19 September 2017
During a routine inspection
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.
The service is registered to provide accommodation and personal care for up to 168 people. At the time of this inspection, care was delivered to people across four separate units. These units were named; Spode, Stafford, Wade and Wedgwood. Spode, Stafford and Wade units provided long term care to people and Wedgwood unit provided short term care and rehabilitation. People who used the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection 116 people were using the service.
At this inspection, we found that the required improvements had not been made and we identified new and continued Regulatory breaches. The service has been rated as ‘inadequate’ overall and will remain in special measures.
The home did not have a registered manager. However, the newly appointed home manager had applied to be registered with us and their application was being assessed at the time of our inspection. 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 and associated Regulations about how the service is run.
At this inspection, we found that the provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not always being identified and addressed by the manager or provider.
Risks to people’s health, safety and wellbeing were not consistently identified and managed and people did not always receive their care in accordance with their care plans. Medicines were not managed safely.
Staff were not always effectively deployed to consistently meet people’s needs in a safe and timely manner. Staff, in particular agency staff did not always know people’s individual needs and care preferences in order to provide safe and responsive care and support.
Incidents of potential abuse and neglect were not always recorded and reported in line with local and national guidance. This meant people were not always protected from the risk of abuse and neglect.
Staff received some training to help them support people. However, there were significant training gaps that left people at risk of receiving poor, unsafe care.
People were supported to access health and social care professionals in response to changes in their health and wellbeing needs. However, advice from professionals was not always followed in a timely manner to promote people’s health, safety and wellbeing.
People’s capacity to consent to their care was not always assessed and we could not always see that the requirements of the Mental Capacity Act 2005 were followed when people were unable to consent to their care. Some people had restrictions placed upon them that had not been assessed and planned for to ensure their rights were protected. We saw that restrictions placed on people were not always requested through the Deprivation of Liberty Safeguards (DoLS) when people could not consent to their care.
People were not always involved in the assessment and planning of their care. This meant people sometimes received care that did not meet their care preferences.
Staff did not always provide care and support in a manner that promoted people’s dignity. People were not always supported to make choices about their care.
Social and leisure based activities were promoted. However, some people felt these did not always meet their individual needs.
Written complaints were managed in accordance with the provider’s policy. However, effective systems were not in place to ensure verbal complaints were consistently recorded and acted upon to improve people’s care experiences.
Safe recruitments systems were in place. However, improvements were needed to ensure the provider could assure people that agency staff were suitable to work at the service.
People were provided with food and drink. However, staff did not always support people to make informed meal choices.
People’s right to privacy was promoted.