Background to this inspection
Updated
23 March 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The first day of the inspection was carried out by an inspector and an inspection manager. The second day of inspection was carried out by a medicines inspector and the third day was carried out by two inspectors.
Service and service type
John Joseph Powell Memorial Centre is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection visits were all unannounced.
Inspection activity started on 20 September 2021 and ended on 07 October 2021. We visited the service on 20, 27 and 30 September 2021.
What we did before the inspection
We reviewed all the information we held about the service since it registered with the Commission. We also obtained information about the service from the local authority and local safeguarding teams.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with six people who used the service and two family members about their experience of the care provided. Throughout the course of the inspection we spoke with care, nursing and ancillary staff, acting managers, area director and other senior managers within the organisation.
We reviewed a range of records. This included 10 people’s care records and 10 people’s medication records. We looked at recruitment records for one staff member employed since the last inspection.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at medication and quality assurance records.
Updated
23 March 2022
About the service
John Joseph Powell is a care home providing accommodation, personal and nursing care for up to 45 people; some of whom lived with dementia and physical disabilities. At the time of our inspection 26 people were living at the service.
People’s experience of using this service and what we found
Risk was assessed, and plans put in place to guide staff on how to safely manage areas of risk. However, risk management plans were not followed placing people at risk of harm. A risk assessment for one person did not have measures in place to make sure the risk was as low as reasonably possible.
People waited long periods of time before receiving the care they needed. Care monitoring records had not been fully completed to reflect the care people needed and received and they had not been reviewed daily as required.
There were insufficient staff deployed across the service to meet people’s needs and keep them safe. Staff told us there had been continuous staff shortages which impacted on their ability to provide people with the safe care and support they needed.
We were not assured that safe infection prevention and control (IPC) measures were being followed. Personal protective equipment (PPE) was not used and disposed of safely, and equipment in use to support people was unclean and unhygienic increasing the risk of the spread of infection. Some other IPC practices undermined people’s dignity and increased the risk of the spread of infection.
We have made a recommendation about the management of medicines. Medicines were generally managed safely, however improvements were needed to ensure the safe recording and storage of some people’s prescribed medicines.
Improvements had not been made following our last inspection in April 2021. This was despite us receiving an action plan from the provider setting out how and when the improvements would be made.
There was no registered manager in post and there were inconsistencies in the management and leadership of the service.
The systems in place for monitoring the quality and safety of the service were not used effectively. They failed to identify and mitigate risk and bring about improvements to the service people received. Daily checks of the environment, aspects of people’s care and staffing had not taken place as required.
People did not receive person-centred care with good outcomes. People were left waiting for long periods of time before receiving the care and support they needed. People’s personal mail had not been given to them (or their representative) for a period of up to three months and there was a risk that people may have missed essential appointments.
Records used to monitor, and review people’s care were not fully completed and kept up to date. We found many examples where sections of care records were incomplete and where people’s care plans had not been updated to reflect changes in their needs.
There was good partnership working with other healthcare professionals.
The Care Quality Commission (CQC) took action to address the serious concerns found on the first day of inspection. The provider was invited to complete and send an urgent action plan, setting out how they were addressing the concerns identified during the first day of our inspection, and how they intend to address other serious concerns identified by inspectors immediately. We received a detailed action plan from the provider within the agreed timescale.
On the third day of inspection we found significant improvements had been made to staffing, leadership, care records, the delivery of care, IPC practices and the cleanliness of equipment, however it should not have required a CQC inspection to prompt the action.
Rating at last inspection
The last rating for this service was requires improvement (published 16 June 2021) and there were breaches of regulations. At this inspection we found continuous breaches of regulations and further breaches of regulations.
You can read the report from our last inspection, by selecting the 'all reports' link for John Joseph Powell Memorial Centre' on our website at www.cqc.org.uk.
Why we inspected
CQC received information of concern about people’s safety, staffing and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. Please see full details in the individual sections of this full report.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection. For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified breaches in relation to risk management, staffing, preventing and controlling infection and the governance and leadership of the service.
Please see the action we have told the provider to take at the end of this report.
Where we are taking or proposing to take enforcement action but cannot yet publish the actions due to representation and appeals process the text below must be added under this heading.
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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Inadequate’ and the service is therefore 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.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.