Background to this inspection
Updated
5 February 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.
This inspection took place on 4 and 5 November 2015, and was unannounced. This followed previous inspections on 16 and 17 July 2015, 6 August 2015 and 19 August 2015.
The inspection team consisted of two inspectors.
Before our inspection we reviewed the information we held about the home and information from the local authority commissioners and the police.
We had received four notifications from the provider since the last inspection. A notification is information about important events which the service is required to send us by law.
During the inspection we spent time observing the care being provided throughout the home. We observed people being supported at lunch time and at other times in the home. We spoke with the manager, the deputy manager, a senior carer, three care workers, and a domestic / care worker.
We looked at records relating to all aspects of the service including care and staffing, as well as policies and procedures. We also looked in detail at three people’s care records and the recruitment files of three care workers.
The provider has employed a person to manage the service. As this person was new in post, we allowed them time to check and send the policies, procedures and Statement of Purpose that were not available on the day of our visit.
Updated
5 February 2016
We inspected 9 Grace Road on 4 and 5 November 2015 and the visit was unannounced. We last inspected the service in July and August 2015. At that inspection, we found breaches of legal requirements in four areas; the reporting of incidents and accidents, assessing risk, good governance and safeguarding people who use services from abuse. That meant the service was placed in special measures. We asked the provider to take action to make improvements however they had not time to send a dated plan by the time we re-visited in November. On this visit we found that there were continued breaches in assessing risk, protecting people from harm, providing safe care and good governance. There were further breaches in failing to provide statutory notifications, medicines administration and providing adequate infection control.
The service does not have a registered manager. Following our visit in July the Registered Manager resigned, a manager is now in post and intends to register with the CQC when the appropriate legal clearances have been received.
The provider has commenced sending us notifications about events happening to people living at the home. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.
Risks to people’s health and safety was not overseen, managed or reviewed. We found a number of infection control issues throughout the home.
There were sufficient numbers of staff to keep people safe and meet their needs, and staff went through a thorough employment process and were recruited safely.
The legal requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) were now being followed. The MCA is designed to protect people who can't make decisions for themselves or lack the mental capacity to do so. The DoLS safeguards ensure that people are not unlawfully restricted.
Staff provided a varied response in dealing with behaviours that challenge, and not referring to people with their chosen name.
People’s privacy and dignity were not upheld or respected.
People were provided with meals that met their cultural and dietary needs. Nutrition was monitored by appropriate health professionals.
People were given greater choice on how they spent their time, as an activity co-ordinator had been employed and made improvements for people’s cultural and spiritual wellbeing.
People’s care plans included personalised information about their individual preferences and communication passports reflected how people could be communicated with on an individual basis.
The provider did not have effective systems in place to assess, monitor and improve the quality of care.
We noted a number of changes and improvements through the inspection, however the majority of these were reactive and limited to the deficiencies reflected in the last report.
There was limited information relating to people’s health needs and associated risks with diagnosed conditions. The health action plans which we saw at the last inspection had been removed from the care files.
At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.
CQC is now considering the appropriate regulatory response to resolve the problems we found.