A warning notice has been issued to Tall Trees care home, which was subjected to a focused inspection in May.
At the time of the inspection there were 29 people living at the home and the inspection was carried out to follow up on concerns received about the management of an abuse incident and overall management of the service.
During this inspection CQC found no improvements had been made in the management of medicines or assessing risks, despite being told these areas needed addressing at an inspection in November 2020.
A CQC spokesman said: "Before the inspection, CQC received information of an incident of abuse. Staff confirmed that the alleged abuser continued to work the remainder of their shift despite the incident being reported. The alleged abuser worked on a further two occasions after the allegation was reported.
"The leadership team was aware of these allegations but did not take appropriate action to investigate them, putting people at risk of potential further abuse. The local safeguarding authority is investigating the incident and CQC was notified that the alleged abuser was later dismissed from employment at their service."
Previously Tall Trees was rated as requires improvement overall, but following the inspection in May, the service is now rated as inadequate overall. The rating for effective moves from good to requires improvement and safe and well-led move from requires improvement to inadequate. As this was a focused inspection, caring and responsive were not rated.
CQC has issued the provider with a warning notice because inspectors were concerned about the safety of care provided to residents, as well as governance of the service.
Rebecca Bauers, CQC’s head of inspection for adult social care, said: “When we inspected Tall Trees, we were incredibly concerned to find very few of the immediate improvements we had previously requested had not taken place. During the inspection we found even more issues that raised concerns. People using this service deserve more.
“People were not protected from abuse and there was a lack of protection from the risk of infection. Responsibilities within the service were not clear, such as what actions management should take on being made aware of allegations of abuse. While we found no evidence that people were being harmed during our inspection, systems were either not in place, or were not robust enough, to demonstrate safety was effectively managed.
"There were also widespread and significant shortfalls in the way in which the service was led. People were at risk of neglect because the processes in place to monitor the quality of care were either out of date, or not operating efficiently.
“We have issued Tall Trees with a warning notice, and this will help the management of the service focus on the areas where we want to see significant and immediate improvement. We are also aware that the local authority is carrying out a review of people who live at Tall Trees, while putting in measures to support the service.
“In the meantime, we will continue to monitor the service closely, in conjunction with the local authority, to ensure that improvements are made and fully embedded. We will also meet with the provider to discuss how they plan to make the required changes to improve their rating and we will re-inspect to check the improvements have been made.”
Inspectors found the following areas of concern.
The provider's safeguarding policy did not detail who was responsible and what actions management should take on being made aware of allegations of abuse, for example, when to instigate immediate suspension. This put people at significant risk of not being protected from potential further abuse.
"We found risks in association with people's oral health care procedures. Although it was against the provider’s policy to use oral swabs with a foam head, we found one on a tray in one person’s room. We found no risk assessment for the use of oral swabs and no oral care instructions, or records were provided. Foam heads of oral swabs may detach from the stick during use which could present a choking hazard for people. Following the inspection, the provider informed us that they did not find any evidence of them being ordered or used when this was brought to their attention," said the inspectors' report.
"One person was assessed as 'unable to communicate' as they had difficulty verbalising their feelings and ideas due to their condition. The pain assessment tool for this person did not consider any ways to identify pain other than conversation, which included moaning and shouting.
"According to their care plan, the person could also indicate 'yes or 'no', but this was not assessed. This meant staff did not have good guidance to identify if people were in need of pain relief to ease their symptoms.
"Some people did not have care plans specific to their condition, for example diabetes. Where people were prescribed medicines which increased the blood glucose level, there were no corresponding 'when required' instructions or a care plan to reflect the GP's instructions. This posed a risk as there was lack of control over people's condition, risk of deterioration, complications and diabetic emergencies.
"We found three topical medicines not dated with the time of opening. This posed a risk of topical creams being used out of their expiry dates which may reduce effectiveness of the medicine."