The inspection visit was carried out on 21 and 22 September 2016 and was unannounced. The previous inspection was carried out in September 2015, when areas requiring improvement were noted. High View Oast Nursing Home is a converted Oast house, and is nursing home for up to 33 people. The bedrooms are situated on both ground floor and first floor, and consist of a mixture of single and double rooms. There is a lift providing access between floors. The communal accommodation is situated on the ground floor and consists of two interlinking lounge areas, a dining room, a small quiet lounge, and a porch area. On the day of the inspection there were 22 people living at the service.
There was no registered manager in post. The service had an interim manager who had left on 16 September 2016. A new interim manager was due to start on 26 September 2016. The regional manager told us they planned to work at the service until a permanent manager had been appointed. 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 and associated Regulations about how the service is run. We were supported by the regional manager, the quality manager and deputy manager.
At our previous inspection on 21 September 2015 the service was rated as ‘requires improvement’. At that time areas for improvement had been identified by the management team and action plans were in place to address the shortfalls. However, at this inspection we found the required improvements had not been made and additional shortfalls in the service were identified, as detailed in this report.
Although people told us they felt safe living at the service, people were not fully protected from harm or abuse. The management team had failed to report incidents of alleged abuse by staff to people to the local safeguarding authority, in line with safeguarding protocols.
Risk assessments to show staff how to support people positively when their behaviour were not detailed enough. There was no information on what may be the trigger to this behaviour and how to reduce the risk of this happening again. Measures were not in place to reduce the risks and keep people as safe as possible. Some risk assessments to support people with their mobility did not have sufficient information to guide staff how to move people consistently and safely.
Accidents and incidents were recorded but lacked detail, and these were not analysed so action could be taken to reduce the risk of further events.
There was not enough staff on duty to ensure people’s needs were fully met. On the day of the inspection the deputy manager confirmed that staffing levels were not up to the preferred levels due to staff sickness. Recruitment procedures had not been followed to ensure staff had been recruited safely.
People were at risk of harm as they were not always receiving their prescribed medicines. The storage room for medicines was not maintained at the correct temperature to ensure the medicines were safe to use.
Checks on the equipment and the environment were carried out, but staff could not find the environmental risk assessments. The service had a ‘grab file’ which was available in case of an emergency such as a fire, and each person had a personal emergency evacuation plan in place. Regular fire drills had been carried out.
The training programme had not ensured that all staff had received the training and training updates they needed to carry out their roles safely.
During the last inspection in September 2015 it was noted that not all staff had received a yearly appraisal to discuss their training and development needs and the programme of staff supervision was not up to date. There was an action plan in place to address these shortfalls, but at that time of this inspection there remained staff who had not had a one to one meeting with their line manager or received an annual appraisal.
Meetings were held with the nursing staff, and care staff to encourage them to voice their opinions of the service and discuss any issues; however minutes of the senior staff meeting were not available at the time of the inspection.
The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. One application to deprive a person of their liberty (DoLS) had been processed through the local authority and granted. Staff did not have a clear understanding regarding DoLS as there were people living with dementia who lacked capacity, and who needed constant supervision and were unable to leave the service. No DoLs applications had been made in these cases.
People’s privacy and dignity was not always upheld. At times people had to wait to be supported with their personal care until early afternoon, whilst others had to wait to be supported with their mobility.
People’s care plans varied in detail and they were not always personalised. The plans contained out of date information which did not give staff clear guidance to ensure people were receiving care in line with their current needs. Monthly care plan reviews were carried out but the main care plans were not always updated with full details of people’s current needs.
Staff told us that they sometimes found it hard to keep up with people’s changing needs as there was only a staff handover between nurses and they did not attend. There was a ten minute meeting each day but this happened at 11am and staff thought this was too late as they needed to know if people’s needs had changed before they went on the shift first thing in the morning. This situation had resulted in poor communication and there had been instances when staff were not aware of people passing away or those who required to attend hospital appointments.
There were two activities co-ordinators who encouraged and supported people to maintain their hobbies and interests. They provided group and individual activities to each person living at High View Oast. People and relatives told us they enjoyed the activities and they had really improved.
Staff greeted people as they went about their duties and people were offered choices about their daily routines, and what they wished to eat. People were encouraged to remain independent as possible and do things for themselves.
The complaints procedure was on display to show people the process of how to complain. The process to respond to complaints had not been followed to ensure that people were responded to within the agreed timescales.
People had opportunities to provide feedback about the service provided. Quality assurance surveys were sent out annually directly from the organisation’s head office. Results had been received in June 2016 but there was no evidence to confirm that people had been advised of the results or what action was needed to improve the service. At the previous inspection in September 2015 we noted that feedback from other stakeholders, staff and visiting professionals had not been gathered to ensure continuous improvement of the service, based on everyone’s views. This had not changed at the time of this inspection.
There were systems in place to review the quality of all aspects of the service but these were not effective. The service had received a ‘mock inspection’ from a quality assurance provider in May 2016 and an action plan was put in place to improve the service. However, not all of the shortfalls identified were included in the action plan, and there remained many areas of concern which had not been addressed and improved.
Staff said they did not feel the service was well led as the management was unstable and different managers and senior staff had left the service in last few months. They told us they did not always feel they were listened to and their opinions taken into consideration.
During the previous inspection in September 2015 it was noted that records about people’s end of life wishes had not always been completed, and there was a lack of people’s personal life histories. At this inspection life histories had been completed and end of life records were in place however, people’s records lacked accuracy and were not always updated and fully completed. Other records, such as the emergency plan, and environmental risk assessments, could not be found.
People were supported by their relatives to be involved in planning their care and to make decisions about their daily lives. People told us they enjoyed the food and they had choices. Records showed that people were assessed to make sure they received a healthy diet to ensure their nutritional needs were met. There were four weekly menus in place but no evidence to show that people had been involved in planning the menus.
People’s physical and mental health was monitored and people were supported to see healthcare professionals. People and relatives told us the staff were kind and respected their privacy and dignity. Staff were familiar with people’s likes and dislikes, and supported people with their daily routines.
Staff had been trained in safeguarding adults, and were aware of the service’s whistle-blowing policy. They knew how to raise any concerns with the manager, or with outside agencies if required. The provider had ensured that the published rating from the previous inspection was on display.
The overall rating for this service is 'Inadequate' and the service is therefore 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 re