We visited the home on 29 September 2015. The inspection was an unannounced scheduled inspection visit.
At the last inspection on 18 November 2013, we asked the provider to take action to make improvements to the ways in which records were maintained and to the ways in which the provider assessed, monitored and improved the quality of the service. The provider submitted an action plan which stated that the legal requirements would be met by the end of March 2014. We found during our latest inspection, that this had not been completed.
Morton Cottage Residential Home is a large house within private grounds, situated in a residential area of Carlisle. The home is registered to provide accommodation for people who require personal care. The home can accommodate up to 32 older people, some of whom may be living with dementia.
Accommodation is provided over two floors in single rooms, but there are facilities for shared accommodation (2 rooms). All rooms have ensuite toilet and wash basin facilities and communal bathrooms and toilet facilities are available throughout the home.
There is a registered manager in post 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 2008 and associated Regulations about how the service is run.
We spoke with people who used this service and to some of their visitors. They told us that the staff were “nice”, “kind” and that “no one was nasty” to them. The relatives we spoke with told us they could “come and go” as they pleased and that they had never seen anything at the home to “worry” them. One person commented; “I can’t fault it here, they look after us and visitors can come when they want, they are not strict like that.”
Allegations of potential abuse and safeguarding had not been managed consistently. This meant that people who used the service had been placed at risk of harm and abuse.
This is a breach Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
People’s medicines were not stored and disposed of safely. This meant that people had access to medicines that were not theirs and had not been prescribed for them, placing them at risk of harm.
This is a breach Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
Where risks to the health and safety of people using this service had been identified, the provider had failed to keep these under review and up to date in order to mitigate any such risks. This meant that people were not properly protected from the risk of harm or injury.
This is a breach Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
We found that the provider had not ensured that the premises were safe and secure. Windows on the first floor did not have restrictors in place and this was a risk to the safety of people living at Morton Cottage. Additionally, we observed poor infection control and prevention practices by staff during our visit to the home. This meant that people who used this service were placed at risk of acquiring infections.
This is a breach Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.
The staff that we spoke with told us about the training and support they were provided with. We observed examples of staff practices during our visit to this home. We found that there were shortfalls in their skills and knowledge.
This is a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014 because lack of staff skills and knowledge placed people at risk of harm or of receiving inappropriate care. You can see what action we told the provider to take at the back of the full version of the report.
Although staff had received some training about the Mental Capacity Act 2005 we found that there was a lack of understanding. We noted that the principles of the Mental Capacity Act 2005 Code of Practice had not been followed when assessing people’s ability to make a particular decision or when placing restrictions on their liberty.
This is a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant that people who used this service did not always receive care and treatment that had lawfully been provided in their best interests. You can see what action we told the provider to take at the back of the full version of the report.
People were provided with meals and drinks, which they told us they enjoyed. On the day of our visit we noted that mealtimes were not a sociable or dignified event. We also found that people’s nutritional needs were not adequately assessed and monitored, where necessary.
This is a breach of Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant that people who used this service were placed at risk of poor or inappropriate nutrition. You can see what action we told the provider to take at the back of the full version of the report.
Staff were inconsistent in the way they supported people with their personal care needs. Some needs were dealt with discreetly whilst other staff lacked understanding of how to support people and communicate with them effectively. We did not receive any complaints about the service but we did notice that many of the people that lived at Morton Cottage appeared unkempt and needed their hair brushed or items of clothing changed.
This is a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant that people who used this service were not always offered the support they needed to maintain their dignity. You can see what action we told the provider to take at the back of the full version of the report.
People told us, and we noticed that there were very limited social and leisure activities available at the home. We were told of some events that had taken place and people told us that they had enjoyed these “very much”.
Care and support records were out of date and staff told us that they didn’t always read them. We saw some examples where people did not get the care and support they needed, when they needed it.
This is a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People did not experience care and treatment that had been personalised specifically for them. You can see what action we told the provider to take at the back of the full version of the report.
There was no effective system in place to help monitor and manage the quality of the home and of the service provided. Personal records were out of date and environmental audits had not taken place.
This is a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant that the provider did not have systems in place to ensure the safety and quality of the service. You can see what action we told the provider to take at the back of the full version of the report.
We have made a recommendation that the service attends to the access arrangements for the home, including the provision of a contact telephone number. This will help ensure that visitors to the home are able to gain access to Morton Cottage.
Safe recruitment processes were in place to help ensure suitable staff were employed to work with people who used this service. There was a low staff turnover and this meant that staff and people who used this service got to know each other very well.
The home had not received any concerns or complaints about the service provided. No one raised any concerns with us at the time of our visit to the service. We checked the information we held about Morton Cottage Care Home. This also showed that we had not received any complaints about the service.
There were some positive aspects to the environment at the home. Individual bedrooms were spacious and all had en-suite facilities. Some floorings and furnishings had been replaced in communal areas, helping to make them pleasant.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.