Archived: High Dene

This inspection took place on 2 June 2015 and was unannounced.

At our last inspection we found that the service had breached Regulations 10, 17, 18,19, of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service was not carrying out appropriate background checks on staff, had not provided staff with training relevant to their role and the tasks they were to perform and did not provide care for people in a manner that promoted their dignity and respect. The provider had failed to carry out effective quality and safety monitoring of the service. They also failed to listen and respond to the complaints or concerns that people had expressed.

The service is registered to provide care for up to 15 people. On the day of our inspection there were 14 people living in the service, some of whom were vulnerable because of their situation.

On the day of our inspection the service did not have a registered manager in place. 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.

There were insufficient staff on duty to provide people with the care they required. This meant that people were left for long period without personal interactions and staff did not complete required documentation appropriately. Staff had not received appropriate training. On the day of our inspection we observed inappropriate and incorrect practice taking place. Appropriate background checks were not always carried out before staff commenced employment.

Risks to people were not managed. Risk assessments had been carried out but where a risk had been identified no actions had been taken to mitigate the risk.

The building was found to be dirty and poorly maintained. Corridors and communal areas were cluttered with odd pieces of furniture which presented a hazard to people with reduced mobility.

Medicines were not managed safely. Training for staff who administered medicines was not up to date and medicines administration was not recorded accurately.

Care plans were generic and did not demonstrate that the person or their representative had been involved. They did not contain information about people’s likes and dislikes to enable staff to meet their needs. Where people were unable to make decisions staff were not aware of the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards which ensures that decisions are made appropriately. This put people at risk of having their liberties unlawfully restricted and physical harm.

Care plans had not been reviewed and updated regularly to ensure that they reflected a person’s current care needs.

People were not supported to maintain a nutritious diet. Care plans did not identify people’s nutritional needs and records of what people had eaten or drunk were not completed appropriately. Where people required support to eat or drink this was not always provided in a dignified manner whilst ensuring people ate and drank a sufficient amount.

Mostly care staff demonstrated a caring attitude. However, this was mostly instinctive and was not supported by the provision of training or procedures in the service. The care provision was task led and we saw that the task sometimes took precedence over the care.

People were not supported to carry on activities they had engaged in before moving into the service. Social engagement between people living in the service was minimal.

People’s health, welfare and safety was compromised because the provider did not have in place a robust quality assurance process that identified issues in service provision and potential risk to people. The provider’s quality and safety monitoring had failed to identify the shortfalls we found at this inspection.

The service did not have an effective complaints procedure to monitor and investigate complaints.

Open communication was not encouraged by the service. No recent residents meetings, staff meetings, or quality assurance surveys had taken place.

The service did not have links with local or national organisations to ensure that the care provided reflected up to date practices and guidance.

We inspected on 26 January 2015. High Dene provides accommodation and personal care for up to 15 older people who require 24 hour support and care. Most people using the service were living with dementia. There were 14 people using the service when we visited. At our last inspection on 12 June 2014, we asked the provider to take action to make improvements in protecting the care and welfare of people, respecting and involving people, records and assessing and monitoring the quality of the service. The provider wrote to us to tell us how they had implemented these improvements. During this inspection we found that there was need for further improvement and we had identified further issues which needed action.

The service is not required to have a registered manager in post. 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. Overall responsibility and accountability for the service lies with the provider, who owns the service.

The provider did not have in place a robust system to ensure that the staffing level was appropriate to the needs of people using the service. People, their relatives and health professionals raised concerns about low staffing levels and how this impacted on people’s needs being met.

The provider did not have in place a robust system to ensure that new care staff were of suitable background and character for the role. Appropriate checks had not been made before staff started work to ensure that they were safe to work with vulnerable people, and this put people at risk of harm.

People were put at risk because staff had not received sufficient training to carry out their caring duties safely. Staff were unable to explain how they would safely reposition someone, and were unaware of their responsibilities with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLs). This put peope at risk of physical harm and at risk of having their liberties unlawfully restricted.

People’s welfare was compromised because staff did not demonstrate a good knowledge of the people they were caring for and interactions observed between staff and people using the service were not always caring and caused distress to people. Staff did not know enough about people to engage them in appropriate meaningful activity, and this led to some people to become bored and distressed.

People were put at the potential risk of receiving unsafe or inappropriate care because their care plans did not contain specific and individualised information about how their needs should be met.

People’s health, welfare and safety were compromised because the provider did not have in place a robust quality assurance process that independently identified issues in service provision and potential risks to people. People did not feel listened to because views they expressed did not lead to the provider implementing changes.

People and their relatives told us they felt safe living at the service and staff were aware of their responsibilities with regard to protecting people from abuse. The provider carried out appropriate investigations when concerns were raised.

People received their medications when they needed them and medications were stored and administered safely.

People and their relatives were involved in the planning of their care, and signed their care documents to indicate their involvement.

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