Lack of Covid measures put care home residents ‘at risk’
IT HAS BEEN RATED AS ‘INADEQUATE’ AND PLACED IN SPECIAL MEASURES
A DERBYSHIRE care home which cares for people with mental, leaning and physical disabilities has been placed in special measures after Covid guidance for protecting people from infection was not implemented and it was rated “inadequate”.
An unannounced visit to Elmwood House by two inspectors from the Care Quality Commission (CQC) on June 29 has resulted in a report being published.
It identifies breaches in relation to safe care and treatment, safe recruitment of staff and good governance.
The report also identifies several points at which there was failure to implement measures to prevent and control infection:
Personal Protective Equipment (PPE) was not always worn in line with guidance. Some staff were wearing non-surgical face masks which are not fluid repellent and therefore not effective in managing the transmission of infection. Other staff did not wear surgical masks correctly; for example, they had them below their chins, touched them frequently and did not clean their hands in between to replace them.
At times some staff did not wear surgical masks and said this was because people living in the home did not tolerate them. However, there were no risk assessments completed and no evidence staff had followed government guidance to desensitise people to accept the PPE. The staff were close to people supporting them and this put the people at heightened risk of infection.
Medical procedures were performed for one person which increased the risk of infection spreading and the provider had not ensured the correct PPE was in place for this.
People were not admitted safely to the service; there were two people who should be completing a period of isolation after admission to the home who were not doing so.
Testing of staff was not in line with government guidance and staff were not always tested weekly. We identified days when staff were at work when they hadn’t been tested for over one week and there was no record of the tests they took at home. In addition, there was no record of agency staff testing records. This meant the provider had not implemented guidance to ascertain the Covid-19 status of staff working in the home to reduce the risk of transmission.
People were receiving visitors in line with amended government guidance. However, the testing and monitoring of visitors’ health in line with Covid-19 was not always sufficient to ensure they were free from infection. For example, there were minimal reviews of tests completed at home and checks at the door such as visitors’ temperatures were not always completed and recorded.
The hygiene practices in the home had been amended to increase cleaning, for example, of frequently touched points. However, some areas of the home were in a very poor state of repair which made cleaning them to a satisfactory standard impossible; for example, some carpets were so worn there was no carpet thread remaining and they could not be deep cleaned.
The provider’s infection control policy was not updated to include information about Covid-19. This, alongside the evidence above, meant we were not assured that any future infection outbreaks would be well managed or controlled.
Other faults detailed in the report include: care plans not always regularly updated; no guidance for specific medicines administration and no assessment was carried out for a new arrival at the home giving limited guidance to provide safe care to a person with a number of health conditions.
The report says that when the concerns were raised with the provider, immediate action was taken to implement changes but CQC says it “will continue to monitor this”.
Some staff had worked at the home for a long time and knew people well, according to the report.
People the inspectors spoke to said “they trusted staff and they were helpful”. One person said: “The staff are understanding and caring.” Relatives also spoke highly of individual staff skills in supporting people.
The Elm Street care home in Hollingwood near Chesterfield caters for 32 people and is a larger home where people move to for additional nursing support.
A CQC spokesman said: “We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. “Based on our review of safe and well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. “Although staff were focused on providing person centred care to people some of the governance systems didn’t ensure these values were embedded in the quality of the home. “People were at risk because government guidance to implement infection control systems to reduce the risk of Covid-19 had not been fully implemented.
“The oversight and governance of people’s care and treatment was not adequate to ensure they were able to live as healthy and independent life as they chose.
“There were enough staff to meet people’s needs promptly and some staff were skilled in supporting people in the least restrictive way identified.
“However, staffing levels were not regularly reviewed and the recruitment of new staff was not thorough enough. The guidance available for staff was not always detailed enough, reviewed regularly enough and for some circumstances such as certain medicines administration was not in place. This meant people were at an increased risk of harm.”
People were included in discussions about the home through meetings and staff felt listened to. Other professionals reported good communication and relationships.
The CQC has requested and action plan from Elmcare Limited, which runs the home, “to understand what they will do to improve the standards of quality and safety”.
The report’s summary stated: “We will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.
“If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures.
“This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.”
The care home was approached for a comment on the report, but has not responded so far.
People were at risk because ... guidance to implement infection control systems had not been fully implemented. Report