This inspection was carried out on 22 and 27 March 2018 and was unannounced. At their last inspection on 27 February 2017, the provider was found to not be meeting the standards we inspected. We rated the service overall as requires improvement. These areas of improvement were in relation to safe care and treatment, keeping people safe from harm and leadership and governance. At this inspection we found that improvements had not been made and there were additional areas that continued to not meet the standards. We found breaches of regulations in relation to providing safe care, supporting staff, obtaining people’s consent, involving people in their care and overall management and governance of the service. Clock Tower Mews is a ‘Care Home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to eight people. At the time of this inspection there were seven people living there.
The service did not have a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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. However a newly appointed manager had submitted an application to CQC to register and at the time of inspection was awaiting this to be assessed.
People were not consistently supported in a safe manner as staff were not aware of how to mitigate some risks to people’s well-being. risk assessments were not completed to support staff with keeping people safe.
Staff knew how to report any risks to people’s safety; however staff were not all able to describe how they would identify when a person was at risk of harm or abuse.
Medicines were not consistently managed safely.
There were sufficient staff available to support people’s needs in a timely manner.
People lived in a clean, hygienic environment although not all staff had received up to date infection control training.
Staff had lacked leadership, development and training over the previous 12 months.
Most people were supported in accordance with the principles of the Mental Capacity Act 2005; however, this was not consistent.
Staff were not consistently aware of people’s nutritional needs, however people were provided with fresh appetising meals they appeared to enjoy.
People were supported by staff in a respectful and kind manner with staff ensuring people’s dignity was maintained. However we found improvements were required in keeping confidential information relating to people secure.
Some people received care in a person centred way but we observed some people who did not. People and their relatives where appropriate, were not always involved in planning their care.
People were provided with limited activities that did little to support their individual hobbies, interests or preferences. There was a complaint’s process which people and their relatives knew how to use. However, people's relatives had not been confident that their concerns would be responded to with the previous management team, although they felt more confident in the new management.
There were systems in place to monitor the quality of the home. However, they had not identified the areas that required improvement that we found on inspection. People, relatives and staff were not all positive about the running of the home.
The overall rating for this service is ‘Inadequate’ and the service therefore is 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
Following the inspection CQC reviewed the concerns and took appropriate action.