Archived: St Ives Disabled Care Centre

Updated 23 November 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 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.

This inspection took place over three days on 29 September, 7 and 15 October 2015 and was unannounced. On the first day the inspection team consisted of four inspectors and an expert by experience with experience in physical disabilities. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. An inspection manager joined the inspection team partway through the inspection and was present when feedback was given to the manager and area compliance manager at the end of the visit. On the second day two inspectors, an inspection manager and the head of inspection visited. On the third day there were five inspectors and an inspection manager.

Before the inspection we reviewed the information we held about the home. This included looking at information we had received about the service and statutory notifications we had received from the home. We also contacted the local authority commissioners and the safeguarding team.

We usually send the provider a Provider Information Return (PIR) before the inspection. 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 did not send a PIR to the provider before this inspection as the inspection was planned at short notice.

We spoke with 19 people who were living in the home, four relatives, 17 care staff, six nurses, three domestics, two cooks, a kitchen assistant, two activity staff, the maintenance person, the manager, the area compliance manager and the area manager. We also spoke with six health and social care professionals who were visiting the home during our inspection.

We looked at 20 people’s care records in detail and others to follow up on specific information, four staff files, medicine records and the training matrix as well as records relating to the management of the service. We looked round the building and saw people’s bedrooms, bathrooms and communal areas.

Updated 23 November 2015

This inspection took place over three days on 29 September, 7 and 15 October 2015 and was unannounced.

At the last inspection on 27 and 28 May 2015 we identified ten breaches in regulations – regulation 18 (staffing), regulation 19 (recruitment), regulation 12 (safe care and treatment), regulation 15 (premises), regulation 13 (safeguarding), regulation 11 (consent), regulation 9 (person-centred care), regulation 10 (dignity and respect), regulation 16 (complaints) and regulation 17 (good governance). Following this inspection we took enforcement action.

We carried out this inspection in response to concerns we had received since the inspection in May 2015. These related to staffing levels in the home and the impact that had on the care delivered to people using the service. The local authority safeguarding team had also been informed of these concerns and prior to our inspection the commissioners had suspended placements at the home.

St Ives Disabled Care Centre provides nursing and personal care for up to 60 people with physical disabilities; the majority of people using the service are under pensionable age. On the first day of the inspection the manager told us there were 37 people using the service, which included 18 residential clients and 19 nursing.The home is a converted listed building and is located on the St Ives Estate close to Bingley. Accommodation is provided on four floors, there are single and shared rooms and many have en-suite facilities. There are three communal areas on the ground floor and there is also a lounge on the first floor.

The home did not have a registered manager. A manager who had started in post on 22 April 2015 was present on the first day of the inspection but resigned with immediate effect the following day. 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.

People told us they did not feel safe in the home due to insufficient staffing levels, particularly at night. The home had no permanent nursing staff and relied on agency nurses to cover all the shifts. Although the provider tried to ensure continuity by requesting the same agency staff, people told us staff did not know their needs. This was confirmed in our observations over the three days of our inspection. People also raised concerns about the reliability of the call bell system. Although the provider put daily checks in place to ensure call bells were working, there were still problems with the system when we visited on the third day. Safeguarding incidents were not always recognised or reported by staff.

Staff recruitment processes had improved although we found one staff member had only one reference. New staff told us they had not completed a full induction. The training matrix showed many staff had not received up-to-date training in mandatory subjects such as moving and handling and safeguarding. Staff were not clear about emergency procedures, such as the action to take in the event of a fire, and emergency equipment had not been checked to make sure it was safe and available for use.

We found improvements had been made to the environment as it was cleaner and many areas had been refurbished and redecorated. However, we found carpets in some people’s rooms needed replacing. Maintenance works were not identified or addressed promptly until we brought them to the provider’s attention. For example, a broken washing machine had been out of action for several months.

We found systems in place to manage medicines were not always safe which meant people were at risk of not receiving their medicines when they needed them. Care records were not accurate or up-to-date which meant people were at risk of receiving unsafe or inappropriate care.

Requests for Deprivation of Liberty Safeguards (DoLS) authorisations had been made for some people following recommendations made by reviewing officers.

People’s nutritional needs and weight were not monitored or reviewed to make sure they were receiving sufficient to eat and drink. People had access to healthcare services but advice and information provided by healthcare professionals was not always communicated between staff or acted upon.

We observed some kind, caring and sensitive interactions between staff and people who used the service. However, we found examples which showed people’s privacy and dignity was not always respected and people’s cultural needs and preferences were ignored. Activities were provided which we saw some people enjoyed, in contrast other people had little engagement or stimulation.

There was a lack of consistent and visible leadership which coupled with poor communication systems led to disjointed and chaotic service provision. Quality assurance systems failed to identify or address risks to people’s health, safety and wellbeing or secure improvements in the service.

Following each day of our inspection we contacted the provider to inform them of our concerns and requested action plans to show how these would be addressed. The action plans were provided however we continued to identify concerns at each subsequent visit. We liaised with commissioners from the Local Authority and Clinical Commissioning Group, as well as the safeguarding team. Following the third day of our inspection the local authority reviewed its position regarding its commissioning arrangements with the home and worked with the provider to put resources in place to ensure the safety of people using the service.

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

Services in special measures 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.

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.