A Sutton care home has been placed in special measures after a health watchdog uncovered multiple regulation breaches.
Elizabeth Court has been given the lowest rating of ‘inadequate’ by the Care Quality Commission, having previously been rated ‘good’ in 2016.
At the time of inspection in December 2018, there were 41 people living in the care home, which is ran by Key Healthcare.
Over the course of three days, inspectors identified breaches of regulations within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Some of the concerns included the delivery of person-centred care, safe and appropriate care, safeguarding people from abuse, the recruitment of staff, staffing levels, staff support and the governance arrangements at the home.
The report said the majority of information held in relation to people’s care was “generic and meaningless” with staff given little guidance, which meant support was not always provided in a “safe or dignified” way.
On one occasion, inspectors observed a staff member try to feed a resident while they were still in a “sleep-induced state”.
The report said: “They had to keep waking the person up between mouthfuls of food and at one point the person fell asleep with a mouthful of food still in their mouth.
“This was not very dignified or a safe way to provide nutritional support as it placed the person at risk of choking and aspiration pneumonia.”
A separate incident at lunch-time, which was described as “chaotic and disorganised”, saw a member of staff wrap an apron around a resident’s neck while they slept, before waking them to feed them.
The report added: “Another person was woken up for their lunch and then sat up by two members of staff and a pillow shoved behind their back whilst they were still half asleep.
“This was not very dignified or respectful.”
Residents with dementia were also not given the right support, according to the report.
“We observed one person struggling to cut up their meal,” the report said.
“When we checked this person’s care file we saw that staff had instructions to ensure this person’s meal was cut up prior to serving. This had not been done.
“One person was trying to eat a piece of fish by spearing it with a knife and another person was trying to eat peas with their fingers.
“Despite this there was little in the way of adaptive cutlery or tableware to encourage people to eat independently and in a dignified way.”
Inspectors also found that some of the language used by staff to describe people’s needs was “inappropriate and disrespectful”.
Residents were described as being able or unable to “feed themselves” and one person’s care plan referred to keeping the person “locked up for their own safety”.
In addition, not all of the safeguarding incidents identified by the provider’s safeguarding system had been reported appropriately to the CQC.
This meant the system was “not effective” in mitigating the risk of abuse or for ensuring the provider complied with the health and social care regulations.
Staffing levels and a lack of supervision for nursing staff was also highlighted in the report.
The inspectors found that, while a system was in place to determine safe staffing levels, the system had been used incorrectly.
This resulted in staffing being under-estimated in the nursing unit and over-estimated in the residential unit.
“This did not make sense, as it meant that the most vulnerable of service users on the nursing unit had less staff support hours than those in the residential unit to meet their needs,” the report said.
While care staff received regular supervision, inspectors found there was no evidence that nursing staff received clinical or other supervision in their job role, which it said is a considered an “essential part of professional practice”.
Many of the comments made to inspectors from residents and relatives were positive.
The care home manager was also described by residents as “approachable”.
Inspectors were shown that complaints had been responded to appropriately by the manager.
Out of the six categories rated by the CQC, Elizabeth Court was rated inadequate in five: safe, effective, responsive and well-led; and deemed to require improvement in the caring category.
The overall rating of inadequate means the care home has been placed into special measures.
Elizabeth Court will be inspected again within six months. If insufficient improvements are not made within the time period, then further action will be taken by the health watchdog.
Richard Keyes, director of Key Healthcare, said a new management team has been put in place following the inspection.
Mr Keyes said: “As a result of recent events Key Healthcare is working in partnership with the CQC, the local authority and CCG with regards to the issues found at Elizabeth Court Care Centre, St Helens.
“Key Healthcare has owned and operated Elizabeth Court Care Centre for 12 years and during this time the home has maintained its CQC good rating.
“As a result of the CQC’s findings a new management team has been put in place at Elizabeth Court Care Centre and the company is progressing to regain its CQC good rating.”