Archived: Perth Green House

Updated 8 March 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 25 and 28 January 2016 and was unannounced. This meant the provider did not know we would be visiting.

The inspection team was made up on one adult social care inspector.

Before the inspection we reviewed the information we held about the service. This included the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally required to let us know about. The provider also completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make.

We contacted the local authority commissioning team, Clinical Commissioning Group, the safeguarding adult’s team, and healthcare professionals.

We contacted the local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

During the inspection we spoke with five people staying at the service and two visitors. We also spoke with the manager, three senior care staff, five care staff and one ancillary staff member.

We reviewed five people’s care records and five staff files including recruitment, supervision and training information. We reviewed medicine records for five people, as well as records relating to the management of the service.

We looked around the building and spent time with people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who did not talk with us.

Updated 8 March 2016

This inspection took place on 25 and 28 January 2016 and was unannounced. We last inspected Perth Green House on 23 January 2014 and found it was meeting the legal requirements we inspected against.

Perth Green House is a care home without nursing and provides short stay services for people who need rehabilitation support. It mainly supports older people, but also younger people with learning and physical disabilities. The service is provided by South Tyneside Council. The building is on the ground floor level with shared dining and sitting areas, bathrooms and toilets.

Perth Green House can accommodate 30 people. At the time of the inspection there were 15 people using the service.

A registered manager was registered with the Care Quality Commission at the time of the inspection. However they had recently applied to cancel their registration with an effective date of 1 August 2015 and they had been absent from the service since 1 July 2015.

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 previous manager had recorded a log of incidents that had been reported to the safeguarding team for consideration. They had not completed any investigation or analysis to identify any trends or areas for improvement. No logs had been completed since November 2015 but the manager told us there were two incidents to be added.

Accidents and incidents were recorded. Analysis of these had been completed until October 2015 when it stopped. The manager said they did not know why it had stopped. The analyses that had been completed had not resulted in any action plan or changes to practice to reduce incidents or accidents in the future.

Medicines were not managed safely, there were gaps on medicine administration records and no action had been taken to identify why. One person had run out of one of their routinely prescribed medicines. Medicine care plans were generic, and there were no protocols in place for ‘as and when required medicines.’

Care plans varied in the degree to which they were person centred but they did not contain detailed information about the support people needed. The specific equipment, aids and adaptations people needed were not always specified on care plans. This meant people were at risk of receiving inconsistent and inappropriate care due to the lack of detail for care staff to follow.

Complaints were not always logged so there was no record of any action taken to resolve concerns or improve service provision. People had completed surveys but no action plan was generated to address any comments they raised. Staff surveys had not been completed as recent practice at South Tyneside Council has been not to undertake staff surveys.

Environmental risk assessments had not been reviewed in line with the planned review dates. The manager was unable to show us an emergency contingency plan and fire drills had not been completed in line with the fire risk assessment.

One care staff member we spoke with told us they had not had a supervision meeting for a while and another said they [supervisions] don't happen now. Staff had not had an annual appraisal. There were gaps in the delivery of training and staff administering medicines had not had their competency observed. Senior care staff were completing moving and handling risk assessment but half of them had not been trained. Care staff completed care plans and commented, “We haven’t been trained we just pick it up as we go along.”

It was the provider’s policy to complete disclosure and barring service checks on care staff every three years, however this had not been carried out.

One wing of Perth Green House was described as the ‘office wing.’ Care records were stored in an unlocked filing cabinet in an unlocked room so anyone accessing the office wing could also access confidential information.

The specific dietary requirements of people was on display near the serving area in the dining room and could be seen by anyone in the area, which did not promote their dignity or privacy.

Some records described people as ‘fallers’, and stated ‘two carers need to put the person in the shower.’ The manager described some rooms as ‘PD’ rooms, referring to physical disability which meant they had been adapted for people living mobility needs. These group labels contravened people’s individuality and dignity and were not person centred.

The service manager said they had not completed any audits and there was no service improvement plan in place. Following major safeguarding meetings with the council and other agencies, an action plan had been put in place for the service to make improvements. The timescale for completion of actions was recorded as immediate or 30 July 2015. We noted that several of these actions had not been completed. A local authority commissioning visit had taken place on 17 and 19 January 2015. The report had identified some areas for development and some priorities.

All of the staff spoken with except one said there were enough staff to meet people’s needs. No staffing tool was used for calculating the number of staff needed to meet people’s needs.

The manager explained that people needed to have the capacity to consent to care and rehabilitation in order to move into Perth Green House so they did not currently support anyone who had an authorised Deprivation of Liberty Safeguard.

People told us they enjoyed a good variety of food which was very tasty, and two people told us that they had gained weight whilst at Perth Green House which they were pleased about.

People had regular contact with an intermediate care nurse and physiotherapist who were based at Perth Green House. We also saw that visiting professionals supported people, such as the district nurse and a general practitioner.

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, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent

enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

You can see what action we told the provider to take at the back of the full version of the report.