This inspection took place on 3 August 2015 and was unannounced.
Following our previous inspection in April 2015 we asked the provider to take action to make improvements as we found evidence of major concerns in relation to the assessment and monitoring of risk, staff training and competence, how the consent of people to the care provided was obtained, the handling of complaints and quality assurance monitoring at the service.
At this inspection we found that some improvements had been made. However, further improvement was required to ensure consistency and sustainability.
The Dell provides accommodation and personal care for up to 40 people. The service mainly provides care to people living with dementia. There were a total of 20 people living in the service at the time of our inspection.
The manager of the service was not registered with the Care Quality Commission but had applied to do so. 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.
A lack of records in some areas including some relevant individual risk assessments, monitoring tools and care plans meant that people may not always be supported consistently and in the correct way.
Plans were being implemented with regards to staff training and professional development in areas specific to people’s healthcare needs. This enabled staff to meet their needs more effectively. However this was not yet fully reflected across the service. This led to some inconsistencies in staff practice.
The provider had strengthened quality assurance and governance systems which enabled them to have a clearer oversight of the service being provided. They were working towards addressing the issues previously identified to drive improvement. However not all improvements had been fully implemented in some areas and we were unable to fully assess if they had taken effect and were being sustained.
A complaints procedure had been put in place and the one complaint received since its inception had been dealt with effectively.
Staffing levels at the service were not sufficient to ensure people received their assessed care needs. The provider did not have an effective method to assess the number of care staff required.
People were not protected from social isolation. They were not supported with individual interests and hobbies.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
The Regulated Activities are now subject to the following conditions imposed by the First Tier Tribunal (Care Standards):
(i) There should be a registered manager as required by the existing registration certificate.
(ii) Quality assurance audits are to be undertaken by the home to include the audit of management which is to be undertaken by Fennell Solutions. This condition shall subsist until 31 December 2015.
(iii) The home shall not admit any new residents until 1 November 2015 and then only at 2 per month. The condition will subsist until 31December 2015.
The overall rating for this provider is ‘Requires Improvement’. However because on two consecutive inspections one of the Key Questions has been rated as Requires Improvement, the service has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:
- Ensure that providers significantly improve
- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.
The overall rating for this service is ‘Requires Improvement’. However, the service has been rated as ‘Inadequate’ in a key question over two consecutive comprehensive inspections and is therefore in ‘Special measures’. The ‘inadequate’ rating may not be in the same question.
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.