Background to this inspection
Updated
4 August 2018
We carried out this comprehensive 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.
The inspection was prompted, in part, by safeguarding concerns that had been shared with us by the local authority.
This inspection took place on 26 and 27 February 2018 and was unannounced. It was completed by three inspectors on 26 February 2018 and one inspector on 27 February 2018.
Before the inspection we reviewed all information we had received about the service, including the provider’s action plan for improvement and notifications. Notifications are information about specific important events the service is legally required to send to us.
We spoke with eight people who use the service and two family members. We spent time observing the way staff interacted with people who use the service. We spoke with the registered manager, the deputy head of care, six care staff, a maintenance worker, a cook, a cleaner and an activity coordinator. We spoke with a GP who had regular contact with the service. Following the inspection, we received feedback from three health or social care professionals who had contact with the service.
We looked at care plans and associated records for six people and records relating to the management of the service, including: duty rosters, staff recruitment files, staff training records, accident and incident records, maintenance records and quality assurance records.
Updated
4 August 2018
Solent View Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The home accommodates up to 19 people and at the time of our inspection 17 people were living at the home, two of whom were in a shared room. The accommodation was based on two floors connected by a passenger lift. The kitchen, sluice room and staff offices were based on the third floor of the home.
This inspection took place on 26 and 27 February 2018 and was unannounced.
There was a registered manager in post at 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 and associated Regulations about how the service is run.
We identified widespread and systemic failings during this inspection. The provider’s governance arrangements had not been effective in ensuring the fundamental standards of safety and quality were met. Appropriate quality assurance systems were not in place, there was a lack of resilience in the management structure and an accessible complaints procedure was not in place.
Staff who administered medicines were not always trained and people did not always receive their medicines as prescribed. Medicines were not always stored safely or recorded in accordance with best practice guidance.
Areas of the home were not clean, including the sluice room and a bathroom. Infection control arrangements were not adequate to prevent the risk of cross contamination. The laundry room was not fit for purpose. Legionella risk assessments and infection control audits had not been completed.
Individual and environmental risks to people were not always managed effectively, including risks posed by choking and pressure injuries. Not all staff had completed fire safety training, including senior staff who were expected to take charge in an emergency.
Action had been taken to reduce the risk of people falling; however, records of people’s falls were not completed accurately to allow the provider to identify patterns or trends.
Safe recruitment procedures were not always followed to help ensure only suitable staff were employed. Not all staff had completed essential training to undertake their roles.
People had mixed views about the food and choices were not offered in an effective way for people living with dementia. We could not be assured that people’s dietary and hydration needs were met consistently.
Staff followed legislation designed to protect people’s rights. However, assessments of people’s ability to make specific decisions had not always been completed.
Some adaptations had been made to the home to make it supportive of the people who lived there, but the home was not accessible to people who used wheelchairs and some people reported excessive levels of noise that upset them.
Some staff showed a lack of consideration for people’s dignity, for example in the way they cared for their clothes and stored continence aids in their rooms.
Most people were complimentary about the attitude of staff, but some described them as “off-hand” or “unhelpful” at times. We observed some positive interactions between people and staff, but also heard inappropriate language being used by staff who were not always discreet.
Staff demonstrated a good understanding of people’s individual needs, although records of the care they provided did not confirm that the needs of four people being cared for in bed had been met.
Staff described how they supported people at the end of their lives, but most had not completed end of life training and people’s end of life wishes had not been recorded in their care plans.
The provider sought and acted on feedback from people, but action taken was not always effective. There was not a policy in place to ensure staff acted in an open and transparent way when people came to harm.
Staff completed pre-admission assessments before people moved to the home and supported people to access healthcare services. They understood their safeguarding responsibilities and there were enough staff deployed to meet people’s needs.
Staff promoted independence and usually involved people in discussions about their care. People had access to a range of activities including one-to-one conversations with an activities coordinator.
Staff were happy working at the home and felt supported in their roles by the registered manager.
We identified eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about the commission’s regulatory response to the breaches will be added to the report after any representations and appeals have been concluded.
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.