Archived: Molescroft Court

The overall rating for this service is ‘Requires Improvement’. However, the service has been placed in ‘special measures’. We do this when services have been rated as ‘Inadequate’ in any key question over two consecutive inspections. The ‘inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. In this instance the continued breach of regulation has been in the same key question and relates to the safe administration of medication.

This inspection took place on 14 December 2016 and was unannounced. We previously visited the service 6 July 2016. The focused inspection in July was carried out to check on improvements made to the service since the previous comprehensive inspection on 10 and 11 May 2016 when we issued warning notices in respect of three breaches of regulation.

At the inspection in May we found that there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medication was not administered safely and recording was unsafe. We issued the registered provider with a warning notice. When we returned to the home in July 2016 we found that they continued to be in breach of this regulation. A Notice of Proposal was issued that added conditions to the registered provider's registration. The conditions required the registered provider to submit information about staff training on the administration of medication and staff competency checks. We received this information within the required timescale. In addition to this, the registered provider was required to send the Care Quality Commission (CQC) copies of monthly medication audits. This condition of the registered provider’s registration is still in place.

During this inspection we found that the registered provider continued to be in breach of Regulation 12 relating to the management of medicines. Despite staff training on the administration of medication and staff competency checks being up to date, errors in administration and recording continued to be made. This means that the registered provider remains in Special Measures.

The registered provider told us they were aware that medication errors continued to be made. Because of this, they had made the decision to reduce the number of units to two instead of three, meaning there would be two medication systems in place for staff to manage instead of three, and less medication ‘rounds’ each day. In addition to this, they had decided to have one senior care worker on duty whose sole responsibility was to manage and administer medication in the two units. It was anticipated that this would reduce the number of errors being made.

At the inspection in May 2016 we found that there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because there were insufficient numbers of staff employed to ensure people received the care and support they required. We issued the registered provider with a warning notice. When we returned to the home in July 2016 we found that the registered provider had employed additional staff so they were no longer in breach of this regulation.

At the inspection on 14 December 2016 we found that the registered provider was again in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as there were insufficient numbers of staff employed to ensure that people’s care needs were met by a consistent group of staff. However, the registered provider had already identified this and had made the decision to reduce the number of units where people were accommodated from three to two. They were confident this would result in there being enough staff employed to ensure people’s assessed needs could be met.

This was a breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have made a requirement in respect of Regulation 18: Staffing.

At the inspection in May 2016 we found there was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of quality monitoring. The registered provider was issued with a requirement. This breach was not reviewed at the inspection in July 2016.

At the inspection on 14 December 2016 we found that, although some recording had improved, quality audits had not taken place consistently and the medication audits identified that errors in the management and recording of medication continued to take place. This is a repeat breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the inspection in July 2016 we found there was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of induction training for staff. We issued the registered provider with a requirement. The registered provider submitted an action plan on 5 September 2016 that informed us of the action they would take to become compliant with this regulation. At the inspection on 14 December 2016 we found that induction training had improved and that the registered provider was no longer in breach of this regulation.

The registered provider is required to have a registered manager in post and on the day of the inspection there was no manager registered with CQC. A registered manager is a person who has registered with CQC 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. In the absence of a registered manager, the home was being managed by the deputy manager with assistance from two experienced registered managers of other services operated by the same organisation.

The deputy manager was following the home's recruitment and selection policies to ensure that only people considered suitable to work with vulnerable people were working at Molescroft Court.

Staff told us that they received appropriate training, including induction training, and this was supported by the records we reviewed. Staff were also happy with the level of supervision they received.

People told us that they felt safe whilst they were living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

The manager and staff were aware of the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us that staff were caring and that their privacy and dignity was respected.

People's nutritional needs had been assessed and people told us they were satisfied with the meals provided. We observed that people's individual food and drink requirements were met.

We carried out an unannounced comprehensive inspection of this service on 10 and 11 May 2016. At this inspection we identified four breaches of regulation. This was because medication had not been administered or recorded safely, the laundry rooms posed an infection control risk, there were insufficient numbers of care staff on duty and the quality monitoring systems had not identified the shortfalls we identified at the inspection. We issued a requirement notice to the registered provider in respect of quality monitoring as this breach was assessed as having low service impact. The registered provider’s compliance in respect of meeting this requirement will be inspected at our next comprehensive inspection.

Two of the three remaining breaches were in respect of Regulation 12 (2) (h) and 12 (2) (g) Safe care and treatment and the third breach was in respect of Regulation 18 (1) Staffing. These were assessed as having a major or moderate service impact and we dealt with these by issuing the registered provider with a written warning notice for improvement for each breach. We informed the registered provider in the warning notices that they had to become compliant in respect of medication, the prevention and control of infection and the numbers of staff employed by 24 June 2016.

We carried out a focused inspection on 7 July 2016 to check whether the registered provider had achieved compliance with three of the four shortfalls we identified. This report only covers our findings in relation to the warning notices. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Molescroft Court on our website at www.cqc.org.uk.

The home is registered to provide accommodation and care for up to 44 older people, some of whom may be living with dementia. On the day of the inspection there were 33 people living at the home. The home is situated in Beverley, a market town in the East Riding of Yorkshire. There are three units within the home; The House, The Annexe and The Haven. Each unit has lounge areas, dining areas, bedrooms and toilets. People living in The Annexe and The Haven have en-suite facilities and The House has communal bathrooms and shower rooms. Accommodation in The Annexe and The Haven is on the ground floor and there is a passenger lift in The House so people are able to access the first floor if they cannot manage the stairs. There are laundry facilities in The House and The Haven.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager who was employed at the home was registered with the Care Quality Commission (CQC). 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 checked the administration, storage and recording of medication, and staff training on the administration of medication. At the previous inspection we were concerned that people who had been prescribed Warfarin and Alendronic Acid by their GP had not received their medication as prescribed, as records were confusing. This could have caused the person harm. At this inspection we noted that people had received this medication as prescribed.

Staff who had responsibility for the administration of medication had received appropriate training. However, we found that some people had not received their medication as prescribed, and there continued to be gaps in recording. We saw there were numerous errors in recording that had been corrected on medication administration record (MAR) charts. This meant that some MAR charts were confusing and not an accurate record of the medication administered. In addition to this, the recording on medication room temperature charts and medication fridge temperature charts was inconsistent.

This was a continued breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

During our focused inspection we found that new care staff had been employed and four more were due to commence work at the home when safety checks and induction training had been completed. This had reduced the number of hours that needed to be covered by agency staff. The registered manager told us, when all of the new staff were in post, this would leave no vacant hours on day shifts and only 48 vacant hours on night shifts. They were in the process of recruiting night staff. In addition to this, bank staff had been employed. This would further reduce the need for agency staff to be used.

We saw these changes resulted in the registered provider meeting the breach of Regulation in respect of the numbers of staff employed, previously identified in the Warning Notice for Regulation 18 (1) Staffing, under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We checked the laundry facilities at the home. We found that the main laundry room in The House had been refurbished and provided clean and hygienic facilities that reduced the risk of infection.

The second laundry room in The Haven had been upgraded but we saw that clean clothes were stored above soiled laundry, and mops and buckets were stored between the ‘clean’ and ‘dirty’ zones. A cupboard had been identified for the storage of mops and, following the inspection, the registered manager informed us that mops and buckets had been moved out of the laundry room in The Haven on the evening of our inspection. This meant the risk of infection had been reduced. The laundry room in The Haven was very small and it was acknowledged that it was difficult to have clearly defined ‘clean’ and ‘dirty’ zones. The registered manager told us that they were considering whether the safest option was to take this laundry room out of use and only use the main laundry room in The House.

We saw these changes resulted in the registered provider meeting the breach of Regulation in respect of the prevention and control of infection, previously identified in the Warning Notice for Regulation 12 (2) (h) Safe care and treatment, under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We had not intended to review staff training during this inspection. However, whilst checking the recruitment records for three new members of staff, we identified that they had not undertaken induction training or shadowed an experienced care worker before they worked unsupervised. This was confirmed by care staff that we spoke with and acknowledged by the registered manager.

This was a breach of Regulation 18 (2) (a) 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.

The home is registered to provide accommodation and care (including nursing care) for up to 44 older people, some of whom may be living with dementia. On the day of the inspection there were 33 people living at the home. The home is situated in Beverley, a market town in the East Riding of Yorkshire. There are three units within the home; The House, The Annexe and The Haven. Each unit has lounge areas, dining areas, bedrooms and toilets, and The House has communal bathrooms and shower rooms. People living in The Annexe and The Haven have en-suite facilities. Accommodation in The Annexe and The Haven is on the ground floor and there is a passenger lift in The House so people are able to access the first floor if they cannot manage the stairs. There are laundry facilities in The House and The Haven.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager who was not registered with the Care Quality Commission (CQC). 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 manager has submitted an application to register with the CQC and we are aware that it is being processed.

On the day of the inspection we saw that there were insufficient numbers of staff employed to meet people's individual needs. New staff had been employed and more were in the process of being recruited, but in the meantime the home was reliant on a high usage of agency staff. This was a breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medication was stored securely but some people had not received the correct medication and records were not completed accurately. This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Communal areas of the home and bedrooms were maintained in a clean and hygienic condition. However, we saw that it was not possible to keep laundry rooms in a clean and hygienic condition due to porous wall coverings and mops and buckets being stored in laundry rooms. This was a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some staff, relatives and care professionals told us that the home was not well managed. Quality audits undertaken by the registered provider and manager were designed to identify any areas of improvement to staff practice that would promote people’s safety. However, we noted that some of the shortfalls identified by us had not been identified in the audits that were taking place, or had been identified but not acted on. This was a breach of Regulation 17 (2) (a) (b) (e) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2008.

The manager was following the home’s recruitment and selection policies in an attempt to make sure that only people considered suitable to work with vulnerable people were working at Molescroft Court. However, we recommended that more care be taken with these processes as we noted one person had only one employment reference in place.

We found that improvements in staff training were needed as we were concerned that some staff had started work before they had completed thorough induction training and we saw there were some gaps on the home’s training record. The manager told us how they were addressing these shortfalls. We made a recommendation about this in the report.

People told us that they felt safe whilst they were living at the home. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

People told us that staff were caring and that their privacy and dignity was respected. Most people told us they received the support they required from staff, although we received comments about people not receiving sufficient showers and baths. We made a recommendation about this in the report.

People's nutritional needs had been assessed and people told us they were very happy with the food provided. We observed that people’s individual food and drink requirements were met.

We saw that any complaints made to the home had been thoroughly investigated and that people had been provided with details of the investigation and an outcome. There were also systems in place to seek feedback from people who lived at the home, relatives and staff.

Staff told us that, on occasions, feedback received at the home was used as a learning opportunity and to make improvements to the service provided.

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

Full information about the CQC's regulatory response to any concerns found during this inspection will be added to the report after any representations and appeals have been concluded.