This inspection took place on 16, 22, and 30 August 2016. The first inspection visit was unannounced, with the second announced to ensure the registered manager and head of care had sufficient time to meet with us. The third visit was an unannounced evening visit, to ensure actions the provider assured us they would take after our second visit, were in place. Due to the seriousness of concerns found during our first two visits we held a meeting with the registered manager and one of the provider’s senior managers. During the meeting we shared our concerns with them and requested that immediate actions were taken to ensure people’s safety. At the time of our third visit we were assured that these actions had been taken.Youell Court is a residential care home which provides care for up to 40 older people, and people who live with dementia. The home has three floors. The ground floor is primarily used to support people on respite; the first floor supports people who live with dementia; and the second floor supports people who are more independent. On the first day of our visit, there were 37 people who lived at the home.
The service had 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. The registered manager had been registered with us since March 2016. Since then, they have had periods of absence from the home and due to ill-health. They had only recently returned when we visited.
Since our last inspection, the provider had undergone changes in the management team at the home. There had been periods of time when there was either no registered manager in post, or when both the previous registered manager, and the current registered manager were absent. There have also been changes to the head of care, and periods where no head of care has been available to support staff.
People were not always safe. There were not enough staff to meet people’s needs. The provider was trying to fill the gaps in the rota with agency and bank staff. The use of agency and bank staff to cover staff vacancies meant people were not provided with continuity of care by people who knew them well. The ‘staffing tool’ (the system which determined how many staff were needed to meet the needs of people who lived at the home) used by the provider did not provide sufficient staff to meet the needs of people or take account of the size and layout of the building.
Risks to people’s health and well-being were not always known by staff, and written risk assessments and care plans did not have up to date information to support staff in their knowledge of people. Senior staff had not had the time to update the care records, and care staff told us they did not have time to read them. During our visit we saw one person’s safety was compromised as a result of staff not knowing what their risks were. Medicines were not always managed safely.
Not all staff had received training the provider had deemed as necessary to meet people’s specific individual needs or ensure their safety. Until very recently staff had not received sufficient supervision or support from the management team to help them work effectively.
Staff knew the importance of seeking consent when providing care to people, but did not have knowledge of the principles of the Mental Capacity Act, and had not received training to help them understand them. Where people had been diagnosed as having a condition which impacted on their capacity to understand, there were insufficient assessments to determine what decisions the person could make, and what needed to be made in their best interest. Deprivation of Liberty safeguards were in place for people whose reduced capacity had meant their liberty had been restricted.
Formal complaints had been addressed appropriately through the provider’s complaints policy and procedure. However informal verbal complaints had not always been addressed to the satisfaction of relatives; and these had not been recorded to determine whether there were any trends or learning points from the concerns raised.
People enjoyed the meals provided, but we could not be assured that people who required support to eat and drink were getting sufficient support to maintain their health and well-being. People were provided with activities but these were mostly group activities, and individuals who either could not, or did not want to attend the organised activities, had limited opportunities to engage in other interests.
Individual staff members were kind and attentive to people. However, due to insufficient numbers of staff available, staff interaction with people was mostly when supporting people with care tasks. Friends and relatives could visit the home at any time during the day and evening.
The provider had not supported the management and staff team to ensure the home provided safe, and good quality care to people. Staff felt the new management team at the home were open and supportive to them. However, not all felt the provider’s senior management team were as supportive, and felt they had not listened to their concerns about the service when they had been raised.
The provider was in the process of improving its responsiveness to people who lived with dementia. They had arranged for a nationally respected organisation to support staff in improving the care provided to people with dementia.
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.
During this inspection we found the service to be in breach of several 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.