Inglewood care home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Inglewood care home is a purpose-built care home in a residential area of Redcar and Cleveland. The service provides residential and nursing care and support for up to 48 older people, some of whom lived with dementia, Parkinson’s disease or a physical health condition. Bedrooms and communal areas are provided over two floors. Each person has access to an en-suite bedroom and there are gardens to the rear of the service. There were 43 people using the service on the first and second day of the inspection and 39 people on the third day of the inspection.
A registered manager had not been in post since 29 September 2017. A manager was in post on the days of inspection and they had started their employment in November 2017. They had submitted an application to become a registered manager four days prior to the inspection. 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.’
Inglewood care home is an established care home, however was newly registered under Crystal Care Services Limited on 12 July 2017. Inglewood care home had been in breach of health and social care regulations since 2014. Although a new provider was in place, further concerns were identified at this inspection about the safety of people using the service.
At the last inspection on 4 April 2016, we found improvements were needed to the quality assurance of the service. We asked the provider to complete an action plan to show us the improvements they planned to make, including timeframes.
There were insufficient staff on duty to provide safe care and support to people. Staff were unable to meet people's needs. Health and safety checks of people were not regularly carried out when needed because staff did not have time. They had been incidents where people had hit other people. This meant people were at risk of harm from the behaviour of other people. The systems in place had not safeguarded people from harm. Care records were not routinely updated when incidents took place. Practices in place to ensure lessons were learned were not effective.
Staff understood the different types of abuse. However, staff did not recognise that their failure to manage the risks to people and keep them safe, placed people at increased risk of physical abuse, organisational abuse and neglect. Improvements to medicines were needed. There were gaps in records and medicines were not always available when people needed them. Infection prevention and control procedures were not followed.
People who needed an adapted diet because of their nutritional needs and swallowing risks did not receive the correct diet or hydration. Records did not clearly indicate the correct diet and fluids which people needed. Staff knowledge was poor. People with adapted diets did not have a choice of meal. Records of the food and drinks people had consumed were not up to date or reviewed to make sure people’s intake was sufficient.
Staff were not supported with regular reviews during their induction. Supervision, appraisals and training were not up to date. People did have access to health and social care professionals, however guidance from them was not always followed or clearly presented in care records.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff worked in line with the Mental Capacity Act 2005. However, Mental Capacity Act assessments had been carried out instead of best interest decisions. People had routinely received vaccinations without best interest decisions being recorded. Staff knowledge about whether people had a current deprivation of liberty safeguard (DoLS) in place was poor.
Some updates to the environment had taken place which included a new boiler system and updated to some bedrooms and communal areas. However further improvements were needed. Flooring had lifted, paintwork and woodwork was scuffed. Relatives and staff struggled with wheelchairs because no ramp was in place to access the garden. The dining room on the first floor was too small to accommodate people. The environment did not support people living with dementia or sensory impairments.
Although staff failed to manage the risks to people and knowingly gave people the wrong food and fluids to eat, we did observe positive interactions between people and staff. Staff did not always have the knowledge needed to provide the most appropriate care to people, however we did observe staff seeking people’s permission. Staff maintained eye contact when speaking to people and dignity was maintained when personal care took place. Outside of personal care, dignity was not always maintained. Staffing levels impacted upon this because staff did not have oversight of people. Care records did not show that people were actively involved in planning and reviewing their care. There was no evidence of people’s voice in reviews.
Information in care records was not always accurate or up to date. These records were not always updated when incidents occurred or when people experienced changes in their health condition. Staff were not aware of the information contained in these records to be able to support people with care which reflected their needs, wishes and preferences. Some people were being supported with end of life care at the time of inspection. Staff were aware of peoples wishes and anticipatory medicines were in place. Training in end of life care was not up to date.
Mixed reviews were received in relation to activities. People and relatives knew how to make a complaint, and records showed they had been dealt with appropriately.
An ineffective auditing system was in place. Our findings were not in line with some of the audits carried out. Where action plans had been put in place, they had not been addressed. Action plans in place by other health professionals had not been addressed.
Staff told us they were able to approach the management team when they needed, and all spoke positively of them. The service had some links with the local community and worked alongside health and social care professionals. Notifications had not always been submitted without delay.
We found multiple breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to requirements relating to registered managers, dignity and respect, safe care and treatment, nutrition and hydration, the premises and equipment, good governance and staffing. We also identified a breach of the Care Quality Commission (Registration) Regulations 2009 for failing to submit notifications without delay.
You can see what action we told the provider to take at the back of the full version of the report.
This is the third consecutive time the service has been rated Requires Improvement.”