The Care Quality Commission (CQC) has rated Iceni House inadequate and placed it into special measures, following an inspection in October and November last year.
Iceni House, run by Norfolk Care Homes Ltd, is a residential care home which provides support to up to 75 older people, and people living with dementia. There were 60 people living in the home at the time of this inspection.
CQC carried out this inspection due to concerns over managerial oversight and an increase in safeguarding concerns.
CQC has rated the home inadequate for safe, effective and well-led and requires improvement for caring and responsive.
The inspection took place shortly after changes to the management structure, with a new management team in post at the time.
CQC has placed the service into special measures which involves close monitoring to ensure people are safe while they make improvements. Special measures also provide a structured timeframe so services understand when they need to make improvements by, and what action CQC will take if this doesn’t happen.
CQC has also begun the process of taking regulatory action to address the concerns which Iceni House has the right to appeal.
Hazel Roberts, CQC deputy director of adult social care in the East of England, said:
“When we inspected Iceni House, we were concerned to find people weren't being kept safe because leaders hadn't given staff the support they needed. We found evidence of a closed culture. Some staff said they were afraid to raise concerns because they feared negative consequences. This meant problems weren’t being properly reported or dealt with.
“Staff didn’t always support people to maintain their personal hygiene. One person told inspectors they often found their family member wearing dirty clothes and looking messy. Call bells weren't always answered in a timely manner. One relative told us their family member waited 20 minutes for help to use the toilet. When staff arrived, they told them to use their pad instead. This was undignified and unacceptable.
“Staff didn't always keep care plans clear or accurate. Inspectors found errors and contradictions that placed people at risk. For example, one person with swallowing difficulties and a risk of choking had sandwiches listed in their care plan. Another person with diabetes wasn't being supported appropriately as they weren't consistently offered food after receiving insulin, despite this being recommended for the type of insulin they had been prescribed.
“Staff didn't always provide care in line with people’s assessed needs. They didn't consistently reposition people who were at risk of skin breakdown, despite guidance from healthcare professionals. For one person, staff failed to reposition them within the agreed timeframe in 12 out of 14 care records reviewed. Staff had switched off fall prevention equipment for a person at high risk of falling, with no evidence they were monitoring it or checking on the person’s safety.
“We’ve shared our findings with the management of the home and will be monitoring it very closely to ensure changes are made and people are kept safe while this happens. We’ve also begun taking further regulatory action which Iceni House has the right to appeal.”
Inspectors found:
- Staff didn’t ensure care plans reflected people as individuals. They lacked information on people's history, lifestyle and what mattered to them. One care plan referred to a female resident as male and used the wrong name.
- Staff hadn't completed actions identified in the fire risk assessment that were marked as needing urgent attention within one week. Inspectors found several fire doors with gaps that could allow fire and smoke to spread. One fire door in the dining room had been bolted shut, and fire exits were not consistently kept clear.
- Staff didn't always speak English in front of people using the service. One staff member told inspectors it is sometimes difficult when the staff are not speaking English in the unit. This could make it harder for people to understand what was happening around them and may have affected communication between staff working together in the same unit.
- Leaders didn’t support staff appropriately and didn't provide regular or timely supervisions or appraisals. There was no regular out of hour spot checks conducted on the service to assess the quality and culture of the workforce.
- There was no registered manager in post at the time of inspection, although the management team had recruited unit managers and a night manager to oversee the service with their support.
However:
- Staff interacted nicely with people and communicated with them when providing support. Inspectors observed interactions that were kind, caring and respectful.
- The new management team had implemented a lesson learned process to share learning with staff.
- The new management team had begun to work on the workforce equality within the team, and this was being noted by staff.