This inspection took place on 18 and 21 August 2017 and was unannounced. We extended our inspection due to concerns raised with the Care Quality Commission (CQC) and attended for another day on 3 September 2017. The inspection was prompted in part by notification of an incident following which a person using the service was involved in a serious safeguarding incident. This incident is subject to a criminal investigation. The information shared with the CQC about the incident indicated potential concerns about the management of risk relating to safeguarding and this inspection examined those risks. The provider told us the local authority requested they complete an internal investigation which has now been initiated.Augustus Court is a residential home providing accommodation for persons who require personal care and people living with dementia. At the time of our inspection there were 57 people living in the home. The provider registered with the CQC in February 2016 and this was their first inspection.
During our inspection there was a registered manager in post. 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 identified breaches of the Health and Social Care Act (Regulated Activities); you can see what action we told the provider to take at the end of the full version of the report. Full information about the CQC’s regulatory response to the more serious concerns found during the inspections is added to reports after any representations and appeals have been concluded. 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.
We found the registered manager had not acted on safeguarding concerns that had been raised and that incidents and accidents were not always recorded which meant processes were not followed in accordance with the provider’s policies and no actions were taken to keep people safe from avoidable harm and alleged abuse.
Statutory notifications were not always submitted to the Care Quality Commission as required. Services that provide health and social care to people are required to inform the CQC of important events that happen in the service in the form of a 'notification'.
Risk assessments did not always reflect people’s needs. We found two assessments had not been implemented when there was documentation to suggest a risk was present.
We found shortfalls in recording, for example, topical Medication Administration Records (MARs), re-positioning charts were not always signed, accidents and incidents were not always documented on the providers ‘Datix’ system and complaints made to the service had not always been recorded formally.
Audits were completed however, we could not be confident that these had reflected all that had happened in the home due to the shortfalls in recording and lack of reporting incidents.
People living in the home told us they felt safe and said the staffing levels were sufficient to meet their needs. Appropriate checks were carried out to ensure staff working in the home were safe to do so.
People and their relatives felt staff had sufficient training to do their job and we found training took place with the staff. Staff were provided with regular supervisions and annual appraisals to develop their learning and any new employees completed an induction programme.
We found the provider was working within the principles of the MCA, with completed assessments in place and relevant care plans in situ. We also saw the provider had made DoLS applications when required.
There were mixed reviews about the food but overall this had improved recently. Fluid and food charts were used for people that required further support although, we found these records were not always robustly maintained.
Most of the people and their relatives told us the staff were caring and spoke positively about their relationships.
People told us staff treated them with dignity and respect at all times. We saw people were being supported to be as independent as possible and explanations about a person’s care was provided.
End of life care plans were individualised to the person’s needs and regularly updated.
Initial assessments and care plans were in place and reviewed regularly. We found that people and their relatives were invited to formal reviews of their care on a six monthly basis.
We saw regular meetings took place with people living in the home to ask for their views and found staff and governance meetings were held.
Surveys had been completed and were overall positive about the home. People living in the home and relatives were provided with annual surveys to complete. Action plans were drawn from this to reflect what the provider and registered manager were doing to support changes, ideas and make wishes and needs a reality at the home.
People and their relatives spoke highly of the activities provided at the home. We saw regular activities, weekly timetables of planned events and monthly newsletters.
The registered manager had positive community links with the local school and put on events to include people in the local community.