Archived: Inglewood Care Home

Updated 2 August 2016

We carried out this 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.

One adult social care inspector and one specialist professional advisor (SPA) carried out an unannounced inspection on 04 April 2016. Two adult social care inspectors and one SPA carried out a further unannounced inspection on 19 April 2016. The registered provider and staff did not know we would be attending on either days of our inspection.

Before the inspection we reviewed all of the information we held about the service, such as notifications we had received from the service and also information received from the local authority who commissioned the service. Notifications are changes, events or incidents that the provider is legally obliged to send us within the required timescale. We also spoke with the responsible commissioning office from the local authority commissioning team about the service.

The registered provider was asked to complete a provider information return (PIR) which they did. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We spent time with people on both floors, in communal areas and observed how staff interacted with people. During this inspection, we spoke with the regional manager, registered manager, 14 staff, five relatives and six people who used the service. We looked at all communal areas of the service and some bedrooms and en-suites with people’s permission.

We reviewed six care records and a range of records which relating to the day to day running of the service.

Updated 2 August 2016

This inspection took place on 4 and 19 April. Both days of inspection were unannounced which meant the registered provider and staff did not know that we would be attending.

Inglewood care home provides support and accommodation for up to 49 people who need residential or nursing care. This includes support for people living with a Dementia. At the time of inspection there were 42 people using the service. The service was located in a residential area within its own grounds and had on-site parking. The service was close to local amenities and a short distance from the coast and town centre.

The registered manager started working at the service in November 2015 and had promptly submitted an application to become registered manager. This application was approved during our inspection of 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.

At the last inspection on 11 and 14 May 2015, we identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance. At the time of inspection there was no manager in place at the service. There had been no meetings for people, their relatives and staff. There were very few audits and action plans in place and there were gaps in some records looked at. Staff expressed their concerns about the staff culture at the service which they described as poor.

At this inspection we could see the registered provider had addressed each of these areas, however gaps in records remained. These gaps related to care, activities, maintenance, ‘Ten at ten’ and clinical handover meetings.

Quality assurance processes were in place. Regular audits had been carried out by the registered provider and registered manager.

Meetings for people, their relatives and staff had been carried out. Staff felt that communication could be further improved.

Staff gave mixed reviews about the leadership and staff team in place at the service. Some staff described low morale; however we could see that the registered provider had taken some action to try to address this.

The registered manager understood the requirements of their role and had submitted notifications to the Commission when needed.

In some bathrooms we found that radiators had been removed and areas left unsafe for people to use. We asked the registered manager to take urgent action to address this. They contacted us after inspection with photographs to show that the areas had been made safe.

Some bathrooms were used to store furniture which posed a health and safety risk to people. We also found that some bathrooms were in need of repair. The registered manager told us that all bathrooms at the service were scheduled to be updated in May 2016.

Safeguarding alerts had been raised when needed and records detailed investigations which had been carried out. Staff demonstrated their knowledge and understanding of the different types of abuse and the procedure they needed to follow if they suspected abuse could be taking place.

An up to date policy was in place for restraint.

Risk assessments were in place for the day to day running of the service. People had risk assessments in place specific to their individual needs. People were supported to take reasonable risks which were fully risk assessed by the service.

Health and safety certificates were up to date. Gaps in fire and maintenance records had been rectified on the day of inspection.

Robust recruitment procedures were in place. Records showed that people had been recruited safely and had not started working at the service until two checked references and a Disclosure and Barring Service (DBS) check had been carried out.

There were sufficient staff on duty to provide care and support to people in a safe manner. A dependency tool was used to determine staffing levels. Staff told us they felt stretched at times which the registered manager told us they would look into.

Medicines were managed safely. Staff worked with people’s GPs to make sure they had access to the correct medicines and the quantities needed. Medicine rounds were often interrupted which caused them to take longer.

All new staff participated in an induction programme. Mandatory training was up to date for all staff. Supervision and appraisals had not been carried out in line with the registered providers policy, however since the registered manager came into post we could see that staff had started to receive regular supervision and appraisal.

People were supported with their nutrition and hydration. Support with eating and drinking was carried out in a dignified manner. Risk assessments and care plans to support nutrition and hydration were reviewed regularly.

People had regular access to health professionals involved in their care. Any contact with the service had been documented in the care records.

The service had appropriately carried out MCA and DOLs applications to keep people safe. Staff demonstrated a good understanding of the principles of each of these.

People had access to communal and private spaces inside the service and within the grounds. Improvements had been made to the service which included dementia friendly bedroom doors and activities within corridors.

People spoke very positively about the care and support they received from staff. People told us they felt well cared for and enjoyed living at the service.

People told us they felt listened to and felt able to approach a member of staff if they needed to.

Staff understood the importance of maintaining and respecting people’s dignity. People we spoke with confirmed their dignity was always maintained. We observed this to be the case when people were assisted at mealtimes.

Information about advocacy was on display at the service. We could see that this service had been offered to people previously.

The service worked with health professionals to provide end of life care to people which reflected their needs, wishes and preferences.

There were gaps in some of the care records looked at. Care plans reflected people's individual needs and contained detailed examples of care which reflected people's wishes. These care plans had been regularly reviewed.

Activity schedules were in place to show what activities were taking place. These included activities provided by the activities coordinator and activities provided by external visitors. We heard mixed reviews about the activities provided. Activities records did not always demonstrate if people had participated in activities.

People told us they knew how to make a complaint and felt able to do so. At the time of inspection nobody had wanted to raise a complaint. When complaints had been made, the service had acted appropriately to address these.

We found one breach in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the premises and equipment and records. You can see what action we told the provider to take at the back of the full version of this report.