Archived: Curzon Park Residential Home

Updated 5 January 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 6 December 2016 and was unannounced. The inspection was completed by an adult social care inspector and inspection manager.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Due to technical problems a PIR was not available and we took this into account when we inspected the service and made the judgements in this report.

Prior to the inspection we were contacted by the fire service who raised concerns about the safety of people using the service. We also spoke with the local authority contracts and commissioning team who raised a number of concerns relating to the environment, a lack of activities and fire safety concerns. We contacted the local authority safeguarding teams who did not report any concerns at the time.

During the inspection we spoke with four people who used the service and four people’s relatives. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who could not talk with us. We spoke with four members of staff and the registered provider. We looked at five people’s care records and the recruitment records for two members of staff. We also looked at other records relating to the day-to-day management of the service. We made observations around the interior and exterior of the premises.

Updated 5 January 2019

We carried out an unannounced comprehensive inspection of this service on the 12 & 14 January 2016. Since that inspection we received concerns regarding the safety of the premises. As a result we undertook a comprehensive inspection to look into those concerns on the 6 December 2016. We also followed up on concerns raised at the last inspection.

Curzon Park is situated in a residential part of Chester. It is registered to provide personal care for up to 25 older people and people living with dementia. At the time of the visit there were 20 people living at the service.

There was no registered manager in post, and the service was without a manager. There had been four managers employed by the registered provider over the last 12 months, and following the visit a new manager started. 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.

In January 2016 the service was rated as ‘requires improvement’ and we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were no systems in place to monitor the quality of the service. At this inspection we found that the required improvements had not been made. We also identified a number of new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Prior to our inspection, the fire service had identified a number of concerns relating to the premises. As a result an enforcement notice has been issued with a compliance date of 9 February 2017.

Parts of the environment were not safe and placed people at risk of harm. In two examples we required the registered provider to take immediate action to keep people safe. There were no audits of the environment to ensure that it was safe, and therefore the registered provider had failed to identify issues that needed rectifying.

Action was not taken to ensure people’s physical health was maintained. There was no system in place to ensure that pressure relieving mattresses were on the correct settings, and in one example we found the setting was far too high. This increased the risk of people developing pressure sores. Risk assessments were not always accurate and action had not been taken to keep people safe. For example, the malnutrition risk assessment for one person had failed to identify that they were at high risk of malnutrition.

There had been a high proportion of accidents and incidents within the service since September 2016 in relation to the number of people using the service. On multiple occasions during the visit we saw that staff had left people unobserved in communal areas, which increased the risk of incidents occurring.

People were not protected from the risk of infection. An up-to-date legionella check had not been completed to ensure that bacteria levels in the water were safe and water temperatures were not being monitored. Laundry processes were not sufficient to prevent cross contamination and parts of the environment were dirty.

Recruitment processes were not robust. Staff had not been required to provide references from previous employers. This meant that the registered provider had not had access to important information needed to make judgements about their suitability to work with vulnerable people. A check by the disclosure and barring service (DBS) had been completed.

Staff had not received training in key areas such as safeguarding, infection control and moving and handling. This meant that the registered provider had failed fulfil their duty to ensure that staff knowledge and skills were up-to-date.

People were not always treated with dignity and respect and their confidentiality was not protected. For example staff spoke sharply to people at times and one person’s care record described them as “demanding” and was not strengths based. Letters labelled as ‘private and confidential’ were not kept securely and were left in a tray near the entrance to the building.

There were limited activities available for people. People’s relatives told us that staff did nail care and baking activities, however during the visit there was no entertainment for people. One relative told us that there had previously been an activities co-ordinator, however this post had been cut to save money.

Leadership within the service was poor. Staff did not have a management structure to refer to and we saw examples where they did not receive the support they needed from the registered provider. There were no audit systems in place to monitor the quality of the service, and the registered provider had not completed quality monitoring checks. This meant that the registered provider had failed to identify and act upon serious issues that we identified.

Following the visit CQC took urgent action and placed a condition on the registration of the provider to ensure that the service had sufficient staff working in the home to maintain people’s safety in the event of a fire.

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.

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.