The inspection of Wordsworth House commenced on 23 August 2017 and was unannounced. A second day of inspection took place on 25 August 2017 which was announced.Before the inspection we received notifications of incidents following which two service users sustained a serious injury. These incidents are subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.
However, the information shared with CQC about the incidents indicated potential concerns about the management of risk of falls from beds and scalding. This inspection examined those risks.
We last inspected Wordsworth House on 29 February 2016 and found it was meeting all legal requirements we inspected against. We rated Wordsworth House outstanding in the caring domain and good in all other domains.
Wordsworth House is a 78 bed care home that provides personal and nursing care to older people, some of whom were living with a dementia. Accommodation is provided over three floors.
At the time of the inspection there were 63 people using the service.
The service did not have a registered manager. The management of Wordsworth House was being overseen by the quality and compliance manager who had been based at the home two days prior to the inspection. The previously registered manager had left their post in May 2017 but had not cancelled their registration until August 2017. Since May 2017 there had been a further two managers overseeing the home, one of whom was a regional manager.
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.
During this inspection we found the registered provider had breached regulations in relation to safe care and treatment, staffing, good governance, safeguarding people from abuse and improper treatment and receiving and acting on complaints.
Not all the people living at Wordsworth House had a personal emergency evacuation plan to support their evacuation in the event of an emergency. A fire risk assessment was not evident at the time of the inspection and was scheduled to take place the week after the inspection. We received confirmation that this had been completed.
A nurse call bell sounder was not working. This had been reported on 4 August 2017 but staff said it had been out of action for two to three months with no risk assessment in place to manage the situation to ensure people received care and support in a timely manner.
Monthly profile bed checks had been completed from June 2017 onwards however the checks had failed to identify that several mattresses did not meet the providers own safety requirements. Not all the people who used bed rails had a bed rails risk assessment completed and there were gaps in the recording of mental capacity assessments, best interest decisions and care plans in relation to the use of bed rails.
The quality and compliance manager could not assure us that appropriate Deprivation of Liberty Safeguards (DoLS) had been considered for people who lacked capacity. This meant people were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did support this practice.
Individual risk assessments contained contradictory information, and lacked the appropriate level of detail and strategies to ensure risks were minimised. For some risks, risk assessments had not been completed or were over two years old. Care documentation also lacked detail, had not always been updated in response to changing needs and reviews were often meaningless.
There were concerns with some people’s fluid intake and no action had been taken to minimise the risk of dehydration.
Everyone we spoke with raised concerns about staffing levels and observations supported this. On four occasions inspectors intervened and physically sought staff out in response to hearing nurse call bells going unanswered and hearing people shouting for help.
Medicines were administered safely, however there were some concerns about appropriate storage and recording. We have made a recommendation about medicines.
The provider had not ensured staff had access to the appropriate training, support, supervision and appraisal they needed to ensure people’s needs were appropriately met.
Safeguarding concerns, accidents, incidents and complaints were logged but there was no evidence of internal investigations or analysis to identify patterns or improvements that were needed.
The provider had failed to ensure an effective system of governance and quality assurance was in place to identify concerns and action to be taken to make required improvements. Everyone we spoke with told us Wordsworth House lacked leadership, management and direction.
We found permanent care and nursing staff treated people with dignity and respect. People were complimentary of the care they received however, the provider was not ensuring appropriate systems were in place to support and develop a culture that was caring and compassionate.
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.
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.