Archived: Littledene House

Updated 5 July 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

One inspector and one assistant inspector carried out the inspection visits on 9 May & 15 May 2019.

Service and service type:

Littledene is a care home. People in care homes receive accommodation and nursing or personal care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service had a manager registered with the Care Quality Commission. The provider was also the registered manager so was legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced.

What we did:

We used the information the provider sent us in the Provider Information Return (PIR). This is something providers send to us to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed notifications which relate to significant events the service is required to tell us about.

We gained feedback from the local authority quality monitoring team and spoke with one healthcare professionals and the local safeguarding team. This information helped us to target our inspection activity and highlight where to focus our attention.

During the inspection we spoke with three people who used the service, one relative, three staff members and the registered manager.

We reviewed three care plans, three medication administration records and looked at two staff files which documented recruitment procedures and ongoing support for staff. We also reviewed rotas, staff training records and other documents relating to the management, safety and quality of the service.

Updated 5 July 2019

About the service:

Littledene Care Home is a care home which was providing personal care to 14 older people at the time of the inspection there were 11 people living at the home.

People’s experience of using this service:

People’s safety was placed at harm because risks were not well managed. Procedures relating to fire safety prevention, infection control, safe staffing levels and risks posed by an unsafe environment, were inadequate and required urgent action in order to ensure people were always safe.

Although staff received training relating to consent, their understanding of the Mental Capacity Act 2005 was inadequate. Records demonstrated that the provider had not always assessed people’s capacity to consent to their care and treatment in line with legislation and some records needed review.

Systems designed to monitor the quality and safety of the service were not robust and failed to identify risks. This was of particular concern in relation to good governance and safety.

The administration of medicines requires improvement due to a discrepancy found in relation to PRN (when required) medications.

There were not were enough staff to meet people’s needs. Not all staff understood their responsibility to keep people safe from the risk of abuse and knew how to raise concerns.

The service was not clean and infection control procedures were inadequate in ensuring people were protected from the risk of cross infection.

Staff had been provided with basic training but due to individual staff’s comprehension of the English language was very limited and their knowledge with regard to keeping people safe was inadequate.

Although people who used the service were provided with a balanced diet, there were no systems in place to support people living with dementia to make an informed choice or preference of food or meals they wished to eat. There were no snacks or drinks available for people to freely access. We have made a recommendation that the registered manager research more innovative ways in how to present soft and pureed meals to people.

People’s health needs were monitored in most cases and the provider made referrals to healthcare professionals. However, there are currently two safeguarding investigation being conducted by the local authority with regard to pressure care and moving and handling practices.

Healthcare professional’s advice needed to be captured accurately in records so that staff were always clear about people’s current needs.

The environment was poorly maintained and placed people at risk of harm. In particular the water temperatures were set at unsafe levels and placed people at risk of harm from scalding and not all window restrictors were in operation. Bedroom doors were ill fitting and some furnishings and fittings were damaged and in a state of disrepair. There were no toilet seats fitted to any of the toilets in the bathrooms or individual toilets. Hand washing facilities were inadequate as some soap dispensers were empty.

Although staff were patient with the people they were supporting there were several examples observed where people’s dignity and respect was compromised. This included staff failing to knock on people’s bedroom doors before they entered. People on several occasions were referred to by their room number and not their name. Bed linen had been labelled using a black marker pen, with the person’s room number written on it. There were no additional aids or prompts within the environment to assist people living with dementia. People were also subjected to the risk of confusion due to the television on at the same time as the radio which was tuned into a Cantonese radio station.

Care plans did not always reflect people’s needs when there had been a change. These were also hand written which made some information difficult to read. Care plans were not person centred and not produced in a format that everyone was able to comprehend. There were limited activities to occupy people’s time and these did not consider or incorporate people’s diverse cultures within the home and also failed to provide activities to support and engage people who were living with dementia. We have made a recommendation regarding specialist training in dementia and behaviour that may challenge.

There is more information is in the full report below.

This was the first inspection since the provider was registered with the Commission in July 2017. The Provider was previously registered the run the service under a different name.

Why we inspected: We received information from the local authority regarding an escalation of concerns about the service; they had been completing monitoring visits. We completed this inspection based on

these concerns. At the time of the inspection, we were aware of incidents being investigated by another agency.

Enforcement: The service met the characteristics of Inadequate in three key questions of safe, effective, and well-led and Requires Improvement in caring and responsive. We are taking action and will report on this when it is completed.

Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local

authority. Two safeguarding alerts were raised as a result of this inspection with the local authority.

The overall rating for this registered provider is '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.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration. If not enough improvement is 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. Where necessary, another inspection will be conducted within a further six months, and if there is not

enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to

varying the terms of their registration.

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. We will have contact with the provider following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.