We inspected this service on 25 November 2016. This was an unannounced inspection. Our last inspection took place in August 2015. At that time we found the provider was meeting the required Regulatory requirements. The service is registered to provide accommodation and personal care for up to 25 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection 23 people were using the service.
There was a registered manager at the home. 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 and associated Regulations about how the service is run.
At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘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.
At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.
Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not always managed safely.
People were not always protected from the risk of abuse because suspected abuse was not always reported as required. Safe recruitment systems were not in place to ensure staff were of suitable character to work with the people who used the service.
Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced. There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.
People told us they enjoyed the food. However, we found that some people did not always receive the support they needed to eat and drink. People’s risk of malnutrition and dehydration were not being effectively monitored.
The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves. We identified one person who was potentially being unlawfully deprived of their liberty.
We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe. Prompt referrals to health and social care professionals were not always made in response to changes in people’s needs or behaviours.
People were involved in the planning of their care. However, people’s care plans were not always accurate and up to date which meant staff didn’t always have the information they needed to provide safe and consistent care.
There was a programme of social and leisure based activities on offer to people. However, we found some people were not always supported to engage in activities that were meaningful to them.
The registered manager and provider did not always notify us of reportable incidents and events as required. The inspection rating was not being displayed at the home as required by law.
People spoke fondly about the staff and at times, we observed some positive interactions between staff and people. However, we found that people were not consistently treated in a caring manner as staff were often busy supporting people with care tasks.
Some people were offered regular choices about their care. However, improvements were needed to ensure all people were offered daily choices about the parts of their care they could make decisions about.
There was an effective system in place to enable people to complain about their care. Complaints were investigated and managed effectively to make improvements to people’s care.
People’s right to privacy was promoted and people and staff described the registered manager as approachable.