Archived: Fourwinds Residential Care Home

Fourwinds Residential Care Home provides accommodation and personal care for up to 35 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. The service has 31 single bedrooms and two double bedrooms that people could choose to share. There were 16 people living at the service at the time of our inspection.

At our inspections in May 2015, July 2016 and March 2017 we found the service was in continued breach of several regulations. We required the provider to make improvements and when they did not we placed the service into special measures and took enforcement action against the provider. This process has concluded and we cancelled the provider’s registration to provide accommodation and personal care to people at Fourwinds Residential Care Home.

A manager was working at the service. A registered manager had not been leading the service since May 2015. The manager had applied to be registered but withdrew their application following our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider and manager did not have oversight of the service and had not taken sufficient action since our last inspection to support staff to provide a consistently good service. The manager began working at the service in June 2017 and told us they had not been supported by the provider to fulfil the role and make the necessary improvements to the service. The provider however told us they had supported the manager, including employing consultants to support improvements.

The manager and staff did not understand the visions and values for the quality of the service provided. Checks on the quality of service provided continued to be ineffective and the shortfalls in the service we found at this inspection had not been identified. The views of people, their relatives and stakeholders had not been used to improve the service. Staff had not been asked for their views about the service or been involved in planning the necessary improvements.

At our previous inspections we required the provider to make improvements to staffing levels. Staffing levels had increased, however; staff were not consistently deployed at the right times to meet people’s needs. People who needed support to tell staff about their needs and wishes, because they could not communicate using speech, received little support and attention from staff. People told us they had to wait for the support they needed at times.

Staff had not completed all the basic training they needed to provide safe and effective care to people despite the provider purchasing a training package. They did not regularly meet with the manager to discuss their role and practice. Staff told us they did not feel supported and were not confident to raise concerns with the manager.

Staff knew the signs of possible abuse but were not confident to raise concerns they had with the manager. They were still not confident to raise any concerns with the provider as they felt they would not take any action.

Previously we required the provider to make improvements to the way risks to people were managed. Action had not been taken to manage all risks and people continued to be at risk of choking or developing skin damage. An analysis of accidents had not been used to identify any changes in people’s needs and then plan care to reduce risks to them. Improvements to the way medicines were managed had not been sustained and people were at risk from poor medicines management.

Food was not always prepared to meet people’s needs, including people at risk of choking. Menus did not offer people a balanced diet. People were not involved in planning the meals provided at the service. People were not supported to stay as well as possible.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS authorisations had been granted for five people who lacked capacity to consent and were restricted. Imposed restrictions on people had not been reviewed to ensure they were kept to a minimum. We observed one person asking to go out being stopped from doing so by staff and staff were not working within the framework of the person’s DoLS to support them to go out.

Staff did not follow the principles of the Mental Capacity Act 2005 and people were not supported to make decisions. Assessments of people’s ability to make day to day decisions had not been completed and guidance had not been provided to staff about how to support people to make decisions.

People and their relatives continued not to be involved in planning their care. People’s care plans had not been regularly reviewed to identify any changes in their needs. Care plans had not been up dated when people’s needs changed and up to date guidance was not available to staff about people’s needs.

Although people and their relatives told us that staff were caring, people were not always treated with respect. Staff continued not to listen and respond to people’s requests, including requests for drinks. Activities some people took part in had improved however other people continued not to be supported to take part in any social activities. People told us they had privacy.

A new complaints process had been introduced. However, some people told us they were not confident to raise concerns they had with the manager and the provider.

Records about the care people received continued to be inaccurate and incomplete. Dates had not been fully recorded so staff and health care professionals could refer to the most up to date information. People’s personal information was now stored safely.

The provider had not notified us of four notifiable events so we could check that appropriate action had been taken. The CQC performance rating was now displayed at the service, as required.

When staff were employed by the service, all the required recruitment checks had been completed, including obtaining a full employment history. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Improvements had been made to the environment, some areas had been redecorated and some new furniture purchased.

The overall rating for this service has been ‘Inadequate’ for more than 12 months and service was in ‘Special measures’. We kept the service under review and took action in line with our enforcement procedures. We cancelled the provider’s registration for the service and the service has closed.

Fourwinds Residential Care Home provides accommodation and personal care for up to 35 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. The service has 31 single bedrooms and two double bedrooms that people could choose to share. There were 19 people living at the service at the time of our inspection.

At the last inspection in July 2016, we found the service was in breach of seven regulations and required the provider to make improvements. The service was rated Inadequate and placed in special measures. The provider sent us information about actions they planned to take to make improvements. At this inspection we found that the provider had not made the necessary improvements. We found continued and new breaches of the Regulations.

A manager was at the service each day. A registered manager had not been leading the service since May 2015. Following our last inspection the provider told us the manager would apply to be registered by January 2017. An application received had been rejected as it had not been completed correctly. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider and manager did not have oversight of the service and had not taken action since our last inspection to support staff to provide a good service. The manager began working at the service in August 2016 and had not been supported to develop the skills, competence and knowledge needed to fulfil the role. Checks on the quality of service continued to be ineffective and the shortfalls in the service we found at this inspection had not been identified.

At our last two inspections we required the provider to take action to make improvements to staffing levels. They had not done this. The assessments of people’s needs used to decide how many staff were required on each shift had not been completed correctly. People told us they had to wait for the support they needed and were lonely and bored during the day.

Staff had not completed the training they needed to provide safe and effective care to people. They did not regularly meet with the manager to discuss their role and practice. Despite this, staff felt supported by the manager and were confident to raise concerns with her. Staff knew the signs of possible abuse and were confident to raise concerns they had with the manager. They were still not confident to raise any concerns with the provider as they felt they would not take any action.

People’s relatives told us that concerns and complaints they had made about the service had not been resolved to their satisfaction. Complaints were not recorded and action had not been taken to use them to improve the service.

At our two previous inspections we told the provider to improve the way risks to people were managed. The provider had taken action to reduce fire risks. However, they had not taken action to manage other risks, including the risks of people losing weight and risks associated with the building. Detailed guidance was not available to staff about how to mitigate risks and people continued to be a risk. An analysis of accidents had not been used to identify any changes in people needs and plan care to reduce risks to them.

People received the medicines they needed to keep them safe and well. Medicines were stored safely however, they were not always recorded accurately to keep people as safe as possible.

Detailed assessments of people’s needs had not been completed to identify their needs and plan their care. People were not involved, when possible, in planning their own care. Guidance had not been provided to staff about how to meet one person’s needs. Guidance about other people was vague and contradictory. People were supported to have health checks such as eye tests.

Although people and their relatives told us that staff were caring, people were not always treated with respect. Staff did not listen and respond to people’s requests, including requests for drinks. People told us they would like more to do because they were bored and lonely at times. An activities person spent time with some people. Other people were not supported to take part in any social activities, including having a chat with staff.

Meal times continued to be too close together and people told us they were hungry at times. Food was not consistently prepared to meet people’s needs and preferences. People who chose to eat in their bedrooms were not supported to do this comfortably.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had not been made to the supervisory body for a DoLS authorisation when people who lacked capacity to consent were restricted.

Staff did not follow the principles of the Mental Capacity Act 2005 (MCA) and people were not supported to make decisions. Assessments of people’s ability to make decisions had not been completed and guidance had not been provided to staff about how to support people.

People, their relatives, staff and stakeholders had not been asked for their view of the service to support the provider to make improvements. The provider had not made sure the manager and staff understood their visions and values for the quality of the service provided.

Records about the care people received continued to be inaccurate. Information was not available to staff and health care professionals to help them identify any changes in people’s needs. Action had not been taken to keep people’s personal information safe and information was still stored in communal records which were accessible to other people and people not involved in their care. The provider was still not displaying their last inspection rating at the service and on their website, as required. Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. They did not return a PIR.

Action had been taken to improve staff recruitment procedures. All the required checks had been completed, including obtaining a full employment history. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.

You can see what action we told the provider to take at the back of the full version of the report.

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.

Fourwinds Residential Care Home provides accommodation and personal care for up to 35 older people and people living with dementia. The service is a large converted property. Accommodation is arranged over two floors and a lift is available to assist people to get to the upper floor. The service has 31 single bedrooms and two double bedrooms that people could choose to share. There were 24 people living at the service at the time of our inspection.

A manager was leading the service. They had resigned and were working their notice at the time of our inspection. A registered manager had not been leading the service since May 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider and manager did not have oversight of the service. They had not supported staff to provide a good level of care and staff were not all aware of their responsibilities. Checks on the quality of care being provided had been completed but the shortfalls in the service that we found at the inspection and not been identified. The provider said that a new manager had been appointed to lead the service but they had not followed their recruitment policy to make sure the new manager had the skills, competence, knowledge and experience to fulfil the role.

At the last inspection on 8 May 2015, we asked the provider to take action to make improvements to staffing levels, this action had not been completed. People’s needs had been considered when deciding how many staff were required on each shift. However, the provider had not taken action to make sure sufficient staff, who knew people, were deployed to meet their needs. Robust arrangements were not in place for the safe management of the service when the manager was absent or on leave. Staff worked as a team to meet people’s needs.

Safe recruitment procedures were not followed consistently. Staff had not completed health declarations stating they were physically and mentally fit to fulfil their role. Gaps in employment had not always been questioned. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Staff did not regularly meet with the manager to discuss their role and practice. Staff told us they did not feel supported and appreciated. They told us they were not confident to raise concerns with the provider. Staff had completed the training they needed to provide safe and effective care to people.

At the last inspection on 8 May 2015, we asked the provider to take action to make improvements to the management of risks to people; this action had not been completed. Action was not consistently taken to manage risks to people, including the risk of people developing pressure ulcers. Guidance for staff about how to manage risks had not always been followed. Some people’s pressure relieving equipment was not used correctly and there was a risk that people would sustain skin damage because of this.

Assessments of people’s needs had not been consistently completed to identify their needs. Detailed guidance had not been provided to staff about how to meet people’s needs For example, how to care for a person with a catheter. No guidance had been provided to staff about how to provide one person’s care. People were supported to have health checks such as eye tests.

People received the medicines they needed to keep them safe and well. However, medicines were not always stored safely or recorded accurately to keep people as safe as possible.

Plans were not in place to keep people safe in an emergency, including plans to evacuate people from the building. Following the inspection we raised our concerns about fire safety with the local Fire and Rescue Service. Risks associated with the building had not been assessed and action had not been taken to manage risk to people, including an open external balcony at the back of the property.

Although people and their relatives told us that staff were kind and caring, people were not always treated with respect. For example, meals for people who required a pureed diet was pureed together and people were not able to taste each separate flavour.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications had been made to the supervisory body for a DoLS authorisation when people who lacked capacity to consent were restricted.

Staff followed the principles of the Mental Capacity Act 2005 (MCA) and assumed people could make decisions. When people needed to make a specific decision their capacity to do so had not been assessed. Guidance was provided for staff about some the day to day decisions people were able to make. Decisions made in people’s best interests had not been recorded to demonstrate how the decision had been made and by whom.

Accurate records were not maintained about the care and support people received. Information was not available to staff and health care professionals to help them identify any changes in people’s needs. People’s personal information was not always kept safe and some information was stored in communal records which may be accessible to other people and people not involved in their care.

People and staff told us some meal times were too close together and there was a long gap between supper in the evening and breakfast. Some items that people liked ran out regularly, such as yoghurts. The dining room was crowded and people did not always get the support they needed.

People and their representatives were confident to raise concerns and complaints they had about the service. However, some complaints had not been recorded so action had not been taken to check complaints and use them to continually improve the service.

People and their relatives were asked for their views each year. Many people did not return the survey they were sent. Action had not been taken to explore other methods of obtaining people’s views and involving them in developing and improving the service. Staff did not have regular opportunities to share their experiences of the service.

People told us they would like more to do. The activities person had left and people were not supported to participate in a range of activities.

Staff knew the signs of possible abuse and were confident to raise concerns they had with the manager or the local authority safeguarding team.

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.

You can see what action we told the provider to take at the back of the full version of the report.

We found that audits were completed regularly and we saw action plans to address any shortfalls that were identified. We saw evidence of regular audits in relation to documentation on accidents, infections, care planning and risk levels. We found that issues and discrepancies were addressed swiftly and effectively.

We saw minutes of regular staff meetings where changes or issues within peoples care were discussed. In addition, we saw evidence of meetings with people who used the service to ensure they were consulted and encouraged to contribute their ideas about the running of the home. We found the service was clean, tidy and free from odours and that some rooms had been newly decorated.