14 October 2020
During an inspection looking at part of the service
St Augustine's Court Care Home is a nursing home providing personal and nursing care for up to 40 people. On the first two days of inspection, 36 people lived at the care home. On the third day, 33 people were living in the care home. The service provides care to people, some of which are living with dementia. The service is a purpose-built property. Accommodation is split across two floors. There are several communal living areas, an accessible sensory garden, a cinema room and a sensory room.
People's experience of using this service and what we found
People did not have good outcomes. Restrictive practice was used at the service, including locking people in rooms and physically restraining them without staff training. One person reported staff being “rough with me”. Another had bruising which supported a received allegation that the person had been restrained. These two concerns were reported to the management team, we returned 12 days later and were not provided with evidence that these allegations had been investigated. This left people at ongoing risk of neglectful care. We repeatedly observed staff not responding to people’s obvious distress and need for support.
Medicines were not managed safely. Staff had received training, however this was assessed as ineffective when observing the service. Care plans were generic and did not provide sufficient guidance for staff to provide safe and person-centred care. There were insufficient staff to respond to people in a safe way. We also observed staff not attend people who required urgent support. Lessons were not learnt when things went wrong. This meant people were at risk of incidents repeating themselves.
Poor leadership and oversight of the service had impacted on the quality of care and treatment people received. Staff reported that the management team shouted at them. There was poor morale at the service.
The service was inspected during the covid-19 pandemic. Staff were observed to wear personal protective equipment in line with government guidelines. People and staff were regularly tested for covid-19.
We communicated our concerns to the management team after the first two inspection days, they responded to our concerns stating that they would work to improve the service. We returned 12 days later and identified that minimal changes had occurred, this left people at ongoing risk of harm. We identified four breaches of regulation.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (Report published 23 October 2020).
Why we inspected
We last inspected this service on 8, 9, 10 and 17 September 2020. After our inspection, we received multiple concerns about the quality of care provided. This included allegations of: low staffing, poor management of incidents, the use of restraint and neglectful care.
As a result of these concerns, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
Enforcement
The previous inspection found no breaches of the Health and Social Care Act 2008 (Regulated Activities).
At this inspection we identified breaches of regulation 12 (Safe care), 13 (Safeguarding), 18 (staffing) and 17 (Governance). These are requirements for the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
After the first inspection site visit, we urgently imposed conditions on the providers registration. These conditions prevented the provider from admitting new service user's without CQC permission. They also required a review of the safety of the service. The provider did not appeal this urgent enforcement action.
When we returned to the service, we identified that improvements had not been made and people were still at risk of harm. We therefore wrote a letter to the provider, proposing that we would cancel their registration with the CQC. Cancelling a provider's registration would prevent them from legally providing personal care support from the premises. The provider informed us that they did not intend to appeal this proposal. We have therefore taken action to cancel the provider's registration.
Follow up
We have cancelled the provider's registration. This provider is therefore not legally allowed to provide personal care support from these premises. If they apply to register another service, this will go through our usual registration assessment processes.