17 October 2023
During a routine inspection
Scholars Mews Care Home is a residential care home providing accommodation with personal care for up to 64 people. It is a purpose-built home in which care is provided across 3 floors. Residential care was being provided on the ground floor and dementia care was being provided on the first and second floor. At the time of our inspection visit there were 43 people living at the home. Some of these people were living with dementia, physical disabilities and mental health conditions.
People’s experience of using this service and what we found
People were not safeguarded from abuse and avoidable harm because safeguarding systems were ineffective in keeping people safe. Staff did not always report allegations of abuse in a timely way. Staff did not always feel able to challenge unsafe or poor practice because their concerns were not always listened to or acted upon.
People’s injuries were not always recorded or reported. Where injuries were reported, these had not always been investigated. This practice prevented the provider completing a thorough review to identify the cause of injury which increased the risk of improper treatment. The provider completed an analysis to identify patterns and trends of accidents within the home. However, this was not accurate because accidents and incidents were not always recorded and reported in line with the providers expectations. Where people had fallen, it was not always clear what action had been taken to reduce the risk of re-occurrence.
Staff did not always take action to mitigate any identified risks to people’s health. Risk assessment tools did not always accurately reflect changes in people’s health. There was limited information in care plans to ensure staff knew how to minimise risks to people’s health and well-being.
The provider did not always ensure there were enough suitably skilled and competent staff on duty which compromised people's health and safety. Senior staff in particular had insufficient time to fulfil their duties. Staff competency was not always assessed to ensure staff had the right skills to deliver safe and effective care.
Medicines were not always managed safely. In each of the medication rooms we found large quantities of medicines that needed to be returned to the pharmacy. These were not stored in line with the providers policy or best practice guidance. Some people needed medicines on an 'as required' (PRN) basis to treat short term conditions such as pain or anxiety. Where medicines had been prescribed to help people manage levels of distress, it was not always clear when these medicines should be considered as guidance contained vague information. There was limited evidence to show a clear rationale for the administration of some PRN medicines.
There had been a period of managerial instability in the home. The provider and senior leaders failed to ensure the home had the right level of support, competency, and skill to provide people with safe, effective, and compassionate care. The provider's systems and processes for monitoring the quality of the service were not effective. The serious and widespread issues found at this inspection had not been identified through internal quality monitoring audits and checks.
People were not always well supported or treated with respect and compassion. People’s privacy was not always respected and promoted.
People were not always supported as individuals, or in line with their needs and preferences. There was a culture where staff encouraged people to stay in their bedrooms. Some people expressed distress through their behaviour. Records did not show this was always responded to consistently.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 26 January 2018).
Why we inspected
The inspection was prompted in part due to concerns received about safeguarding, staffing numbers and risk management specifically related to falls. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.
Enforcement
We have identified breaches in relation to safeguarding, staffing, risk management, dignity and respect, person centred care and governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.