The inspection took place on 18, 20 and 21 July 2016 and was unannounced, which meant the provider did not know we were coming. This was the first inspection of the service following the Care Quality Commission registration in September 2015. The service was previously registered under another provider. There was a new manager at the home who became registered shortly after our inspection on 26 June 2016. The manager is also registered at another Runwood Homes Limited service in Doncaster and we were informed that they will be based at Owston View until further notice. 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.
Owston View is a care home situated in Carcroft, Doncaster which is registered to accommodate up to 36 people. The service was split into two units the Croft unit which cared for people living with dementia and Willow unit which had bedrooms on both the ground and first floor. This was classed as the residential unit. The service is provided by Runwood Homes Limited. At the time of the inspection the home was providing care for 21 people, some of whom had a diagnosis of dementia.
Concerns had been raised to us before the inspection in relation to staffing levels and an incident involving one person whose care needs had not been appropriately met. This was still being investigated at the time of the inspection.
At the time of our inspection we found there were not enough staff on duty to ensure people’s care needs could be met in a timely manner. The system to alert staff when people needed assistance was not working effectively.
People cared for in bed did not receive appropriate care and treatment. Some issues identified on the first day of the inspection had not been addressed when we returned on the second day. Some
people were at risk of being socially isolated due to their high dependency needs, the only interaction with staff was when staff were assisting with personal care tasks.
Care records were not always fit for purpose. Some lacked detail, were out of date or contradictory. When care records were reviewed, the reviews did not always result in relevant changes being made to people’s care plans or risk assessments. We identified instances where care was not being provided in accordance with people’s assessed needs.
Safeguarding arrangements in the home were in place. Staff we spoke with appeared to be knowledgeable and were trained in this area, and appropriate procedures had been followed when abuse or suspected abuse had occurred. However, during the inspection we identified safeguarding concerns which had not been recognised and we have report these to the local authority.
The manager was aware of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place and key staff had been trained. This helped to make sure people were safeguarded from excessive or unnecessary restrictions being place on them. We found some improvements were still required to ensure mental capacity assessments and best interest decision records were more detailed and decision specific.
Health professionals told us that communication within the home was poor. They told us their instructions were not always followed which meant people’s care needs were not always met.
We found staff approached people in a kind and caring way. However, most of the interactions we observed were task orientated. People could not access activities. Staff told us they did not have time to arrange activities. Signage around the home was not dementia friendly. Notice boards were not kept up to date and menus were not always displayed.
The secure garden area was not safe for people to use. Old broken furniture, no shade and overgrown bushes meant people would be at risk of injury. People accessed the garden through fire doors which could not be opened from the outside, therefore people had to wait until staff were available to let them back in.
The provider told us systems were in place to guide staff on safe administration of medicines. However, we identified these were not followed and people did not always receive their medication as prescribed. Medication was not stored at the recommended temperature. Protocols for the administration of ‘as required’ medications were generic which meant they were not effective.
We identified that inadequate staff were on duty to meet people needs, although the provider did review this during our inspection. We observed people had to wait for assistance and staff were not always present in communal areas to ensure people’s safety. Staff and relatives we spoke with told us they could do with more staff to ensure people’s needs were met in a timely way and maintain their safety.
People were not always supported to eat and drink sufficient to maintain a balanced diet and adequate hydration. We found the meal time experience did not meet the standards expected by the provider.
Infection prevention and control policies were not always adhered to; therefore safe procedures were not always followed.
We saw the provider followed safe recruitment procedures to ensure people employed to work with vulnerable people were fit to do so. However, we found staff induction was not completed and staff had not received supervision in line with the provider’s policies. Staff told us morale was very low which was impacting on the people who used the service.
The systems and processes in place to monitor the quality and safety of the services provided were not effective. There was a complaints procedure; however relatives told us that they were not satisfied with the standards of care. One relative told us they were not satisfied with how their complaint had been handled.
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.