This unannounced inspection took place on 25 and 30 May 2017. Sonacare is a detached property situated in a residential area close to the centre of Cleveleys. The home is registered to care for up to fifteen people assessed as requiring residential care. Accommodation is located on the ground and first floor of the building which can be accessed by a passenger lift. There is a communal dining room as well as a lounge area. The majority of bedroom accommodation is for single occupancy although there are two shared bedrooms for people who would prefer this option. On the morning of the first inspection visit 11 people resided at the home. An additional person moved in later that day.
There was a registered manager in place. 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 service was last inspected 07 April 2015. At this inspection we found the service was meeting all the fundamental standards and was rated as, ‘Good.’
At this inspection visit carried out in March 2017, we found not all requirements had been met and the registered provider was not meeting all the fundamental standards.
Deployment of staffing did not always meet the needs of the people who lived at the home. Two people we spoke with told us staffing levels did not always meet needs. This meant they sometimes had to wait for assistance. We saw evidence of this occurring at the inspection visit. We found deployment of staffing was inconsistent which meant oversight in communal areas was not always achieved. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Staffing).
We looked at how the service managed risk to keep people safe. We found risk was not consistently addressed and managed. When risk assessments were present they were not consistently followed. We also found when risks were evident; these were not always addressed proactively. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).
Person centred care was not always considered and provided. One person asked for something to eat but this was denied. Three people had asked the provider to support them with their cultural needs. We found no evidence these requests had been addressed and actioned. This was a breach of Regulation 9 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Person Centred Care).
Infection control and standards of hygiene within the home were poor. Communal chairs and carpets were stained. There was no evidence deep cleaning had taken place at the home. Hand washing facilities were not always adequate. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).
We looked at how medicines were managed at the home. We found good practice guidelines were not always followed. Documentation of medicines management was poor. This was a breach of Regulation 12 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).
People were not always protected from the risk of abuse. Staff responsible for providing care and support had knowledge of safeguarding procedures and were aware of their responsibilities for reporting any concerns. However, through the inspection process we identified an incident which had not been reported to the local authority safeguarding team and the Care Quality Commission (CQC) for review. Following the inspection visit we raised a safeguarding alert with the local authority safeguarding team. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Safeguarding service users from abuse and improper treatment).
Processes were not consistently followed to ensure people were deprived of their liberty lawfully. We observed several restrictions were in place at the home which had not been considered as such. On the first day of the inspection visit not all DoLS applications had been submitted as required by law to ensure people were lawfully deprived of their liberty. This was a breach of Regulation 13 of the Health and Social Care Act (2008) Regulated Activities (2014) as suitable processes were not implemented to ensure people were lawfully deprived of their liberty.
We found the environment was poorly maintained and did not always meet the needs of the people who lived at the home. This was a breach of Regulation 15 of the Health and Social Care Act (2008) Regulated Activities, 2014 (Safe care and treatment).
We found privacy and dignity was not always considered and implemented by staff. During the inspection process we observed some interactions where dignity was not upheld. This was a breach of Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) 2014, (Dignity and respect.)
We looked at records maintained by the service. Records were not always stored appropriately so information could be easily accessed. We found records were not always accurate and up to date. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)
During the inspection visit we reviewed the auditing systems established and operated by the registered provider. We noted some audits did not take place. Those auditing systems in place were ineffective and failed to identify the concerns we identified during the inspection process. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (Good Governance.)
During the inspection visit we were made aware of an incident whereby police had been called to the home to provide assistance. This was a notifiable incident which should have been reported to CQC. This had not been completed. This was a breach of Regulation 18 of the Care Quality Commission Registration Regulations 2009 (Notification of other incidents).
We found the registered provider had failed to display their current rating as required within the Health and Social Care Act 2008 regulations. This was breach of Regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) 2014.
Recruitment procedures were implemented prior to people commencing work; however we found these checks did not always ensure risks were fully assessed and decisions documented to ensure the suitability of staff employed. We have made a recommendation about this.
We received mixed feedback about the provision of recreational activities at the home. On the days of the inspection visits we observed some activities taking place at the home. These were not always appropriate activities and did not meet the needs of the people at the home who were living with dementia. We have made a recommendation about this.
The registered provider did not always consider the Mental Capacity Act 2005 (MCA) and the relevance to their work. We looked at processes in place for determining capacity and decision making. We found correct processes were not consistently followed. When people lacked capacity to make decisions for themselves, there were no capacity assessments in place to show capacity had been assessed. When decisions had been made on behalf of people there was no documentary evidence to show that decisions had been made in the best interests of people. We have made a recommendation about this.
We received mixed feedback about the quality of the food provided at the home. We discussed this with the registered provider who said they would look into this. Systems were in place for managing people’s dietary needs. We saw evidence of input from health specialists when people were at risk of malnutrition.
We received mixed feedback about the caring nature of staff. Three people told us staff were not always caring. We observed some interactions which demonstrated that caring relationships were not always nurtured.
Staff said they felt supported within their role. They told us training was provided to meet their training needs.
We noted no complaints had been raised to the registered provider. We spoke with people who lived at the home about their right to complain. We received mixed feedback from people about being confident to complain and their complaints being taken seriously.
Systems were in place to seek feedback from people who lived at the home as a means to develop and improve service delivery. People were encouraged to have an annual review of their care to discuss their care. We saw however from the three reviews held, families and representatives were not routinely involved.
The registered provider had a system for managing complaints. People were aware of their right to complain. However, we received mixed feedback from people as to how complaints were dealt with. Two people said they could approach the registered manager if they had complaints. One person told us there had been occasions when they had raised concerns and they were disappointed in the staff response.
Staff at the home told us they considered the home to be well managed. They praised the approachability of the registered manager and the owner. Staff said the senior management team could be called upon for emergencies and would offer support when required. They described a positive working environment. Staff told us they received regular supervisions to assist them in their role. We saw recorded evidence this occurred.
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