9 April 2019
During a routine inspection
People’s experience of using this service:
•Care plans and risk assessments were not always updated to reflect changes in people’s care needs. •Risks to people were not always identified and risk management plans were not in place to manage risks safely.
•Monitoring charts, including close observation charts, elimination charts and food and fluid charts were not always completed to help ensure people's safety.
•People's medicines were not always safely managed.
•Incidents were not appropriately logged or investigated to reduce the risk of repeat occurrences.
•Staff were not effectively deployed and were not always aware of their responsibilities. Staff training was not up to date and staff were not always supported through supervisions to ensure they carried out their roles effectively.
•The provider had not followed safe recruitment practices when recruiting new staff.
•People were not always supported and encouraged to eat a healthy and well-balanced diet
•People and their relatives told us and we saw staff were not always kind and did not always respect their privacy, dignity or promote their independence.
•People were not involved in planning their care and support needs.
•People who could not communicate were not provided with information in a format that met their needs.
•The provider’s quality monitoring systems were not effective.
•The registered manager had a lack an understanding of their regulatory responsibilities as they had not reported incidents to the local authority safeguarding team or CQC where required.
•People and staff commented that the registered manager was not visible and did not provide adequate leadership and support.
•People told us they felt safe. There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse.
•People were protected from the risk of infection because staff followed appropriate infection control
protocols.
•Assessments were carried out prior to people joining the service to ensure their needs could be met.
•People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
•People had access to healthcare professionals when required to maintain good health.
•People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.
•People were aware of the provider’s complaints procedures and knew how to raise a complaint.
•The service was not currently supporting people who were considered end of life but the provider was aware of best practice in this area.
•The provider worked in partnership with the local authority to ensure plans were in place to meet people's.
Rating at last inspection: Inadequate (report published 19 February 2019).
Why we inspected: This inspection was a responsive inspection to follow up concerns we had received about the service.
Enforcement: We found breaches of Regulations in relation to safe care and treatment, person centred care, dignity and respect, staffing, recruitment, good governance and notifications. The majority of which were continued breaches from our previous inspection.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up: We will continue to monitor the service closely and discuss ongoing concerns with the local authority. The overall rating for this registered provider is 'Inadequate' and the service therefore remains in 'Special Measures'. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk.