Archived: Asmall Hall Care Home

We last inspected this location on 25 March 2015 and we found several breaches of the Health and Social Care Act (2008) Regulated Activities Regulations. These related to care and welfare, assessing and monitoring the quality of service provided, safety, availability and suitability of equipment, safety and suitability of premises, management of medicines and cleanliness and infection control.

That unannounced inspection was conducted on 25th March 2015 This inspection took place on 27 April 2016, and was unannounced. During this inspection we checked if action had been taken to address the outstanding breach of regulations from the previous inspection. We found that whilst some improvements had been made, not all actions identified on the action plan submitted by the provider had been completed.

The registered manager of the service was present throughout our inspection. 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 checked to see if medication was handled safely within the home. We found there were no care plans for "as and when medication". People's medicines were not stored and administered safely.

We found systems for identifying and managing risks at service level were present, however these were not robust and not effectively put into practice, which meant that the systems did not help to anticipate risks within the service.

We observed poor infection control practice within the home; staff failed to remove protective clothing at point of care. The home was generally unclean throughout, the décor was tired and contents and fixtures were in need of replacement.

Safeguarding procedures were in place and provided staff with guidance about reporting any potential or suspected abuse of people who used the service. However, we found that some reports of suspected abuse had not been dealt with adequately. The registered provider had a specific plan in place detailing the arrangements to deal with emergency situations including fire.

We looked at how the service gained people’s consent to care and treatment in line with the MCA. We found that the service did not have sufficient systems in place to enable assessment of a person’s mental capacity prior to completing any best interest decisions.

The dining experience differed across the two units for people who used the service. We found inconsistencies in staff support for people who required assistance. Food was served luke warm and the dining experience was not person centred.

We found that although staff displayed a good understanding about how to treat people with privacy, dignity and respect, this was not being put into practice during their interactions with people who lived at Asmall Hall.

Care files contained informative life histories and were person centred, however these were not used to inform care planning. It was evident that not all of the care plans viewed reflected the person’s current needs and individual preferences.

We found that the registered person had not protected people against the risk of unsafe care or treatment, because systems for assessing and monitoring the quality of service provided were not always effective.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, governance, staffing, consent, dignity and respect, safeguarding service users from abuse and improper treatment, premises and equipment and meeting nutritional and hydration needs.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We talked with eight staff and nine people who lived at the home as well as family members.

We noted minor inaccuracies in care plans because information was not being reviewed appropriately.

The majority of people who lived at the home who were able told us they were satisfied with their care.

On the day of our visit we saw activities had been arranged and people were supported to participate in them.

People lived at the home told us they felt safe there.

At our last visit we identified areas were the provider was not meeting the standard, which we followed up at this visit. We noted improvements but further improvements were to be made. We judged the provider was not meeting the standards for the care and welfare of people, safety and suitability of the premises and quality assurance of service provision.

At our last visit in 2013 we noted in the Mulberry unit there was an odour of sour milk throughout the unit. At that inspection we shared our concerns with the manager who agreed that carpets in the Mulberry unit would be cleaned. We found this had not rectified the odour problem when we visited this time.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people.

People had their needs assessed and we saw that they were asked about their care and support . People told us they were treated with kindness and respect. People's care and support plans detailed their care needs. These were kept under review. The provider had policies and procedures in place to ensure people's dignity was respected but we observed people were not always treated as such.

There were some rules in place for people who lacked the capacity to understand individual risks to their health. Staff were trained to protect people and people said they were safe. They told us if they had concerns or complaints about their care but would speak with the manager or the staff if they needed to.

We identified areas of non compliance at this visit. Concerns remain about the management of medicines and the required improvements had not been made. We found that assessment and decisions about mental capacity were not always understood. From our SOFI observation we saw that staffing arrangements in the Mulberry unit did not support people to remain safe.

Some people living at Asmall Hall were less able to express their views about medicines handling due to a variety of complex needs. We observed part of the morning medicines round and saw that patient support was offered where people needed help with taking their medicines.

However, we found that where people needed additional support with their medicines, or where medicines were prescribed 'when required' there was not always individual guidance for staff to help ensure a consistent and assessed approach.