Care home in Cornwall placed into special measures

Averlea Residential Home is a care home situated in the small village of Polgooth and provides personal care for up to 14 primarily older people, some of whom may be living with dementia.

At the time of the inspection, 12 people lived at the service and CQC inspectors spoke to nine people who used the service and two relatives about their experience of the care provided. Inspectors also spoke to three members of staff, including the registered manager. 

According to the inspection report, published on October 23: "The registered manager and provider did not always have clear oversight of the service.

"Audits were not completed. The registered manager told us they had not completed any audits since the COVID pandemic. Staff had not practiced fire drills. There were no personal emergency evacuation procedures (PEEPs) in place to inform emergency services of people's needs in the event of an evacuation.

"No maintenance checks, including checks of fire alarm systems or legionella checks, had been carried out. No staff training matrix was available, and staff told us they had not received training. No staff supervision record was held and the registered manager informed us they had not completed any supervisions.

"No records of falls, injuries, or accidents had been completed. People who regularly refused food and fluids did not have appropriate monitoring charts in place. People had not been referred to appropriate professionals, for example, advice had not been sought from dieticians. There were insufficient staff working with people.

"Two care staff covered each shift to care for 12 people. On the day of the inspection, one staff member had only completed three shifts previously and so was unlikely to know people well. There was no staff dependency tool used to assess how many staff were needed to keep people safe.

"The registered manager spent most of their time during the inspection cooking for the residential home as well as nearly 100 meals for a service they provided in the local community. The staff rotas showed the registered manager had covered five kitchen shifts during the week of September 3, 2023, to September 9, 2023. This meant they had not undertaken required management tasks and responsibilities.

"We found the registered manager and provider had not sent death or injury notifications to the Care Quality Commission (CQC) as required. Each person had a file holding a body map. None had been completed to show where people had marks and bruises. No accident forms had been completed.

"People had little or no interaction with staff. Our observations showed there were often no staff present during the day in the main lounge area. There were no records of peoples' individual activities and no activity coordinator was employed. Staff had not had any up-to-date training in dementia care to help ensure they had the skills to enable people to pass their time in an enjoyable way. One person told us, "I'd like to go out more." While another said, "Not much to do."

"There were two televisions in a shared lounge which were angled so people at either end of the room could see a screen. Both televisions were switched on and tuned to different channels. This meant people were unable to hear either television set. The internal environment needed updating and attention.

"We had been notified by a relative of a rat infestation. On the day of our inspection, we were informed by the registered manager this infestation had been dealt with. The main area of concern, a bedroom, had been vacated and floorboards removed, and the carpet pulled up waiting for refurbishment.

"Other areas of the service required work. The carpets were torn in places and heavily stained. Many areas of the service, including the main dining area and one of the bathrooms, were cluttered. The chairs and other furniture were old, dated, worn and stained.

"We found chemical products left around the building which were easily accessible to people and posed a risk. A door separating the dining room and kitchen had a glass panel to allow people entering the dining room to see if there was anyone on the other side. The panel had been covered by notices obstructing the view from the kitchen.

"On the day of the inspection there was an accident when a member of staff opened this door and made contact with a service user they had been unable to see, who was using a walking aid on the other side, causing them some discomfort. Medicines audits had not been completed and staff had not had checks of their competency to administer medicines safely. We could not be sure people received their medicines as prescribed as there were gaps in the MARs (Medication Administration Record).

"No records were available to support the safe administration of external medicines, such as creams and lotions. Some people were prescribed 'as required' pain relief medicines but there was no guidance or protocols in place to help staff make consistent decisions about when these medicines might be needed. Some people were receiving these 'as required' medicines on a regular basis and not 'as required.' The home held medicines that required extra security. No audits of these medicines had taken place and an error was noted on one person's record.

"People had not been given the chance to feedback on the care and support they had received. No resident meetings or quality assurance survey had been completed.

"We observed 1 person being given a choice of food at lunchtime. However, they commented to us that they normally were not offered a choice. One person's records showed they had their food liquidised. There was no record of consent or rationale as to why this happened. People had bed rails and pressure mats in place without any authorisations in place or evidence they had consented to the restriction."

After the inspection, the CQC's overall rating of the Averlea Residential Home service was changed to "Inadequate."

The Packet has contacted Averlea Residential Home for comment.