24 October 2016
During a routine inspection
Dawood House is situated in the village of Bentley which is approximately three miles from the town of Doncaster. The home provides personal care for 40 older people, some of who may be living with dementia type conditions. Bedroom facilities are provided on the ground and first floor level of the building. Access to the first floor is by a lift. There were communal areas including two lounges, a conservatory and separate dining areas. The home stands in its own grounds and there is a car park at the front of the building. At the time of this inspection there were 31 people living at the home. The service has been in administration since May 2016 and is being run by Carport a company appointed by the administrators
The service is required to have a registered manager. 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 2008 and associated Regulations about how the service is run. The service has been without a registered manager since October 2015. Several managers had been in post since that date but none had been registered with the Commission.
Prior to this inspection we received information of concern from other health professionals that visit the service. They told us the service was not safe. High volumes of safeguarding referrals had been received and were being investigated. Occupational therapists, district nurses and quality monitoring officers from Doncaster council were involved in the service. This was because they had received anonymous calls from people who had witnessed inappropriate moving and handling of people who used the service.
Care records were not always fit for purpose. Some lacked detail, were out of date or contradictory. When care records were reviewed, the reviews did not always result in relevant changes being made to people’s care plans or risk assessments. We identified instances where care was not being provided in accordance with people’s assessed needs.
Health professionals told us that communication within the home was poor. They told us their instructions were not always followed which meant people’s care needs were not always met.
We found staff approached people in a kindly manner. However, most of the interactions we observed were task orientated. The service was using a number of agency staff to cover shifts which meant they did not know the people who used the service. We observed people had to wait for assistance and staff were not always present in communal areas to ensure people’s safety. Relatives we spoke with told us that they were concerned for people’s safety as they had observed falls because no staff were available in communal areas.
The provider told us systems were in place to guide staff on safe administration of medicines. However, we identified these were not followed and people did not always receive their medication as prescribed. Protocols for the administration of ‘as required’ medications were not in place which meant people were not given pain relief at the times they required them. Medicines no longer required had not been disposed as they should have been.
People were not always supported to eat and drink sufficient amounts to maintain a balanced diet and adequate hydration. We found the meal time experience did not meet the standards expected by the provider.
Infection prevention and control policies were not always adhered to; therefore safe procedures were not always followed.
The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were in place to protect people who may not have the capacity to make decisions for themselves. However we were told by the acting manager that they were unable to confirm who had authorised DoLS in place. This meant we could look at any conditions that may have been put in place for people who used the service. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.
The systems and processes in place to monitor the quality and safety of the services provided were not effective. There was a complaints procedure; however relatives told us that they were not satisfied with the standards of care. One relative told us they were not satisfied with care provided and had raised concerns about the lack of communication which meant they had no confidence in the provider.
We asked the provider to tell us what immediate action they were going to take to reduce the risks to people. We went back to the service on the 9 November 2016 to check if improvements had been made and that people were safe and receiving appropriate care and treatment. The provider had developed an action plan to identify and implement the improvements required. We looked at records introduced by the provider to check on progress against the action plan.
We are considering what further action we are going to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
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 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.
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.