Archived: Ismeer

Ismeer is a residential home for up to 27 older people. At the time of the inspection 17 people were living at the service, some of whom were living with dementia.

Ismeer is required to have a registered manager. 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 had been no registered manager in post since January 2015.

The provider had passed away in April 2016 and the service was being overseen by the provider's representative who was one of two executors of the estate. The provider's representative lived overseas and was unable to monitor the service on a day to day basis. The provider's representative had appointed an agent who was based at the service two or three days a week and they communicated regularly. There were also two full time acting managers in post who had responsibility for the day to day running of the service.

There was a lack of risk management for people living at Ismeer. Risk assessments were either out of date or had not been put in place despite people being identified as at risk. Systems to ensure staff were aware of people's changing needs were not robust. For example, the day before the inspection a visiting GP had identified one person was dehydrated and had associated low blood pressure. They had advised the person be encouraged to drink six glasses of water a day. This had been recorded in the person's notes by the GP but staff on duty were unaware and were therefore not acting on this advice.

Recruitment processes were not robust, one new member of staff was working unsupervised. They had not had a completed Disclosure and Barring check and only one telephone reference had been received. This was contrary to the service policy.

Records showed shortfalls in staff training identified as necessary for the service. For example, no staff had undertaken recent refresher safeguarding training. There had not been any training to meet people's specific needs.

The provider was not working in accordance with the processes set out in the Mental Capacity Act (2005) or associated Deprivation of Liberty Safeguards (DoLS). Only one DoLS application had been made to the local authority. The local management team acknowledged several people were not free to leave and therefore should have had DoLS authorisations should have been applied for. There was no evidence of any mental capacity assessments or best interest meetings taking place. One person with capacity was being kept from going out of the home, which was against their legal rights.

The service was based in an old property and there were structural problems with the building which had resulted in considerable damp forming. Bedrooms showed signs of damp and mould, the décor was in need of updating and furnishings were of a poor quality. There was a general air of neglect throughout the property. Systems for reporting faults and defects were not robust and repairs were not always happening.

Information in care plans was out of date and was at times inaccurate. There was no evidence of regular reviews taking place. People and/or their representatives had not signed to indicate they were in agreement with their plan of care.

There was a lack of organised activities taking place and one person told us they were bored. On the day of the inspection we did not observe anyone being supported to take part in activities. One person we met chose to stay in their room but only had access to one channel on the television. They were unable to operate the radio.

There was a lack of oversight of the service from the provider's representatives. There was no effective leadership to support the prioritisation of tasks necessary to make improvements to the service. There were no systems in place to help ensure stakeholders opinions were sought to help drive improvement. For example, no staff meetings were taking place, there were no residents meetings or ways of gathering their views and families were not asked for their experiences of the service.

There was no system to ensure regular audits took place in order to monitor the quality of the service. For example, while falls were recorded as required they were not audited in order to highlight any patterns or trends.

We identified several breaches of the regulations. You can see these listed at the back of the full version of the report.

We carried out this unannounced inspection of Ismeer on 5 January 2016. At this visit we checked what action the provider had taken in relation to concerns raised during our last inspection in September 2015. At that time we found breaches of legal requirements related to the management of medicines, risks associated with the environment and premises, a lack of training and supervision for staff, failure to adhere to the requirements laid down in the Mental Capacity Act (20015), poor infection control practices, out of date care plans, poor monitoring records, ineffective auditing systems, and inadequate oversight of the service.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Ismeer on our website at

www.cqc.org.uk.

There had been no registered manager in post since January 2015. 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.

At the time of this inspection there was an acting manager in place, who had the day to day responsibility for running the service, but they had not applied to be registered manager. They told us there had been delays in obtaining an updated photo driving licence but they were intending to apply for the position. Due to ill-health the provider was not able to oversee the service. Family members had Lasting Power of Attorney (LPA), and had taken over responsibility for the business. The manager told us they had telephone and email contact with one of the LPA’s. However, the LPA did not live in the UK and visited infrequently. Following the last inspection this LPA had written to us outlining future arrangements for supporting the manager in their role. However these had not been adhered to.

At this focused inspection we found improvements had been made in respect of the management of medicines. A senior care worker had been given responsibility for the ordering and checking of medicines. This meant there was a more consistent approach to the process. Arrangements for the disposal of unused medicines were robust.

Care plans were being updated and were well laid out and comprehensive. However information was not always up to date and did not accurately reflect people’s current needs. There was no evidence people, and/or their representatives, were involved in planning their care or consented to the plans.

Monitoring records were not always put in place as necessary to ensure people’s identified needs were met. Where monitoring records were in place these were not consistently completed to allow staff to have a comprehensive understanding of any changes in people’s health needs.

Parts of the building were in need of updating and redecorating. Although a maintenance worker had been contracted to work 16 hours a week at the service this was not sufficient to address the defects in the building and furnishings. There were areas in the building where water had penetrated the walls leading to areas of damp, mould and peeling wallpaper. Furniture in people’s bedrooms was mismatched and some items were damaged or broken. Soft furnishings were of a poor standard.

Staff were well supported by a system of regular supervision, training and staff meetings. The manager told us they spoke with staff informally on a daily basis and had an understanding of the day to day issues affecting the service because they often supported care workers to provide care.

The registered manager was aware of the legal requirements laid down by the Mental Capacity Act (2005). They had arranged for healthcare professionals to review people living at the service with regard to this legislation. Applications had been made for potentially restrictive care plans to be authorised, as appropriate.

There were robust systems in place to protect people who were at risk of falls. All falls were documented and the manager regularly reviewed the information in order to highlight any trends or patterns. The Care Quality Commission (CQC) had been informed of significant events such as accidents, as is required by law.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The actions we have asked the provider to take are detailed at the back of the full version of the report.

Although, on this occasion, we did not inspect how people's care and welfare needs were being met, the staff support we observed to the people present in the home was to a good standard. People looked well supported with their personal care and there was a happy, friendly atmosphere in the home.

At this inspection we judged appropriate action had been taken regarding the previous compliance actions we issued. For a fuller picture regarding our assessment of standards in this home the reader is referred to our report dated 6 and 7 June 2013.

Every one we spoke with was happy with the care. Comments included ' I am very well looked after, the staff are very good and the manager answers my questions,' 'they do a good job,' and 'the home is nice, I feel safe here.' We spent time informally observing care during lunch. The staff on duty were observed as being very attentive to people's needs. Staff spoke and worked with people in a respectful manner. People said the food was very good, there was enough staff and staff would respond promptly to their needs. People said they had no complaints or concerns, but they said if they did, they were sure the staff and the management would respond to them appropriately.

Accommodation was decorated and furnished to an acceptable standard. However some of the decorations and furnishings needed upgrading as they were beginning to look worn . The home was clean and generally odour free; although there was a smell of urine in two bedrooms. The medication system operated satisfactorily. Some health and safety checks needed completing.

Staff recruitment checks and staffing levels were satisfactory, but training needed improving. There needed to be a better quality assurance system.

To help us to understand people's experiences, we used our SOFI

(Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend

time watching what was going on and helped us record how people spent their time, the

type of support they got and whether they had positive experiences.

We spent 60 minutes observing life for people in one of the communal rooms. We focussed our attention on five people but others were in line of sight.

During the observations we saw staff helping two people to mobilise. We also saw staff conversing with people when they were laying tables for lunch. We saw staff assisting people to eat their lunch. We saw people talking to each other at lunch time.

We witnessed staff interaction with people which was generally positive. There were some occasions when staff helping to feed people were not communicating with them.

We spoke to two visitors who told us that they were pleased their relative lived at Ismeer. We spoke to people and spent time observing people and staff over a meal period. We saw people's privacy and dignity was respected and staff were helpful. We saw people chatted with each other and with staff. We heard care workers asking people what they would like to do and giving them ideas if they could not make a choice.