About the serviceFourways is registered to provide accommodation and personal care for up to 44 older people, including people who living with dementia. At the time of our inspection visit there were 42 people living at the home. Care is provided across three floors and communal lounge and dining areas were located on the ground floor. People’s bedrooms were not all ensuite so people used communal bathroom facilities located on each floor.
People’s experience of using this service and what we found
Since the last inspection visit, the provider sent us an action plan telling us how they would drive improvements within the service. We found some positive examples where people were more engaged and included in day to day events at the service. However, limited oversight and actions meant some quality improvements were not made and we found some issues we found last time continued. For example, the quality and accuracy of record keeping had not improved and, in some cases, was inaccurate and not timely. We still found examples of call alarm bells that were not in place or alarm mats that were not effective, which we found at our last visit.
Staff and managers did not consistently ensure people's medicines or prescribed items were administered safely due to excessive temperatures in people’s rooms during a period of hot weather. This had been identified by the provider in June 2019, but appropriate measures to retain the efficacy and manage this risk of those medicines, had not been taken. During this visit we continued to find medicines stored above recommended limits. There was no risk assessment to determine if people’s medicines remained fit for use.
Infection control checks were not always completed and we found examples where risks for cross infection could cause potential risk. Cleaning schedules implemented by the provider to drive improvements had not been completed or checked.
The service was not always responsive. People enjoyed the food; however, the food choices given to people during our visits were not seasonal. There was a continuing hot spell of weather, yet set planned meals continued to be provided without consideration of lighter options. Drinks were sometimes out of reach for people and staff offered some people their favourite drinks, rather than seeing if they wanted cold drinks or other options which would encourage them to keep hydrated.
Improvements to the wider organisational governance were being rolled out in July 2019. The director of quality and compliance felt these improvements would make sure day to day staff practice and good care outcomes would be identified and improved more quickly.
Overall, people’s comments were positive and people felt comfortable and relaxed at the home. People complimented staff’s attitude and approach and that staff were supportive. The provider used agency staff to support their own staff whilst recruitment continued. The provider used the same agency staff for consistency although some people said agency staff were not always as knowledgeable about their care needs as permanent staff.
There were sufficient numbers of care staff on duty to meet people’s needs. The provider used a staff dependency tool to ensure staffing levels continued to meet people’s needs. The interim manager and deputy manager could support staff on the floor if emergencies happened. High agency staff use supported staff rotas, however plans to recruit more staff were in place.
Staff understood their roles and responsibilities, such as safeguarding people from poor practice. Staff told us they were confident to record poor care and if no action was taken, staff were more confident to refer onwards to safeguarding teams and to us. However, we found numerous examples of unexplained bruising and a lack of body mapping which meant we could not be assured, people always received safe care and treatment. The provider had not notified us of one safeguarding incident but they sent us a retrospective notification following our visit.
Staff training was completed but plans were in progress to ensure staff’s levels of training met the provider’s own targets. Further staff training sessions were planned for.
People’s dietary needs, preferences and nutritional needs were assessed and known by staff and when needed, people were referred to other professionals to support their healthcare needs. Some people had their food and fluid intake monitored and further improvements were needed to ensure those records were of value to determine next steps.
People were supported to have control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Where people’s freedoms were restricted, processes and authorisations had been followed.
A programme of audits included health and safety, environmental checks, water quality and fire safety were completed. People and relatives’ feedback was sought at planned meetings and events.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
Following our last Inspection in June 2018 where the provider had a breach of the Health and Social Care Act, the provider completed an action plan after the last inspection to show what they would do and by when to improve.
During this inspection the provider demonstrated that some improvements had been made and provider wide quality assurance systems had been developed and were due for rollout in July 2019. However, during our inspection visits we found some issues we identified at the last inspection remained. Further examples relating to people’s care delivery were not identified through audits and checks and some records failed to show what actions had been taken. We found a breach of Regulation 12 of the Health and Social Care Act 2014 (Regulated activities). We found the service continued to be requires improvement overall and there was a repeated breach of Regulation 17 of the Health and Social Care Act 2014 (Regulated activities). Further improvement and embedding of new quality assurance oversight is required to ensure positive changes are embedded into daily practice.
The last rating for this service was Requires Improvement (published 27 July 2018).
Why we inspected
This inspection was based on the rating at the last inspection. We undertook this comprehensive inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the Key Questions Safe, Effective, Caring, Responsive and Well Led.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk