Archived: Partridge Care Centre

The inspection took place on the 14 and 15 January 2016 and was unannounced. Partridge Care Centre is a purpose built home set over three floors. It provides personal and nursing care for up to 117 older people, some of whom live with dementia. At the time of our inspection 73 people were using the service. Following our previous inspection of the service in July 2015 we imposed a condition on the provider’s registration to prevent them from admitting any further people to Partridge Care Centre because of the concerns that we found.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, there were management arrangements in place as the deputy manager was performing the role of manager and the clinical lead was acting as their deputy. The provider contracted an independent health and social care consultant to help support the interim managers of the service in the absence of a registered manager.

When we last inspected the service on 23 July 2015 we found it was not meeting the required standards. We found breaches of the Regulations in relation to safe care and treatment, staffing, safeguarding people, consent, privacy and dignity, person-centred care, good governance and notifiable incidents to CQC. At this inspection we found the provider continued to be in breach of regulations. Although some improvement had been made the provider had not taken sufficient action to ensure people received safe, effective and compassionate care.

We found that there were inconsistencies in meeting people’s needs safely at all times. The provider was using a high number of agency staff to cover for staff vacancies and both planned and unforeseen absences. This was poorly managed and the agency staff used had not been given access to up to date information about how to care for people in a safe way. For example, a safe induction process was not operated for agency staff who had not had their skills and competency assessed to ensure they were able to provide care safely. Care records were available for agency staff to read however these were not detailed enough to ensure they were able to support people safely and appropriately.

People identified as being at risk through falls had experienced harm because the risks had not been managed effectively.

People were assisted by staff who used unsafe moving and handling techniques. For example, helping people to stand up by lifting and pulling under their arms. Recommendations from occupational therapy staff were not always reflected in the people’s care plans or put into practice. Staff were not familiar with the recommendations made on how to use equipment to assist people with their transfers.

Some people’s freedom of movement was restricted and restrained in ways that did not comply with nationally recognised good practice or the deprivation of liberty safeguards (DoLS). For example, people’s freedom of movement was restricted by the use of tables, mobility equipment such as Zimmer frames being removed or placed out of reach, and by physical restraint observed by the inspection team. The processes designed to ensure people were safe with the least restrictions on their freedom were not followed.

Accidents and incidents were monitored and reported to the local safeguarding team and CQC where necessary and appropriate. However, there were lack of internal systems to identify trends and patterns and there was a lack of action taken to prevent accidents and incidents from reoccurring.

People who needed their food to be pureed and their drinks thickened to mitigate the risk of chocking were administered some of their medicines in tablet form. This was not discussed with the GP or the specialist speech and language therapist team (SALT) to ensure that having medicines in tablet form had not increased the risk of choking.

There were significant differences in the skills and knowledge demonstrated by permanently employed staff and agency staff. Permanently employed staff had comprehensive training and were able to tell us their responsibility towards people under the safeguarding procedure, signs of abuse and they were confident that their report will be taken seriously by the management team and acted on. Not all agency staff was familiar with the safeguarding procedure or knew how to recognise and report possible abuse.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs. However, there was a high turnover of staff; the provider told us permanent staff vacancies were difficult to fill due to candidates not meeting the standards required.

We found that people had their medicines administered by nurses who were trained and had their competencies monitored by the manager. There were regular effective audits carried out in relation to medicines which identified any errors and these were dealt with promptly.

People had mixed views about the quality of the food provided, however they all said there were alternatives and always two choices offered.

Communication between management, staff and people who lived at the home had improved since our last inspection. There were more effective hand over processes and also a daily meeting where staff had the opportunity to report any concerns they may had about people`s needs. Staff, relatives and people told us about the management arrangements and confirmed that management was visible and approachable.

Records were reflective of people`s needs and were regularly reviewed by staff. However, we found that care plans were generic and had little person centred information about people`s likes and dislikes. There was little involvement from people or their representative in care reviews, particularly when peoples` needs changed.

The management team had implemented systems to monitor and improve the quality of the service provided; however some areas like accident and incident analysis were not as effective as they should have been. There were regular relatives and staff meetings.

We found a number of continuous breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The inspection took place on the 23 July 2015 and was unannounced. At our last inspection on 28 April 2015, although we found no breaches of the regulations, we asked the provider to make several improvements. This was because the service was not consistently Safe, Effective, Caring, Responsive or Well Led. At this inspection we found the provider had not taken sufficient action to remedy these concerns.

Partridge Care Centre is purpose built home set over three floors. It provides personal and nursing care for up to 117 older people and for people who live with dementia. At the time of our inspection 83 people were using the service.

There is a manager in post who is currently not registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. However, the manager was in the process to register with CQC.

This inspection was carried out in response to information of concern received by CQC. The inspection considered whether the service was safe, effective, caring, responsive and well-led. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Partridge Care Centre on our website at www.cqc.org.uk.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection applications had not been made forall thosepeople whose freedom had beenrestricted. We saw staff using some forms of restraint. People were sat in wheelchairs with belts on and on several occasions staff held residents hands down to ensure they were moved out of the way if they refused to move, or to prevent them physically assaulting the staff who was closely supervising them.

We found that the effectiveness of staff deployment lacked consistency across the home and there were insufficient staff to cope with the demands placed upon them. The quality of care provided suffered across the home mainly because of lack of staff. People and staff told us that they felt their needs were not met safely at all times due to lack of staffing.

Where incidents of avoidable harm or potential abuse had been identified, the management team had not taken appropriate action to investigate and report these. As a result people’s care had suffered and they remained at risk of harm or abuse.

Safe and effective recruitment practices were not followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs, gaps in employment were not investigated.

We found that medication had not been administered following best practice guidelines. We found that records were signed to indicate that medicines were administered, however when we counted the medicines we found that there were more in numbers that it should have been.

People were not protected from the risk of infections. The environment was well maintained however the equipment used for manual handling was not clean. Wheelchairs that had dark brown stains on the seats and staff used these to move people. Crash mattresses and alarm mats were stained and sticky.

Some of the staff we spoke with could not recall training they had received in how to safeguard people against the risks of abuse. However records were seen that demonstrated to us staff signed the training attendance. They were not able to describe what constituted abuse and the reporting procedure they would follow to raise their concerns.

Communication was not effective between management, staff and people. People were not aware of the recent management changes in the home and not able to tell us who the manager was. This meant that leadership in the home was not visible at all levels.

Records were not current and had not been reviewed when people’s needs changed, or when required by the provider’s policy.

As a result the provider failed to recognise and report incidents to the local safeguarding team.

The manager had not implemented robust systems to monitor and improve the quality of the service provided. They were not monitoring or analysing the high staff turnover and the inability of the service to retain the employed staff.

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 found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. CQC is considering the appropriate regulatory response to resolve the problems we found.