The Care Quality Commission (CQC) has rated Scholars Mews Care Home in Stratford-upon-Avon in Warwickshire, inadequate, and placed it in special measures to protect people following an inspection in October.
Scholars Mews Care Home, run by Avery Homes (Nelson) Limited, is a residential care home providing accommodation with personal care for up to 64 people.
The inspection was prompted in part due to concerns received about safeguarding, unsafe staffing numbers and risk management regarding falls.
Following the inspection, the overall rating for the home is inadequate, as well as the areas of safe, effective, responsive, caring, and well-led. The service was previously rated good overall, and in all these areas.
The service has been placed in special measures which means it will be kept under close review to make sure people are safe and, if CQC do not propose to cancel the provider's registration, there will be a re-inspection to check for significant improvements.
Amanda Lyndon, CQC deputy director of operations in the midlands, said:
"When we inspected Scholars Mews Care Home, we found a home where poor leadership had resulted in a significant deterioration in the standard of care being provided since our last inspection. We found very serious concerns regarding safeguarding procedures, safe staffing and the management of risks to people’s health and well-being. Staff didn’t have the right skills to support people safely and we heard people being spoken to disrespectfully. People’s needs were not being met which the provider must address urgently.
"Throughout the inspection, staff shared examples with us where they had witnessed poor care practices. One staff member had instructed someone not to ring their assistance bell at night in a derogatory manner. Another staff member carried out personal care with someone whilst they were lying in urine soaked sheets without changing them which is totally unacceptable and undignified.
"We also saw one person’s care plan that instructed staff to be firm with them and show them their soiled clothing and hands if they had been incontinent which is abusive behaviour and totally inappropriate.
"In addition, the provider did not ensure staff had the right skills which put people at risk of not having their needs met. A healthcare professional and staff at the home told us they were really concerned that people weren’t being supported properly and were at risk of falling due to insufficient staffing numbers.
"Some staff tried their best to provide compassionate care to people, had raised concerns, and were dedicated to making the required improvements at the home, but were let down by poor leadership.
"We will continue to monitor the service closely to ensure the necessary improvements are made and keep people safe during this time. If improvements are not made by the time we next inspect, we will not hesitate to take further enforcement action."
Inspectors found:
- Allegations of abuse were not always reported in a timely way. Where allegations were reported, appropriate action was not always taken to keep people safe.
- Injuries to people were not always recorded, reported, or investigated.
- People were not always 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.
- Risks to people’s health and well-being were not always managed safely.
- Medicines weren’t always stored or disposed of safely.
- Staff competency wasn’t always assessed to ensure staff had the right skills to deliver safe and effective care.
- There was limited evidence to show how people were supported to express their views and make decisions about their care.
- 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 report will be published on the Scholars Mews Care Home profile on this website.
Journalists wishing to speak to the press office outside of office hours can find contact details on the page for Our media office.