Archived: John Joseph Powell Memorial Care Centre

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.

John Joseph Powell is a care home providing accommodation, personal and nursing care for up to 45 people in one adapted building over two floors with lift access to the upper floor. 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 assessments relating to the health and safety of people were completed, however records did not always reflect the care people needed and the care provided to safely manage identified risks. Monitoring records in use for people who were at risk of dehydration and skin breakdown did not always provide all the necessary information and guidance for staff to effectively manage risk. These records were not always completed to demonstrate that people had received the care and support they needed.

A number of permanent nurses were recruited recently however there was still a reliance on the use of agency nurses to cover some shifts. Although an initial check was carried out on agency nurses at the point of deployment further checks did not take place to ensure their continuing professional development.

There were systems in place for monitoring the quality and safety of the service, however they were not always used effectively. Audits and checks failed to identify and mitigate risk associated with people’s care, staffing and the environment. There was a lack of oversight by the manager and provider to ensure that the systems for assessing and monitoring the quality and safety of the service were fully implemented.

Medicines were safely managed, and safe processes were followed for the recruitment of staff. Staff knew what constituted abuse and they were knowledgeable and confident about reporting any concerns they may have about people’s safety. People told us they felt safe living at the service and that they trusted staff. Family members were confident that their relative was kept safe and well cared for.

The environment was clean and hygienic, and staff followed good infection prevention and control (IPC) practices. People and their family members spoke positively about their experiences of the care provided by staff and they described the manager as approachable and supportive. Staff commented on how morale amongst the staff team had improved since the appointment of the new manager in January 2021.

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)

The last rating for this service was requires improvement (published 28 March 2019). There were no breaches of regulation found, however we made recommendations about staffing and records. During this inspection we identified breaches of regulations.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for John Joseph Powell Memorial Centre our website at www.cqc.org.uk.

Why we inspected

The inspection was prompted in part by information of concern CQC received about the management of people’s care and treatment. This inspection examined those risks.

Due to the COVID-19 pandemic, we undertook a focused inspection to only review the key questions of safe and well-led. Our report is only based on the findings in those areas reviewed at this inspection. The ratings from the previous comprehensive inspection for the Effective, Caring and Responsive key questions were not looked at on this occasion. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The provider took some action during and following the inspection to mitigate the risks.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have identified breaches in relation to Regulation 12 (Safe care and treatment) Regulation 17 (Good governance), Regulation 18 (Staffing) at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

John Joseph Powell Memorial Centre is a care home that provides personal and nursing care for up to 45 people, some of whom are living with dementia. At the time of the inspection 34 people lived in the service.

What life is like for people using this service:

Improvements had been made since the last inspection. People now received care that was dignified and person centred.

We have made recommendations about records. The registered providers system for checking on the quality and safety of the service need further improving to make sure records fully reflect people’s identified needs and the care given. The manager took prompt action during the inspection to make the improvements.

Action had been taken to improve the management of medication following an audit carried out by the medication management team prior to our inspection. Medication was safety stored and medication administration records (MARs) were kept up to date. People received their medicines safely and on time.

People who were able consented to their care and support. Decisions made on behalf of people who lacked capacity to make their own decisions were made in line with the Mental Capacity Act, however records about people’s mental capacity needed improving. The manager took prompt action during the inspection to make the improvements.

People were protected from abuse and the risk of abuse because staff understood their role and responsibilities for keeping people safe from harm. People told us they felt safe and family members were confident that their relative was kept safe. The premises were kept clean and hygienic and staff followed good infection control practices.

We have made a recommendation about staffing. At the time of the inspection people’s needs were met by the right amount of suitably skilled staff. However people and family members told us there had been times when they felt there were not enough available to meet people's needs in a timely way.

Staff were provided with the training and support they needed for their job. People told us staff met their needs. People received the right care and support to maintain good nutrition and hydration and with their healthcare needs.

People were treated with kindness, compassion and respect. People told us that staff were kind and respectful of their privacy and dignity and encouraged their independence, and we saw examples of this. Staff had formed positive relationships with people and their family members. Visitors to the service were made to feel welcome.

People received personalised care and support. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff were complimentary about the registered manager and the way they managed the service. The registered manager was described as supportive and approachable and we were told they had made improvements since their appointment. People, family members and staff were engaged and involved in the running and development of the service. The manager and staff worked in partnership with others in the best interest of people using the service.

More information is in Detailed Findings below

Rating at last inspection: Requires Improvement (report published 06 February 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection, however further improvements were required for the service to achieve a rating of Good.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. We will meet with the registered provider to discuss how they plan to address the issues identified during this inspection.

The last inspection of the service was carried out in September 2016 and during that inspection we found breaches of regulations in respect of the management of medication, records and assessing and monitoring the quality and safety of the service. Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led, to at least good.”

During this inspection we found that the required improvements had been made however we found other improvements were required.

John Joseph Powell Memorial Care 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. John Joseph Powell Memorial Care Centre is registered to provide accommodation, personal and nursing care for up to 45 people. There were 44 people living at the service at the time of the inspection.

The service has a registered manager. 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.

Improvements had been made to the management of medication. People received their prescribed medication at the right times, this included food supplements. Each person had a medication administration record (MAR) which listed their prescribed medication and instructions for use. Body maps were available to guide nursing staff on the use of medication patches to help ensure that they were safely applied.

Improvements had been made so that people received effective care. People’s needs were assessed and planned for. Supplementary care records for monitoring aspects of people’s care such as fluid intake and skin integrity had been completed in full. They recorded what the expected outcome was for the person and details of the care provided.

Improvements had been made to systems for checking on the quality and safety of the service and for making improvements. The service was assessed and monitored in line with the registered provider’s quality assurance framework. Where risks to people’s health, safety and welfare were identified action plans for improvements were developed and followed through promptly so that risks to people and others were mitigated. However more robust checks were required to ensure that people's needs were met by sufficient numbers of staff and in a dignified person centred way.

People did not always receive dignified person centred care and treatment in line with their care plans. People and family members commented that the staff were kind and caring and we observed examples of this. However we observed occasions where staff spoke about people and provided care and support in an undignified way.

We have made a recommendation about staffing. There were occasions when there were insufficient staff to meet people’s needs in a timely way. People were left waiting for staff to assist them and staff were rushed. Staff commented that their workload meant that it was often difficult to attend to people’s needs in a timely way. An increase in staffing levels on the second day of inspection meant staff were less rushed and able to meet people’s needs in a more timely way.

People’s end of life wishes were planned for and taken account of. A multidisciplinary approach to planning care for people at the end of their life ensured that they were comfortable, free from pain and treated in a dignified way.

Allegations of abuse were acted upon to ensure people were safe from abuse or the risk of abuse. People were protected by staff who knew about the different types of abuse and how to recognise indicators of abuse. Allegations of abuse had been reported to the relevant agencies in a timely way.

Safe procedures were followed for recruiting new staff. The suitability of staff was assessed prior to them being appointed. They were subject to a series of pre-employment checks including a check on their criminal background and checks carried out with previous employers. Staff entered onto an induction programme when they started work at the service and relevant training and support was provided to all staff on an ongoing basis.

People knew how to complain and they were confident about telling someone if they were unhappy. Complaints received were listened to and acted upon in line with the registered provider's policy and procedure. A record of complaints received was maintained and showed that complaints were acknowledged, investigated and action was taken to improve the quality of the service people received.

There was a breach of the Health and Social Care Act 2008 (Regulated Activities) 2014 regulations. You can see the action we have told the provider to take at the end of this report.

John Joseph Powell Memorial Centre is registered to provide nursing care for forty-five people. The service is located in the Prescott area of Liverpool, close to local shops and road links. There were 37 people using the service at the time of this inspection.

A registered manager was not in post at the time of this inspection visit. However a manager had been appointed and they had applied to become the registered manager with the Care Quality Commission. 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.

We carried out an unannounced comprehensive inspection of this service on 10 March 2016 and found that the service was meeting all the requirements of Health and Social Care Act 2008 and associated Regulations. After that inspection we received concerns in relation to the management of people’s medication, unsafe care and the leadership of the service. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for John Joseph Powell Memorial Centre on our website at www.cqc.org.uk”

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Prior to our inspection we received concerns from commissioners about the management of people’s medication. We found improvements had been made in response to those concerns, however we found other concerns. This included people not receiving their prescribed medication because they were not available and a lack guidance in relation to the use of some people’s medication.

Prior to our inspection we received concerns from commissioners about the premises. We found some improvements had been made in relation to the concerns raised. However the lack of security at the entrance of the service remained a concern; because the main door was wide open on our arrival. In addition to this fire exits were obstructed with equipment causing a risk to people in the event of a fire or having to evacuate the building in the event of an emergency.

Prior to our inspection we received concerns from members of the public and commissioners about the care and welfare of people. We found some improvements had been made in relation to the concerns raised, however we found ongoing concerns. The monitoring of some people’s care was ineffective. This was because monitoring records such as fluid and repositioning charts did not include essential information to ensure people received effective care. For example, the amount of fluid people needed to consume in a 24 hour period to remain hydrated was not recorded on their fluid intake chart. In addition the amounts of fluid people had consumed were not calculated to determine whether or not they had achieved their required target. The settings of air flow mattresses were not always recorded on repositioning charts as required, which meant there was no guarantee that mattresses were correctly set to people’s individual requirements.

Prior to our inspection we received concerns from members of the public and commissioners about the leadership of the service. We found some improvements had been made in relation to the concerns raised, however we found ongoing concerns. Quality monitoring systems failed to identify the lack of effective and safe care planning for people who used the service. New care planning documentation which had recently been completed did not accurately reflect people’s care need requirements, putting them at risk of unsafe and ineffective care.

Since the last inspection in March 2016 the management of the service had been inconsistent which caused unrest amongst people who used the service, family members and staff. However a permanent manager had recently been appointed and had applied to the Care Quality Commission to become the registered manager. Positive comments were made about the new manager including, “She [manager] is supportive and approachable”, “The new manager has made some good improvements already” and “I’ve noticed a positive difference already”.

John Joseph Powell Memorial Care Centre is registered to provide nursing care for up to 45 people. The service is located in the Prescot area of Liverpool, close to local shops and road links.

The service does not have a registered manager because the previous registered manager had recently left. A new manager was appointed and has applied to the Care Quality Commission to become the registered manager of the service. 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 last inspection of the service was carried out in May 2013 and we found that the service was meeting all the regulations that were assessed.

People who used the service were safeguarded from abuse and potential abuse because the registered provider had taken steps to minimise the risk of abuse. Clear procedures for preventing abuse and for responding to an allegation of abuse were in place. Staff were confident about recognising and reporting suspected abuse and they said they would not hesitate to do so.

Procedures were in place to keep people safe from hazards and to respond to emergencies. Staff had undertaken training in health and safety matters and they were confident about dealing with an emergency situation should one arise.

The registered provider had a policy and procedure relating to medication management. Staff responsible for administering medication completed the relevant training and had their competency checked regularly to ensure they were managing people’s medicines safely.

People were cared for and supported by the right amount of suitably qualified staff. The process for recruiting staff included a range of checks which were carried out to check applicants’ suitability and character prior to them commencing work at the service.

Staff received the training and support they needed. New staff completed an induction programme and all staff received ongoing training relevant to their role, responsibilities and the needs of the people they supported.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff understood what their responsibilities were for ensuring decisions were made in people’s best interests. Staff were aware of the need to obtain people’s consent prior to them providing any care and support.

People were treated with dignity and respect and staff were patient and caring in their approach. Staff knew people well, including their likes, dislikes and preferred routines.

Staff worked together as a team and with other professionals including GPs, McMillan Nurses and other specialist teams to help to provide the highest standard of care possible for people at end of life and their families. People were given the opportunity to express their wishes regarding their care at end of life and an appropriate care plan was put in place for this.

An assessment of people’s needs was carried out and appropriate care plans were developed. Care plans detailed people’s preferences with regards to how they wished their care and support to be provided. Care plans were regularly reviewed with the involvement of the person and other significant people such as family members and relevant health and social care professionals.

People were well supported to access a range of healthcare professionals as appropriate to their individual needs. People’s health and wellbeing was monitored to ensure they remained healthy and well and staff quickly recognised any health concerns and sought appropriate advice.

Systems were in place to monitor the safety and quality of the service and to gather the views and experiences of people and their family members. The service was flexible and responded to any issues or concerns raised. People told us they were confident that any concerns they might have would be listened to, taken seriously and acted upon.

Staff had access to information about the care and support people needed and how it was to be provided. People commented that the staff knew them well and had always provided them with the help they needed.

Staff had received training on how to deal with emergencies and they were confident about how to respond in an emergency situation such as if a person suddenly became ill or collapsed.

People were provided with the equipment they needed to ensure their comfort and help with their mobility. Equipment used at the home had been regularly checked and maintained to ensure it was safe to use. People told us that their beds and easy chairs were comfortable.

People were supported and cared for by the right amount of staff who were knowledgeable, skilled and appropriately qualified to do their jobs. People's comments about staff included: 'There always seems to be plenty of staff around', 'Staff are excellent and available when needed'.

People had been given information about how to complain which they understood and they told us they felt confident about raising any concerns they had.

We spoke with seven people who lived at the home who told us: 'They are pretty good here they are all quite nice.' 'Nothing is too much trouble for them.'

Comments from relatives included: 'I would say it is one of the best.' 'They let me know if 'x' is not well.' 'They offer us drinks whenever we visit.' 'We can speak to the manager at any time.' 'They are absolutely brilliant with 'x'.' 'Carers are smashing with 'x'.'