The inspection was carried out by one inspector. We gathered evidence to help us answer our five questions; Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well-led?
Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.
Is the service safe?
The service was not safe.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had submitted one application to their Supervisory Body which received standard authorisation. This was to ensure the person was deprived of their liberty in the correct way and this was done only in the person's best interests and in the lest restrictive manner. This meant people who used the service were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the DoLS.
We observed staff working practice was not in line with the service's policy and procedures. Although care and treatment was planned it was not always delivered in a way that was intended to ensure people's safety and welfare. We were told by the manager every person in the home had a folder which contained supplementary charts such as, 24 hour food intake chart, fluid intake charts, positioning turning charts, observation charts. The charts had to be completed as soon as care was delivered. We observed a supplementary folder had been taken from a person who was in their room and completed without them being present. Whilst in another room we observed a staff updating a record for a care task they had not completed. This meant the information would not have accurately reflected the care delivered and had the potential of placing the person's safety and welfare at risk.
We visited one person in their room in the morning on day one of our inspection. They showed us two empty drink containers and commented, 'I am meant to get refills of drink throughout the day but his does not happen.' We returned later in the afternoon to the person's room and saw the drink containers were still empty. This meant people could not be confident they would be supported to drink sufficient amounts to meet their needs.
The manager told us the service's infection control lead was the housekeeping manager. When we spoke with the housekeeping manager we found they were not aware of this or the infection control procedures. We observed two staff members were not wearing personal protection equipment (PPE) when changing dirty bed linen. However we were told by one of the staff member's that the correct procedure was to wear one. This had the potential of cross contamination and placed people and staff employed by the service from identifiable risks of acquiring an infection.
Medicines were safely administered. We saw all medicines were kept locked away in trolleys and controlled drugs were kept in a double locked cupboard. This meant medicines were handled safely, securely and appropriately.
People who were identified at risk of dehydration or malnutrition were placed at further risk because 24 hour food and fluid intake records did not accurately reflect what people had drank or eaten.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service, meeting peoples' nutritional needs, infection control and records.
Is the service effective?
The service was not effective.
There were no regular social activities arranged for people. This meant peoples' social needs were not being met.
We observed the lunch period in the ground floor dining room on the first day of our inspection. Tables were set before people entered the dining room. None of the people referred to the menus that were available. Instead they asked staff what food was available. We saw some of the people observed had limited communication. This meant although there was accessible information about meals, the written menus did not meet the needs of some of the people they were designed for.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service and records.
Is it caring?
The service was not caring.
We observed some positive interaction between staff and the people they supported. People were spoken to in a respectful manner. People gave positive and negative comments about the care such as, 'They are very good and look after me well' and "It was very good when I first came here but I don't get to see staff regularly. They don't have enough time to talk to me.' They proceeded to change the person's bed linen and only spoke with the person when the individual asked them a question. This meant people's dignity were not promoted.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service.
Is it responsive?
The service was not responsive.
We observed one person who could not verbally communicate had waited 25 minutes before a staff member brought them their meal. We saw no staff interaction with the person during this time. The staff member returned with their meal, sat down and proceeded to assist them. This meant people were not being supported to eat and drink in a timely manner.
Another person called out to say they were ready for their pudding. We observed even though there were staff within hearing distance, no one acknowledged the person. After calling out a couple of times the person became frustrated to the point they were unable to verbalise what they wanted. Staff eventually acknowledged them but it still took a while before they were given their pudding. This meant people were not treated with dignity and respect.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to care and welfare of people who use the service and meeting people's nutritional needs.
Is it well-led?
The service was not effective.
We found systems put in place to monitor, manage and improve the quality of the service were not effective. There were no processes to ensure identified actions for care audits carried out were followed through. Care audit records were not kept securely. We saw no audits of supplementary folders which contained monitoring records that were not accurate, factual and fit for purpose. Complaints received were not dealt with in line with service's policy and people were not made aware of the complaints procedure. There were no regular social activities to meet peoples' needs. This meant systems put in place to identify, analyse and review risks were not effective.
We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation assessing and monitoring the quality of service provision.