A St Helens care home is under threat of closure after being rated inadequate by a healthcare watchdog for the second time in six months.
Elizabeth Court Care Centre in Sutton was given the lowest rating of ‘inadequate’ by the Care Quality Commission (CQC) in February.
During the three-day inspection in December 2018, inspectors uncovered multiple regulation breaches at the care home, which is ran by Key Healthcare.
The CQC report described how one staff member was observed trying to feed a resident while they were still in a “sleep-induced state”.
A separate incident saw a member of staff wrap an apron around a resident’s neck while they slept, before waking them to be fed.
Another incident saw a resident woken and then sat up by two members of staff. A pillow was shoved behind the resident’s back while they were still half asleep.
Inspectors also found that some of the language used by staff to describe people’s needs was “inappropriate and disrespectful”.
Following the inspection, Elizabeth Court was placed in special measures.
Once a service is placed in special measures another inspection is conducted within six months. This took place at Elizabeth Court over three days in June.
While the service did show improvements, the provider was still in breach of multiple regulations and it remains in special measures.
It is understood the CQC has begun enforcement procedures, which could lead to the watchdog cancelling the service’s registration.
Following the inspection, Elizabeth Court was rated inadequate in the safe and well-led categories, while requiring improvement in the effective, caring and responsive categories.
The CQC report says there were “widespread and significant shortfalls” in service oversight, which did not assure the delivery of high-quality care.
Inspectors found that Key Healthcare had failed address a previous regulation breach relating to how it robustly assesses the risks associated with quality monitoring and governance.
The CQC report says: “Systems in place for the monitoring and ensuring quality and safety were not effective and put people at risk of not receiving the care and support they needed.
“Monitoring systems had failed to identify improvements needed in relation to risk management, medicines management and the implementation of the Mental Capacity Act to protect people’s rights.”
Current system in place for the oversight and monitoring of people’s care planning documents was “ineffective”, inspectors found.
The CQC report says the current system failed to identify the gaps and inconsistencies in people’s care records with regards to assessing and minimising risk, the planning of people’s care and the monitoring of the care they received.
“People’s records were not person centred or always managed in a way that promoted privacy and respect,” the report says.
“Communal communication books used by staff were seen to contain records of meeting relating to people’s health and end of life care, complaints made about the service and records relating to safeguarding concerns.
“This meant that areas of concern that required further action or investigation were not always identified or acted upon by the management team.”
Additionally, the CQC report says people were not always protected from abuse as appropriate procedures were not always followed.
Inspectors found that records of incidents that had occurred had been recorded “inappropriately” in staff communication books.
The lack of appropriate reporting had resulted in the registered manager not being made aware of incidents that had occurred.
Subsequently, no further investigations had taken place, which put people at “unnecessary risk of harm”.
Key Healthcare and its representatives regularly visited the home, the report notes, although no evidence was shown to demonstrate that quality checks had been carried out.
“A record of the dates and reason for the visits was maintained,” the CQC report says.
“However, no further information was available to demonstrate that any monitoring or quality checks had been completed during these visits.
“Therefore, there was no evidence to demonstrate that the provider had sufficient oversight over the quality and safety of the service.”
A number of changes have been made since December’s inspection, particularly to address a regulation breach relating to insufficient staffing.
A new registered manager was in post at the latest inspection. A qualified nurse, serving as clinical lead for the service, was also in post.
The provider is no longer in breach of this regulation.
Despite the watchdog’s concerns, comments from residents remained positive.
One person living in the residential unit said staff were “fantastic” and “cannot do enough”. Another said staff were “polite and caring”.
Additionally, family members told inspectors they were confident their relative was safe from harm.
Following the latest CQC inspection, Richard Keyes, director of Key Healthcare, said: “Key Healthcare has made positive steps in re-establishing Elizabeth Court’s reputation which includes a new management team, who, along with the CQC and the local authority, are making good progress in the delivery of care services at the home”.
For the time being, Elizabeth Court will remain under review by the CQC.
Where necessary, another inspection will be conducted within a further six months.
If there is not enough improvement the CQC will move to close the service by adopting its proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.