areas of concern was not completed and we saw no evidence that this information had been used to improve the service.

The records in the service were not of good quality and were not accessible. Records of accidents and incidents were not in the file marked as being for their storage and could not be located during the inspection or supplied afterwards. Daily records were loose in the medicines room and there was a care plan which was not in the file of the person it related to and was found to be loose in the medicines room.

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

When we visited this service on 15 July 2013 we found people's privacy, dignity and independence were not respected; care and treatment was not delivered in a way that ensured people's safety and welfare; people who used the service were not protected from the risk of abuse and people were not protected against the risks associated with medicines, because the provider did not have appropriate arrangements in place. We asked the provider to make improvements. We went back on this visit to see whether improvements had been made.

Since our last inspection the service has reduced the regulated activities they are registered to provide. This means that nursing care is no longer provided at the home.

During our visit, we spoke with the home manager, two senior care assistants and four people who lived at the home. A senior care assistant told us there were 22 people living at the home on the day of our visit and one person who was receiving respite care. The manager told us they had been in post since 23 September 2013 and were applying to become the registered manager for the service.

During our visit we observed people interacting with staff in the lounge areas. We also looked at four people's care records and four staff files. We found care records were not all accurate. We also found care and treatment was not always delivered in a way that ensured people's safety and welfare.

The four people who lived at the home all told us they felt safe living there and staff respected their privacy and dignity. They told us the food at the home was good and they got choices about their daily living. One person said, 'The food is alright; it can be a bit late sometimes' and another person said, 'I'm 92. It's nice living here; I like it.'

Three people also told us their sleep was regularly disturbed by another person who persistently called out through the night. They told us they had complained to the manager about this but they had not taken any action. One person said, 'They keep everyone awake, they're shouting out all night.' Another person said, 'It's terrible. I was awake at 2.15am last night and then I couldn't get back to sleep; it's every night.' The third person said, 'They even wake me up and I'm at the other end of the building.' When we asked the manager about this they told us they were aware of this problem and people complaining about it. They told us they would look into different options for minimising the disruption this person caused to other people's sleep and rest.

Three of the four people we spoke with told us they were very concerned about the staffing levels at the home. One person said, 'I've only been here six weeks and it's gone downhill in that time. Last week I didn't get to bed until nearly midnight because there were only two night staff on instead of three.' Another person said, 'I've been here 12 months; it used to be really good 12 months ago. Staff are leaving and not being replaced.' This meant there were not enough qualified, skilled and experienced staff to meet people's needs.

We looked at staff rotas for the week of our visit and the previous three weeks and these confirmed what people had told us about staffing levels at night. When we asked the manager about staffing levels at the home they told us they were aware of the staff shortages and had plans in place to fill the vacancies as soon as possible.

Two people told us that they had nothing to do with one person saying "I sleep too much but I have nothing else to do". We observed very little engagement between staff and the people who lived at the home other than when personal care needs were being met.

One person told us that the staff are lovely and a person visiting their relative agreed with this but said there just were not enough staff available. Another visitor we spoke with was very concerned about the level of care being offered to their relative.

We identified some issues which staff at the home had failed to report through safeguarding processes and were concerned about some of the care practices we became aware of.

Two of the company's senior managers were present at times during the inspection. They agreed with the issues we identified and began immediate measures to address the concerns.

We saw that some staff were kind in their approach to meeting people's needs.

We saw that staff did not engage with people other than when meeting their care needs.

One person told us that they enjoy working with the activities organiser.