Archived: Chy Byghan

Updated 26 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

The unannounced inspection took place on 12 February 2018. The inspection was carried out by one adult social care inspector. The inspection was prompted by information of concern received regarding the safety of the fire system and staffing levels at the service.

Before the inspection we reviewed the information we held about the service. This included past reports and notifications. A notification is information about important events which the service is required to send us by law.

During the inspection we spoke with six people who used the service, the provider, service manager and three staff members. We also spoke with one healthcare professional familiar with the service.

We looked at three records relating to the care of individuals including medicine records for 13 people, staff records and records relating to the running of the service including audits.

Following the inspection we spoke with commissioners, Local Authority Quality Assurance managers and two representatives off the Fire Authority.

Updated 26 May 2018

We undertook an unannounced focused inspection of Chy Byghan on 12 February 2018. This inspection was undertaken following information of concern received by the Commission regarding the safety of the service. The team inspected the service against two of the five questions we ask about services: is the service safe and is it well led?

The service was rated as Requires Improvement at the last inspection in March 2017 when we identified three breaches of the regulations. We identified concerns included how the service operated under the Mental Capacity Act (2005) and concerns about the submission of Deprivation of Liberty safeguard applications to ensure people were not unlawfully detained. We also identified that the provider was not fully assessing the risks to people or doing all that was reasonable practicable to mitigate any risks. We identified that staff were not receiving the appropriate level of support, training or supervision to enable them to safely carry out their duties.

Following the last inspection in March 2017 the service sent us an action plan stating what action it was taking to meet the requirements of the regulations. This inspection is based on information about increased risk which preceded the planned inspection visit to check on the action the service had taken to meet the requirements of the regulations.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Chy Byghan is a care home which offers personal care and support for up to 19 predominantly older people. At the time of the inspection there were 13 people living at the service. Some people were living with physical disabilities, long term physical health and mental health conditions including dementia.

At this inspection we found concerns with the safety of fire systems. For example, the fire protection system was not currently operating as designed. For example the provider told us a heat sensor had been disabled by an electrician in November 2017 because it was defective and a fire exit had been closed off. The service did not have a fire safety risk assessment in place potentially putting people at risk of harm. We found issues with the safe running of the electrical system. The electrical system was repeatedly ‘tripping off’ and cutting the power supply. There was currently a high loading on the electrical system due to the use of four electrical heaters in various rooms. When the electricity supply was cut off the pressure relieving air mattresses used by one person deflated putting people’s skin integrity at risk, and where people were dependent on electrical heaters for warmth, these were not available to provide heating during these periods. A fire door on a person’s room on the ground floor was kept open with a wooden wedge. The person who used this room required the use of oxygen dispensed from a cylinder. The failure to keep the fire door shut when oxygen was being used posed a fire risk to all those using the service.

We had concerns about the provision of adequate heating to people living at Chy Byghan and the risk this caused to the service users of becoming cold. There was a fault with the heating and hot water boiler. The boiler fault meant that three bedrooms and the lounge were currently not being heated by the radiators served by the boiler. The current heating arrangement in the rooms which were not being heated by the central heating system, was through the use of portable electric heaters. These radiators were not always sufficient to keep these rooms at an adequate ambient temperature. The lounge particularly did not have adequate heating from the available electric heater.

Nine rooms including two bedrooms upstairs did not have a supply of hot water. This meant staff had to carry hot water upstairs in order to provide personal care to a person who was cared fr in bed and very frail. The hot water available across the rest of the service was checked and found to be only available at a tepid temperature. Maintenance records showed that the gas boiler had not received an annual service since June 2016. This meant that service users did not have an adequate supply of safely delivered hot water in order to meet their needs.

We had concerns about current and future appropriate staffing levels for the service. This was because one-third of the current core staff group had resigned because of uncertainty about the financial security of the service. The provider was heavily reliant on agency staff to maintain the staffing rota. On the day of inspection the service was already one staff member short of the three staff members usually allocated to cover the morning shift from 8:00am to 2:30pm. We saw that one of the remaining two staff had to leave the service for one hour and forty-five minutes during the morning, leaving only one staff member available to provide care and support for 13 people. Staff told us they did not consider the service to be safe because of the current level of staff absence and uncertainty about the future of the service.

Overnight staffing cover was limited to one member of care staff to provide care and support to 13 residents. The staffing rota showed that the night period was planned to be shared by two staff members on seven occasions between 12 February and 14 March 2018. Staff told us these shifts were having to be shared because the staff responsible for care overnight were also needed to cover for the day shift on the following day. Therefore these staff could not cover the entire night shift if they were to have enough sleep to work the following day. We saw that one staff member worked from 2:00pm on 11 Feb through till 2.00am on 12 Feb and then resumed work at 6:45am to finish at 2:30pm on 12 February. This meant that this staff member had only had 4.75 hours sleep over the course of 24 hours on duty. This placed an additional pressure on staff working when tired. This had the potential to put people at risk of harm.

The medicines administration system was unsafe. We checked the medicine records of all 13 people living at Chy Byghan. We found multiple incidents where medicines had been administered but not signed by staff as given. We also found one incident where a medicine had been signed as administered but was still in stock. We saw medicines audits conducted over the last six months that recorded two queries about whether a person’s Warfarin medication had been administered. This had not been followed up with medical professionals. Records stated it was ‘unclear’ if the medication had been given. There were no records of any follow-up discussions with staff or attempts to obtain medical advice putting the person at risk. The provider had also not ensured there was enough stock of one medicine to be administered. This had the potential to put people at risk of harm.

There was no care plan or risk assessments in place for a person who had moved into the service in January 2018. From a review of the person’s hospital health assessment we saw the person had serious health concerns that had not been appropriately assessed or planned for, during their stay at Chy Byghan. Plans to ensure people who required repositioning to protect their skin were not consistently followed. These issues had the potential to put people at risk of harm.

The sluice room which contained chemicals hazardous to health was unlocked. We were told it could not be locked because the key had been lost. The boiler cupboard was similarly required to be kept locked to keep people safe but was open because the key was lost. The cupboard holding the service’s electrical circuitry had a sign stating ‘keep locked’ and ‘high voltage’ and we found this too was unlocked. Staff found the key for this and locked it when the need for it to be locked was pointed out.

There were inadequate governance arrangements in place to monitor and assure the quality of the service. Staff felt the provider was not addressing the serious issues facing the service.

The provider told us the financial viability of the service was in serious doubt. The question of the financial viability of the service put people who lived at Chy Byghan at risk of not receiving the care service they require.

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

• Services placed in special measures will be inspected again within six months.

• The service will be kept under review and if needed could be escalated to urgent enforcement action.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. The breach of Regulation 12, Safe Care and Treatment, had continued since the previous inspection in March 2017. The CQC has imposed Conditions on the Registration of the service in light of the risks to people using the service.