Blair House is a large Georgian building registered with CQC to provide residential care for up to 29 older people. At the time of the inspection there were 20 people living at the home including four people staying at Blair House for a period of respite care. There was a lift at the home and due to the layout of the home a chair lift was available to some of the upper floor rooms which could not be accessed by the lift.This was an unannounced inspection which took place on 14 and 16 November 2016.
Blair House was inspected in September 2015. Two breaches of Regulation were identified in Regulation 15 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured all premises and equipment was properly maintained. The provider did not have systems in place to assess, monitor or improve the quality of service provided.
The provider sent us an action plan stating they would have addressed all of these concerns by October 2016. However, at this inspection we found although some improvements had been made in relation to the premises, new areas of concern were identified. This was a continued breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the provider had failed to make adequate improvements to ensure an effective system was in place to regularly assess and monitor the quality of service that people received. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Some further breeches of regulation were also found during this inspection.
People’s level of care and support needs varied. Whilst some people could take care of themselves and were mobile, others used walking frames or required assistance from staff for all personal care and mobility needs. Those who remained predominantly independent required prompting and support at times to ensure they remained safe. Some people had mental health concerns, dementia or memory loss. A couple of people went out alone or with friends and family, whilst others required more assistance with all care needs and remained in bed or in the communal areas of the home as they chose.
Blair House had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
The registered manager was in day to day charge of the home.
Pre admission assessments did not identify people’s health needs. People with specific health and care needs did not have care plans and documentation in place to inform staff. People with dementia did not have any assessments to identify how this impacted on their daily lives or how their dementia presented in day to day life. People who used continence aids did not have this information included in their continence care plan. Care plans did not routinely include information regarding peoples mental health needs. People who were assessed as requiring pressure care equipment did not have daily checks in place to ensure pressure areas were assessed and monitored to identify concerns. People’s safety was not being fully assessed and maintained. One person who was unsafe to go out alone had the door opened by staff who were unaware they were not safe to leave unaccompanied and they went out.
Some health and safety checks had not been completed since the maintenance employee left in May 2016. This included water temperature, descaling, cleaning and flushing of water systems, fire alarm checks and some day to day maintenance around the home. Infection control measures had not been maintained. We found areas of the home that needed cleaning. There was no designated laundry person and care staff were currently responsible for this. People’s personal items of clothing had not been treated with respect. Laundered clothing had not been folded and stored tidily. Personal and confidential care records had not been safely stored to ensure peoples personal information could not be accessed by others.
Systems to manage and store medicines needed to be improved. Medicines were not safely stored and this could pose a potential risk to people living at Blair House as they were not locked away at all times. Medicine procedures for PRN or ‘as required’ medicines were not consistent. People were risk of being given their medicines in an inconsistent manner.
Procedures to document and report accidents and incidents were not consistently followed. Forms were not always completed or lacked detail. Body maps were not in place for all injuries. Actions taken in the response to accidents and incidents were not documented on the form. The registered manager had not completed an audit/ analysis of accidents and incidents since February 2016. The documentation did not show that people’s safety was being maintained after injuries or accidents occurred.
Mental Capacity Assessments (MCA) had not been completed. Deprivation of Liberty Safeguards (DoLS) applications had been made without underlying information about how this decision had been made. Information regarding people’s capacity, mental health and who was legally entitled to be involved in decisions had not been completed in care files.
The registered manager had not ensured that staff had the appropriate, skills, knowledge or experience to meet people’s needs. Staff inductions did not show how staff were assessed as confident and competent before working unsupervised. Training records were not up to date to identify who had completed e-learning recently. New staff who had been left in charge of the home did not have a full understanding the homes procedures and reporting systems. Staffing levels had not been assessed in accordance with the needs of people living at Blair House. Dependency assessments had not been completed and staff felt that they needed more staff due to the number of new admissions to the home and people who required a high level of care and support.
An activity schedule was in place including visiting entertainers. However, there was no designated activity person and staff were responsible for providing activities for people at other times. Activities were not individualised and staff told us they did not always have time to do them.
An effective quality assurance systems was not in place. Audits had not identified concerns we found during the inspection. Audits completed by the registered manager and sent to the provider did not correspond with areas of concern we found during the inspection. Some audits were delegated to other staff but had not been checked to ensure they had been completed. The registered manager did not have oversight of all areas of the home and the checks completed.
Staff had an understanding of recognising and reporting abuse. Care staff new to the home were keen to improve and increase their skills and knowledge to enable them to provide the best care they could for people. We saw that care staff spoke to people in a kind and considerate manner. When providing care, staff spoke to people to ensure they were involved and aware of what was happening. For example whilst assisting people to move using a lifting hoist support and guidance was given in a calm and supportive manner.
We received positive feedback regarding the meals. People were offered a choice at mealtimes and could request an alternative if they wished. People had access to hot and cold drinks throughout the day.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.