Archived: The Evergreens

Updated 29 September 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

A comprehensive inspection of all aspects of the service was undertaken on 19 December 2014 and 15 January 2015. This inspection identified a breach of regulations. We visited again on 6,12 and 18 of August 2015 to carry out a further comprehensive inspection and to also follow up on actions taken in relation to the breach of legal requirements we found on 19 December 2014 and 15 January 2015. You can find full information about the outcome of this visit in the detailed findings sections of this report.

The first day of the inspection on 6 August 2015 was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 12 and 18 August 2015. On the first day of the inspection the inspection team consisted of three adult social care inspectors. On the 12 and 18 August 2015 there were two adult social care inspectors. Before the inspection we reviewed all of the information we held about the service.

We did not ask the registered provider to complete a provider information return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make.

At the time of our inspection visit there were twenty four people who used the service. We spent time with people in each of the bungalows. We spoke with nine people who used the service and four relatives. We spent time in the communal areas and observed how staff interacted with people.

During the visit we spoke with the project manager, the operations manager, the deputy manager, three team leaders, three senior support workers, four support workers, an agency care staff worker and one domestic staff.

During the inspection we reviewed a range of records. This included six people’s care records, including care planning documentation and medication records for people in three of the bungalows. We looked at rotas from June 2015, DoLS and MCA information. We also looked at staff files, including staff recruitment and training records, records relating to the management of the home and a variety of policies and procedures developed and implemented by the registered provider.

Updated 29 September 2015

We inspected The Evergreens on 6, 12 and 18 August 2015. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 12 and 18 August 2015.

The Evergreens is a complex of purpose built properties on the outskirts of Hemlington. The service comprises of five self-sufficient bungalows, Aspen, Redwood, Pinewood, Maple and Juniper. Each accommodates between four and ten people who have physical and / or learning disabilities

The home has not had a registered manager in place since 4 June 2014. 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 the inspection the project manager for Executive Care was acting as manager. The project manager is to apply for registration with the Care Quality Commission.

At our last inspection of the service on 19 December 2014 and 15 January 2015 we found that staff were unclear about what action they needed to take to ensure the requirements of Mental Capacity Act (MCA) 2005 were followed. There weren’t any records in place to confirm that staff had completed capacity assessments where appropriate and made best interest decisions. Staff did not know if people who used the service were subject to a deprivation of liberty safeguards authorisation (DoLS). From our review of records we saw that assessments and support plans had been developed but these had not been updated when people’s needs had changed. Effective systems for monitoring the service were not in place. The registered provider sent us an action plan telling us they would be compliant by 30 April 2015. At this inspection in August 2015 we checked to make sure that the registered provider had followed their plan. Following examination of records and discussion with the acting manager we found that the registered provider had not followed their plan and legal requirements had not been met.

Staff did not understand and work within the requirements of the Mental Capacity Act 2005. Capacity assessments were inaccurate or they did not clearly outline what decisions they specifically related to or why they had been completed. Where people had been found to lack capacity staff had not taken steps to complete ‘best interest’ decisions within a multidisciplinary team framework.

We saw that people had been deemed to lack capacity and then asked to sign consent forms for sharing their information and having their pictures taken. This was contradictory and staff could not explain the rationale behind these decisions.

Relatives made decisions for people but the care records did not to show whether relatives had become Court of Protection approved deputies, or if they had enacted power of attorney for care and welfare or finance or if they were appointees for the person’s finance. Relatives cannot make decisions about care and welfare unless they have the legal authority to do so and the person lacks the capacity to make these decisions for themselves.

We found that some people had difficulty making decisions; were under constant supervision; and prevented from going anywhere on their own. Staff did not know whether people were subject to DoLS authorisations, which are needed if people lack capacity to make decisions and these types of restrictions are made. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Care and support plans had been developed but these had not been updated when people’s needs changed. Information was recorded in the daily records but staff did not appear to use this to assist them to evaluate whether the support plans remained appropriate.

The arrangements in place for quality assurance and governance were not effective. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations.

The service’s procedures for recruitment did not protect people. Not all staff had completed an application form and proof of identity was not available for all staff employed. Gaps in employment were not always explored and one staff member had been recruited without a Disclosure and Barring Service check (DBS). The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults. This helps employers make safer recruiting decisions and also to prevent unsuitable people from working with children and vulnerable adults.

At times people who used the service showed behaviour that challenged to the point that staff needed to physically intervene. We found that staff had not received any training around the appropriate use of physical interventions such as physical restraint and breakaway techniques.

Examination of rotas and discussion with the acting manager identified that on some occasions the service had worked short because staff had not turned up for shift and alternative cover had not been found. It was agreed that staffing levels at times had not been sufficient and this had led to people not being able to go out. At times the service had needed to cover some shifts with agency staff. Agency staff at times had been the only staff in some of the bungalows.

We had concerns in relation to the management of medicines. Medicine storage was untidy and medicines were not stored appropriately. Medicines were not always administered as prescribed and appropriate records were not always kept.

We found that the registered provider did not provide adequate supervision and training to staff to enable them to fulfil the requirements of their role. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. We looked at seven staff files and found that five of the seven people had not received supervision.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Nutritional screening had been undertaken and people were weighed on a regular basis.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that activities and outings were arranged and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People said that they would talk to staff and the acting manager.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service 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."

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.