Martins House is registered to provide accommodation and personal care for up 60 older people some of whom live with dementia. At the time of our inspection 47 people were living at Martins House. We previously inspected in December 2015 and found the service was meeting the required standards at that time.The inspection took place on 11 August 2016 and was unannounced.
Since our last inspection there had been significant changes within the senior management team and new ways of working at a senior level were being implemented with the further development of a service quality improvement team. The registered manager who previously worked at Martins House had been transferred to another home owned by the provider after our inspection in December 2015. At the time of our inspection a manager had been recruited who was due to commence employment on 15 August 2016. The home was also without a Deputy Manager and the provider was in the process of recruiting for both positions.
Martins House had two managers since the registered manager’s departure who had not registered with CQC and had both subsequently left the organisation. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
We inspected Martins House due to concerns raised with us by the local authority. These were related to people’s continence needs were not being met, care was not being provided safely and regularly reviewed, and there were concerns regarding the competency and deployment of staff to meet people’s needs. We found at this inspection breaches of Regulations 09, 10, 11, 12, 13, 14, 15, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009. Following this inspection we took urgent action to suspend admissions to the home and sought urgent assurances from the Provider about how they would safely meet people’s needs.
At this inspection we found that there were numerous permanent staff vacancies and as a result there was a use of agency staff mainly at nights. This led to inconsistencies in the quality of care people received. People experienced delays in getting assistance and also receiving care when they needed it. People's continence needs were not met in a prompt manner as required. Risks to people’s health and well-being were not consistently identified and responded to positively. People’s medicines were not administered at the times indicated by the prescriber. The environment people lived in was not effectively maintained and cleaned.
Staff shortages and lack of skills of some of the staff working at the home had impacted on care delivery, maintenance of records, and the management of medicines and people's access to health care professionals. Staff told us they did not feel supported and had not received appropriate training to carry out their role. Staff morale in the home was low, and they told us they did not feel supported by the managers or the provider.
Permanent senior staff responsible for providing leadership on each of the floors of the home had limited support and training from the provider to be able to do this effectively. The training and development deficiencies had impacted on the care people received. People’s nutritional needs were not consistently met and monitored. People were not freely able to choose what they ate and people were not always referred promptly to the range of health professionals when their health deteriorated.
People's dignity and privacy was not protected by some staff and people were not cared for in a manner that promoted their wellbeing and personal hygiene. Some people were observed to be left in an undignified manner; however we also found that some staff interacted with people in a kind and friendly way. Some of the people we saw were comfortable in the presence of staff and close relationships had been formed.
We observed staff delivering care and support in a task orientated way and there was little interaction seen between people and staff. People’s social needs were not consistently met and there was little opportunities for them to pursue their hobbies and interests. People were unsure of where or to whom they were able to raise their concerns and complaints, and relatives told us that when they had recently raised complaints these had not been thoroughly responded to.
People did not always receive high quality care that was well led. The provider had not taken account of issues identified in other of their local homes recently to review and monitor the quality of care people received at Martins House. A service improvement plan recently developed was not sufficiently robust and did not identify many of the areas identified at this inspection. The provider had not sought to constantly monitor and review the quality and safety of care people received. Care records, and records relating to the management of the service were incomplete. Staff and relatives told us they felt the support from the provider was below of what they expected. The provider had not proactively engaged with people, relatives or staff to try to improve the service delivered. The provider had signed up to a complex care premium programme where they committed to improve staff training, moral and subsequently improve care to people however they failed to deliver on their commitment.
Following this inspection we took urgent enforcement action to restrict admissions to Martins House and imposed this condition immediately following the inspection. We also met with the provider to also seek urgent assurances that people's care needs would be met safely. We have reported our findings to the local authority, clinical commissioning group and local authority safeguarding team.
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 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 are 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.
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