All inspections: St Ives Disabled Care Centre

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.

This inspection took place on 27 and 28 May 2015 and was unannounced. At the last inspection on 26 and 27 November 2014 we found six breaches in regulations which related to staffing, care and welfare, nutrition, respecting & involving, records and quality assurance. We requested an action plan from the provider detailing how improvements would be made but did not receive one. At this inspection we found improvements had not been made.

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. The manager told us there were 43 people using the service when we inspected, which included two people who were in hospital. 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 had a registered manager who left the organisation in March 2015. A new manager started in post on 22 April 2015 and was present during this inspection. 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.

Although people told us they felt safe we found people’s safety was compromised. People were not kept safe from harm as staff had not received up to date training in safeguarding and allegations of abuse were not always acted upon. We made safeguarding referrals to the local authority safeguarding team.

People told us there were not enough staff and this was confirmed in our observations. Although we found a small number of rooms were clean and well maintained, the majority of the home was dirty and there were insufficient domestic staff on duty to keep it clean. Infection control practices were not always followed which meant people were not protected from the spread of infection.

We found the home was not well maintained and the décor in places was shabby. Although some rooms were comfortably furnished and clean, many had stained carpets and damaged furniture. Systems in place to check and respond to environmental risks were not effective which meant health and safety and fire safety issues were not always addressed. We reported our concerns to the fire officer who visited and took action.

We found people had access to health care services, although we were not assured these were always accessed in a timely manner. Although we found people received their medicines when they needed them, the handling and management of medicines was not always safe.

Recruitment processes were not robust as thorough checks were not always completed before staff started work to make sure they were safe and suitable to work in the care sector. Staff training was not up-to-date which put people at risk of unsafe or inappropriate care.

Most people spoke positively about the staff who they felt were kind and caring and we saw some positive interactions. Yet we also saw practices that showed a lack of respect for people and compromised their dignity. People’s care was not always planned or delivered in a way that met their individual needs and preferences.

There was a range of group activities and outings provided, however, these appeared to benefit only some of the people and others told us they were bored. People gave mixed feedback about the food but were generally satisfied. However, we found people’s nutritional needs were not assessed and monitored to ensure they maintained a stable weight.

We found the home was disorganised and chaotic with inadequate communication systems which meant senior staff were not always aware of what was happening in the home. Although the home had quality assurance systems in place these were ineffective and had not addressed the issues we identified at this inspection, many of which were similar to those we found at the previous inspection in November 2014.

Overall, although we found significant shortfalls in the care and service provided to people. 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). The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this provider is ‘Inadequate’. This means 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 the provider 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.

The inspection was carried out over two days. It started on 26 November 2014 with an unannounced evening visit between the hours of 6.45pm and 10pm and resumed at 8am on 27 November 2014.

The last inspection was in March 2014 and the service was meeting the regulations we inspected.

St Ives provides nursing and personal care for people with physical disabilities; the majority of people using the service are under pension age. The home is a converted listed building and is located in 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 has a registered manager. 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.

There were not always enough staff to meet people’s needs. The system the provider used to decide how many staff they needed was not reliable and this created a risk people would not get the right care.

People who used the service told us they felt safe at St Ives. The required checks to make sure staff were suitable to work in a care home were done before new staff started work. Staff who had recently started working at the home told us they had been given induction training which prepared them to carry out their roles. After induction there was a planned programme of training for all staff. Although some staff were overdue for training we found this was being dealt with.

The home was clean and well maintained. Some staff were not aware of the correct evacuation procedures and there had been no fire drills for the night staff.

Medicines were managed safely and people told us they received their medicines correctly.

Some people said they did not always get enough to eat and the arrangements for providing people with snacks overnight were not adequate. We observed meal times and found there was a lack of consideration and respect in the way some people were supported to eat and drink.

The legal requirements relating to Deprivation of Liberty Safeguards (DoLS) were being met.

People were supported to meet their health care needs and had access to the full range of NHS services.

The majority of staff were kind and caring in their interactions with people, however, we found most interactions were linked to tasks such as supporting people with personal care. Activities were offered but they were not person centred and there was little evidence of people being supported to develop independent living skills. The location of the service made it difficult for people to become involved in the local community because the home did not have their own transport.

Most people were involved in planning and reviewing their care, however, people’s care was not always planned and delivered in such a way as to meet their individual needs and preferences. Where it was appropriate people were supported to obtain the services of an advocate.

People knew how to make a complaint and complaints were recorded and dealt with. However, people living at the home said they did not feel the provider always listened to them or took their concerns seriously.

The systems in place for assessing and monitoring the quality of the services provided were not always effective in identifying shortfalls in the service and risks to people’s health, safety and welfare.

We identified a number of areas where the provider was not meeting the requirements of the law. You can see what action we told the provider to take at the back of the full version of the report.

We spoke with six people who used the service. We observed staff, although busy, were responsive to people's individual's needs/preferences. For example, offering people a different snack and/or a favourite drink.

Everyone said they felt safe at St Ives; comments ranged from 'It's ok here' to 'Hand on heart I can say they are fantastic'. People told us they felt comfortable speaking with any of the staff if they had any concerns.

We found peoples care and/or treatment was planned and delivered in a way that was intended to ensure their safety and welfare.

Some people said they felt the communal rooms on the ground floor were not big enough to accommodate large numbers of people comfortably and we saw that some people went to their bedrooms after lunch rather than watch the film on offer.

People said the meals were 'OK'. We saw two people who declined lunch were offered a snack instead. One person said 'I don't like eating in the dining room it is too busy' and another said 'I would prefer to eat alone'.

People said they did not have enough opportunities to go out. They said they used to have their own minibus but it was now shared with two other services which limited their ability to go out and about. One person said 'I would like to go out more'.

We found people's medicines were managed safely and people's records were kept securely and could be located promptly when needed.

We spoke with four people who used the service. One said 'It's ok living here,' they said the staff looked after them. Two other people said they liked living at St. Ives, they said 'It's like being at home'. They told us they were involved in the care planning and could make suggestions if they wanted to change things. They said the manager was approachable and the staff listened to them. They said staff never treated them badly. They told us there were always plenty of activities but it was up to them whether or not they joined in. Three people told us about holidays they had planned. Another person said they liked living at St. Ives, they said the best thing was the freedom to come and go as they pleased. They said staff spoke to them respectfully and they felt safe. They said if they were unhappy about something they would tell the staff. We spoke with one visitor who told us they did not feel involved in their relatives care; they said staff did not tell them things they had to 'guess'. They said some staff were better than others.

We found improvements had been made to protect people who used the service from the risk of abuse.

We found suitable checks were carried out before new staff started work.

We found inconsistencies in the way people's care and treatment was planned and delivered which could put people at risk of receiving inappropriate or unsafe care.

We found improvements were needed to the way records were managed.

We observed staff offering people choices and saw people taking part in planned activities. We saw positive interactions between staff and people who used the service, for example we saw people having a laugh and sharing jokes with staff.

We spoke with five people who used the service. For the most part people were satisfied with the care and support they received. One person said 'I like it here'; another said 'It is a generally good place, but there is a few niggling things.' One person said they had seen some improvements since our last inspection but they felt the service had not yet lived up to their expectations.

We saw that improvements had been made to the way people's needs were assessed and planned for. Most of the people we spoke with said they were involved in planning their care and felt they were listened to. One person said there was still scope for improvement in this area. They said they felt some of the staff did not really understand how their illness impacted on their ability to carry out their day to day activities.

The staff we spoke with were able to tell us about the different forms of abuse and were aware of how to report concerns. However, we found that some incidents and allegations had not been recognised as abuse or potential abuse and had not been reported to the relevant agencies.

There were systems in place to support people who used the service to express their views and contribute to how the service was provided.

We spoke with five people who used the service. They told us the staff were friendly, helpful and respected their wishes. One person said 'I feel comfortable asking them for anything I need.' People said staff respected their privacy and always knocked on the door before entering their rooms.

We asked people who lived at St Ives what it was like and one person said 'I like it because they are not invasive I can choose what I want to do and when I do it', another said 'I like it here there is plenty of space to move about and the people here are my friends.'

People told us they took part in various activities both inside and outside the home. One person said they went out to the shops with staff and another said they took a taxi and went out shopping on their own. One person told us they enjoyed cooking and another said they liked to use their computer; they said the home had Wi Fi which meant they were able to access the internet.

People told us they took part in meetings and were involved in decisions about various things such as planning menus and activities.

One person told us they had been involved in planning their care, another person said they had not.

One person told us the home was usually warm and there was no problem with the hot water. Another person told us their bedroom was not very warm and a supplementary heater had been provided. The surface of this heater was very hot and it was not protected.

During the visit we spoke with a relative who is a regular visitor to the service. They told us their relative had a room overlooking the courtyard and said the courtyard was an 'eye sore' because it was used as a dumping ground. They said it had taken months of complaining to get the provider to move a skip from the courtyard and no sooner had it been moved than some stair lifts had been dumped there. They said there were 'leaks all over the place' and their relative had two buckets in their room to collect water when the roof leaked. They said the provider was 'always going to do' and had promised to repair the boilers in the summer but the summer was moving on and nothing had been done. They said they could not understand why there were workmen outside painting the railings when there was so much work that needed to be done inside the home.

People told us they were satisfied with the care and support they receive. They said the food is good. They told us they were happy with the refurbishment work that had been done and were looking forward to seeing more improvements. The told us they felt safe. They said the acting manager listened to them and took notice of what they said. They told us that staffing in the home has improved recently.

Archived: St Ives Disabled Care Centre

All Inspections

29 September, 7 & 15 October 2015

During an inspection looking at part of the service

27 and 28 May 2015

During a routine inspection

26 & 27 November 2014

During a routine inspection

4 March 2014

During an inspection looking at part of the service

19 June 2013

During an inspection looking at part of the service

14 March 2013

During a routine inspection

19 December 2012

During an inspection looking at part of the service

12 July 2012

During an inspection looking at part of the service

10 January 2012

During a routine inspection