This comprehensive ratings inspection took place on the 25th October 2016 in response to safeguarding concerns and a quality assurance inspection undertaken by the local council, which raised concerns about other aspects of care provided at Dunedin residential home. We found significant concerns during this inspection and took immediate action to address these concerns. However, we received additional information on the 10th November and returned to the service unannounced. At which time we found additional evidence about the lack of managerial oversight at the service and the safety of people living there. On the 16th of November 2016, an inspector and inspection manager met with the providers at the service to discuss on-going concerns.
Dunedin residential home is registered to take up to 23 people requiring accommodation and personal care. At the time of inspection there were 16 people residing at the home. On the day of inspection, the local authority had placed restrictions on the service admitting local authority funded people to the service.
On the 26 October 2016 the registered manager was absent and an acting manager was in place to ensure the continued running of the home. During the duration of the inspection period the registered manager was removed from 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 2008 and associated Regulations about how the service is run.’ In the absence of the registered manage the provider had promoted a senior carer into the role of manager.
We found a number of significant concerns relating the safety and managerial oversight at the service. The environment and equipment at the home was not safely maintained and there was a lack of good infection control practices.
Cleaners found it difficult to maintain the cleanliness of the environment due to its age and run down state. We had to request environmental health inspectors to come to the home to check the safety of the kitchen area due to the lack of cleanliness in the storage of food. Whilst no risk to people was found, it was agreed that the home needed to improve its cleanliness and rotation of food, some that had passed the best before dates.
When incidents of behaviour that challenged occurred, staff did not appropriately record and investigate to discover the cause of the behaviour, and whether they could have prevented the incident. Consequently, there was a culture of not learning from incidents. External professionals did not always receive referrals from the home to support people with complex needs, for example the speech and language therapists and falls team. There were no systems in place to chase up referrals when these were made, such as repair of people’s hearing aids, without which left people unnecessary isolated from the environment.
Staff had received training, which appeared to be in date; however, training certificate dates did not match management audits of training undertaken. Only one member of staff had in date manual handling training. Witness statements of staff written following the management of behaviours that challenged demonstrated a lack of knowledge in how to engage with people who were confused and de-escalate potentially unsafe behaviours during incidents of distress.
The dining experience was poor and few people were moved from their seats to enjoy a meal together, often not moving for very extensive periods of time.
Staff demonstrated kindness in their interactions with people and people told us that staff were very kind to them. However, staff used old stained and misshapen bedding for people that they would not use for themselves and supported people to use a toilet / shower area that was dirty. Staff told us when questioned that they would not be prepared to use these themselves.
People who had capacity and were able to vocalise were observed to have positive interactions with staff. People with cognitive impairment, and more difficulty in communication were left for long periods without any interaction or engagement. There was a lack of stimulating activities on offer at the home.
Care plans were not person centred. As a result, people who presented with high-risk behaviours or physical health needs did not have in place interventions that would instruct staff how to be response to their needs, preferences, and wishes.
There was a significant lack of leadership and management across the service, with little effective governance systems in place to monitor the quality and safety of the service provided. The providers had trusted all the running and oversight of the home to a manager who was now absent. They had not assured themselves that the registered manager had been running the service safely. In the place of the registered manager was a senior carer acting up into the role without being given any guidance on how to run the service and what their roles and responsibilities were. This lack of oversight had resulted in significant failings at the service, which had previously been rated as “good” in January 2014.
Consequently, 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. If we have not taken immediate action to propose to cancel the provider’s registration of the service, they will be inspected again within six months. You can see what action we told the provider to take at the back of the full version of the report.
The expectation is that providers found to be 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.