The Care Quality Commission (CQC) has rated St Brelades in Herne Bay inadequate overall, following an inspection in May.
St Brelades is a residential care home providing personal care to up to 37 people, including people living with dementia, run by St Brelades Retirement Homes Limited. At the time of the inspection there were 33 people living there.
CQC carried out an unannounced focused inspection to look at how safe and well-led the service was after receiving information of concern regarding the management of medicines.
St Brelades was previously rated good overall, and good for being safe, effective, caring, responsive and well-led. Following the inspection, the overall rating, and the ratings for being safe and well-led dropped to inadequate.
The service is now in special measures which means it will be kept under review, both by CQC and the local authority safeguarding team, and re-inspected to check sufficient improvements have been made.
Hazel Roberts, CQC’s head of inspection for adult social care, said:
“When we inspected St Brelades, people told us they were happy living there, and relatives said they felt their loved ones were safe and well cared for. But we found there was a lack of strong leadership and the provider and the registered manager had failed to identify a number of shortfalls at the service.
“Staff morale was low, and staff said they didn’t always feel appreciated by the registered manager or provider, and that they were slow to resolve issues. Staff cared for people, and did their best, but most staff hadn’t completed in-depth dementia care training which is essential for caring for people living with dementia, and they weren’t always providing dignified and respectful care.
“For example, one person was upset as they were wearing trousers which kept falling down. They had other trousers they could have worn, but staff hadn’t helped them to change into these. Some people were wearing other people’s clothes, despite relatives complaining to staff about this.
“We found risks to people weren’t always well managed. We saw one person calling for help and trying to stand up from a chair. They had previously fallen out of bed and staff had been instructed to intervene if this person was at risk of falling, but there was no system in place to alert staff to the risk, meaning they might fall again.
“One staff member put a person at risk of choking when they tried to put a spoon full of food in their mouth while the person was chewing. The person looked distressed and pulled their head away.
“We also found medicines weren’t being managed safely. One person had been given a lower dose of blood thinning medicine than they should have had three times in the week before our inspection, and they had previously missed 19 doses. Blood thinners are critical medicines and it is important the correct dose is given at the right time to ensure they are effective. If people don’t receive their medicine as prescribed, they could be at risk of blood clotting, leading to serious health conditions, such as a stroke.
“Some people received their medicines without their knowledge, crushed and disguised in food, which is known as 'covert medicine administration'. However, records were contradictory about which medicines were to be given covertly. In October 2021 one person ate food containing another person's prescribed medicine, but the service didn’t take action to ensure this didn’t happen again.
“Most of the issues boil down to the fact that the management team wasn’t working effectively to lead the service. There was a lack of clarity over who was responsible for what and no oversight of tasks such recruitment, training and medicines management. The provider and operations manager visited the home each month but didn’t review whether checks or audits had been completed as part of their visit.
“The registered manager had taken on new responsibilities when the current provider took over the running of the service in 2018, but the provider hadn’t checked the manager had the skills the needed to do their job effectively. Following our inspection, the operations manager told us they would spend more time at the service supporting the registered manager.
“We are now monitoring the service closely and will return reinspect and check that sufficient improvements have been made.”
Inspectors found the following during this inspection:
- Staff had not been supported to develop the skills they needed to fulfil their roles. Most staff had not completed in-depth dementia care training or other training to meet people's needs, including safeguarding training, catheter care, diabetes and epilepsy management.
- Staff had not been recruited safely and robust checks had not been completed on staff's conduct in previous roles.
- People were not protected by robust policies, processes and equipment. Staff accessed electronic care records on their personal mobile phones as the equipment provided was ineffective.
- Risks to people were not constantly managed to protect them from harm. Some risks had not been assessed and action had not been planned to mitigate other risks.
- People's medicines were not well managed, and some people had missed doses of important medicines. Effective systems were not in place to record medicines stocks and identify errors.
- Mealtimes were not planned to support people effectively. At lunchtime people were sitting for a long time before they received their meal and some people left the dining table before they had eaten.
- Feedback from staff and relatives had not always been used to improve the quality of the service people received, and lessons had not always been learnt when things went wrong, so there was a risk that incidents would occur again.
- The registered manager was unclear about what they were required to notify CQC about and they had failed to report an allegation of abuse at the service. There had also been a delay in another notification being submitted. The provider's rating was not displayed to inform people and visitors of the quality of the service.
However:
- The service was clean, and people were protected from the risk of the spread of infection.
- Staff followed detailed guidance around moving people safely.
- Meals and drinks were prepared to the correct consistency for people who were at risk of choking.
- The service was working within the principles of the Mental Capacity Act and if needed, appropriate legal authorisations were in place to deprive a person of their liberty.
- People's relatives told us they were informed promptly of any changes in their relative's needs, including any accidents.
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