The inspection was carried out on 30 May and 2 June 2017 and was unannounced. This meant the provider and staff did not know we would be visiting. This was the first rated inspection since its registration with the Care Quality Commission on 7 November 2016.The service had a registered manager. 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.
The Porterbrook is a purpose built home with accommodation situated on the ground and first floor. The home accommodates up to 44 people who require personal care. It is situated on the outskirts of Sheffield and is close to local shops and amenities. At the time of the inspection there were 21 people living at the home.
Before this inspection we received information of concern. Concerns were in relation to staffing levels, staff training and competencies and the management of medication. We therefore brought this comprehensive inspection forward.
The provider had safeguarding procedures in place and staff were aware of the procedures. However, we found people were not always protected from abuse. We sent safeguarding referrals to the local authority following our inspection.
Care records were not always fit for purpose. Some lacked detail, while others had not been completed. Risk assessments were not sufficiently detailed to ensure staff could meet people’s needs. We identified instances where care was not being provided in accordance with people’s assessed needs.
People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines but these were not always followed.
We found staff approached people in a kindly manner. However, most of the interactions were only brief as they were extremely busy meeting people’s personal care needs. We observed people had to wait for assistance and staff were not always present in communal areas to ensure people’s safety. This indicated to us that there was insufficient staff deployed to meet the needs of people who used the service.
Staff recruitment processes were not sufficiently robust. Some staff files only had one reference and others did not have any documents to confirm their identity. Staff did not receive sufficient support and formal supervision. Staff clearly told us that they did not feel supported. Yearly appraisals had not been completed as the home had only been providing care for a number of months.
Training and induction of staff was not sufficient to ensure staff had the competencies and skills to meet the needs of people who used the service. We were told by staff and relatives and we saw evidence that there was a high turnover of staff which was a concern.
We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a satisfactory understanding and knowledge of this, and people who used the service had been assessed to determine if a DoLS application was required. However, we found it was not being carried out in practice and best interest decisions were not considered.
A well balanced diet that met people’s nutritional needs was provided. However, we found people who were at risk of weight loss and people who required encouragement to eat, were not always supported appropriately.
Best practice guidance was not always followed for people living with dementia in respect of managing behaviour that may challenge and adaptations to the environment.
Activities in the home were infrequent. Relatives and people who used the service that we spoke with raised concerns about the lack of social stimulation.
People’s needs were not identified and many people did not have plans of care in place. This meant staff were not always aware of people’s individual needs and how to meet their needs.
People and their relatives we spoke with were aware of how to raise any concerns or complaints. They described some complaints they had raised. However, we found the registered manager had not recorded these and told us they were only aware of one that was received the day of our inspection.
There were processes in place to monitor the quality and safety of the service. However, these were not effective and had not identified issues we found at the inspection.
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.
We found 5 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the end of this report. However, following our inspection the provider agreed to a voluntary suspension of any further placements until improvements had been made. They have also provided an action plan of intended improvements.