Archived: Qumran Rest Home

Qumran is a care home which offers care and support for up to ten predominantly older people. At the time of the inspection there were ten people living at the service. Some of these people were living with dementia. Bedrooms were arranged over two floors. There was a communal lounge and a dining area on the ground floor. A stair lift assisted people to access the first floor.

The service did not have a registration requirement to have a registered manager in post because when the service was registered the provider was actively managing the service. The management arrangements at Qumran had subsequently changed and the service had appointed a trainee manager, supported by a registered manager of another service in the group, Eshcol House. At the last inspection in March 2016 the provider had assured us that an application for a registered manager would be sent to the Care Quality Commission following the inspection. This action had not been taken.

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.

The service was not meeting the requirements of the Mental Capacity Act 2005, including the associated Deprivation of Liberty Safeguards. Where it was recorded that people living at the service did not have capacity to make their own decisions, it was not evidenced how staff came to this conclusion. We found some assessments had not been appropriately recorded. The manager told us they were aware they may be restricting some people but had not made the necessary applications for an authorisation.

Care plans were not consistently updated and did not provide staff with guidance and direction to enable them to meet people's needs effectively. People living at the service and where appropriate, their families, were not routinely involved in the development of care plans and subsequent reviews.

Risks were not consistently identified, assessed and monitored for any changes. We found falls risk assessments were contradictory to information held in mobility sections of one person’s care plan. The management of the service had carried out their own audit on risk assessments and acknowledged there was room for improvement in the consistency and quality of risk assessments.

We found the fire safety regulations highlighted in a Fire Safety inspection in August 2016 had not been met. The service had been visited by an external fire risk assessment company and a report issued. The recommendations from this report had not been fully implemented.

People and relatives had recently been asked for their views and experiences of living at the service. Views were generally positive although there was a consistent complaint about the consistency and quality of food served. People’s comments included “Food wise, there is good and there’s bad. I’ve brought it up at our monthly meetings. Nothing changes.

People living at the service did not have access to sufficient meaningful activities to occupy their time. People told us there were not regular activities offered at the service. One person commented, “It does get boring at times. You can go into the garden, weather permitting, or watch TV or read but there’s not a lot going on.” We saw the service had an advertised activity of the day which showed a different activity against each day. Staff told us this was ‘a work in progress’ and we noted the advertised activity on the first day of inspection did not take place.

We looked at how medicines were managed and administered. We found it was possible to establish if people had received their medicines as prescribed. Regular medicines audits were being carried out. However, we saw errors in transcribing were made when handwriting medicines administration records from one format to another and instances when these had not been appropriately double signed by staff to help ensure any errors would be identified and addressed.

Qumran did not have appropriate systems in place to assess, monitor and improve the quality of the service.

Staff were clear on how to report any concerns they may have regarding the safeguarding of people at the service. Staff had recently been supported with supervision and appraisals. Training had been provided in key areas such as moving and handling. Fire warden training had been identified as being required. There was a training schedule in place to ensure staff were kept up to date.

Staffing levels at the service were adequate to provide safe care. Staff reported feeling supported by management. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

We walked around the service which was comfortable and personalised to reflect people's individual tastes. People were treated with kindness, compassion and respect.

We identified breaches of the regulations. You can see what action we have told the provider to take at the back of the full version of the report.

Qumran is a care home which offers care and support for up to ten predominantly older people. At the time of the inspection there were six people living at the service. Some of these people were living with dementia. Bedrooms were arranged over two floors. There was a communal lounge and a dining area on the ground floor. A stair lift assisted people to access the first floor.

The service did not have a registered manager in post. 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. Qumran was being supported by the registered manager of another service in the group, Eshcol House. The provider assured us that an application for a registered manager would be sent to the Care Quality Commission in the near future. It had been decided that the registered manager of Qumran was to be the person who was also currently the registered manager of another service, Eshcol House. Qumran has benefited from management support from Eshcol House since the last inspection.

In October 2015 we had concerns about the lack of consistent management of the service. At that time there was not adequate management support for the people and staff at the service. Fire safety regulations had not been fully met regarding requirements for the safety of fire doors at the service. There was no emergency evacuation plan available to provide an overview of the procedures to take in the event of an emergency. We were concerned that risks to people’s health and welfare had not been consistently assessed and there was a lack of sufficient guidance to help staff to manage risks safely. The service had not reported allegations of abuse to the local authority in a timely manner. There were not enough staff available to meet people’s needs, particularly at night. Staff were not receiving appropriate training or adequate supervision to support them in their roles. Care plans were not updated and did not provide staff with guidance and direction to enable them to meet people’s needs effectively. The service was not meeting the requirements of the Mental Capacity Act 2005, including the associated Deprivation of Liberty Safeguards. Where it was recorded that people living at the service did not have capacity to make their own decisions, it was not evidenced how staff came to this conclusion. Qumran did not have appropriate systems in place to assess, monitor and improve the quality of the service. People living at the service did not have access to sufficient meaningful activities to occupy their time. People who were confined to bed due to their healthcare needs were at risk of social isolation.

At this inspection we found improvements had been made in areas where we had concerns. However, the manager who was supporting Qumran told us; “It’s not all in order yet.” We found the fire safety regulations had now been met. The service had been visited by an external fire risk assessment company and a report issued. The recommendations from this report had mostly been implemented. We were told one fire door closure remained to be completed shortly.

Care files had been fully reviewed and thoroughly updated. People living at the service and where appropriate, their families, were involved in the development of care plans and subsequent reviews. People were given the opportunity to sign in agreement with the content of their own care plans. The care plans now contained emergency evacuation guidance for staff relating to each person’s individual needs. Risks were identified, assessed and monitored for any changes. Staff were clear on how to report any concerns they may have regarding the safeguarding of people at the service.

Staff had recently been supported with supervision and appraisals. Training had been provided in key areas such as moving and handling. There was a training schedule in place to ensure staff were kept up to date. Staff reported feeling more confident, empowered and involved in the service.

Following the concerns raised at the last inspection regarding a person who required care and support during the night, the service had employed agency staff to meet this person's needs. However, this person had recently died and the staffing arrangements for people at the service during the night had reverted to what we saw at the October 2015 inspection. This meant that staff were continuing to work a 12 hour shift, 8 am to 8 pm then remain at the service to sleep-in that night till 8 am the following day. Staff who did sleep-in shifts reported being woken if people required assistance during the night. People confirmed to us that if they called for assistance at night staff always arrived promptly to support them. Care file records detailed care provided at night for some people. Service management recognised the potentially increasing needs of people at night and were actively recruiting for night staff. However, they had not received any applicants at the time of this inspection.

Staff had increased their knowledge of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). However, we found some assessments had not been appropriately recorded and some information was conflicting. The manager told us they were aware they may be restricting some people but had not made the necessary applications for an authorisation, as the care plans were not yet ‘good enough’ to be sent to the DoLS service.

People has been asked for their views and experiences of living at the service. The service told us they had sent out quality assurance surveys in October 2015. However we were unable to evidence this and we were told the service had not had any questionnaires returned.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. People were treated with kindness, compassion and respect.

We looked at how medicines were managed and administered. We found it was possible to establish if people had received their medicines as prescribed. Regular medicines audits were being carried out to help ensure any errors would be identified and addressed.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy. However, the recording of people’s food and drink intake was not always sufficiently detailed and effectively monitored.

Some activities were provided for people. Care files contained some information on the activities that people took part in. However, activities lacked planning and structure and were arranged on an ad hoc basis by care staff. The manager assured us this issue was being addressed with a member of staff from Eshcol House starting to work across the two homes and arranging activities for people in a more co-ordinated way.

The service was in the process of appointing a deputy manager to support the applying registered manager for Qumran. This person would support this registered manager at both Qumran and Eschol House.

Qumran had carried out the necessary improvements to meet the requirements of the Health and Social Care Act 2008 regulations. There were no breaches of the regulations found at this inspection. However, the overall rating for this service remains at Requires Improvement, this is because we need to see the improvement sustained for a longer period of time.

We saw care plans were detailed and gave direction as to the care and support people needed. We saw people's care records had been developed and reviewed with them or their representative when appropriate, although reviews had not taken place regularly.

There were robust systems in place for the storage, administration and disposal of medications.

Staff told us they had opportunities to talk to each other regularly and had informal support systems in place.

The records were kept securely. They were well organised and detailed.

Everybody we spoke to said they were very happy with the care and the support they received. We also spoke to several relatives and to staff, and they were also very positive about the service provided. The small size of the home, and the attitude of the staff were seen as key reasons for people's contentment. One person said ' the staff are very kind and caring, nothing is too much trouble.'

Although care and support were good there were some gaps in documentation regarding health and safety checks completed, and to validate that staff had received training in some areas.

On the day of the inspection the home was clean, odour free and well maintained. Furnishings and d'cor helped to provide a homely and comfortable environment. At the time of the inspection staffing levels were satisfactory, and there was evidence that staff suitable recruitment checks were completed.