Archived: Horncastle House

Updated 5 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 13 September 2018 and was unannounced. The inspection was an urgent, focussed inspection looking at specific areas of the Safe and Well-led domains only. It was carried out in response to information of concern received from a relative and the local authority, and which indicated that people living at Horncastle House may not be safe. The inspection was carried out by two inspectors.

Before our inspection we reviewed the information we held about the service including previous inspection reports. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law.

We observed their care of people using the service, including breakfast and some activities. We inspected the environment, including communal areas, bathrooms and some people’s bedrooms. We spoke with two registered nurses, three care staff, the manager, the peripatetic manager, the service review and transformation lead, a quality manager supporting the service and the provider’s registered person.

We ‘pathway tracked’ 12 of the people living at the service. This means we looked at people’s care documentation in depth and made observations of the support they were given. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care and whether care is delivered in line with people’s needs.

During the inspection we reviewed other records. These included staff rotas, risk assessments, accidents and incident records, quality audits and handover information.

Updated 5 February 2019

This inspection took place on 13 September 2018, was unannounced and in response to concerns raised with us from a relative and by the local authority.

Horncastle House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Horncastle House accommodates up to 43 people in one adapted building. There were 23 people using the service during our inspection. Horncastle House provides nursing care to older people; most of whom live with dementia or memory loss.

Services operated by the provider had continued to be subject to a period of increased monitoring and support by commissioners. As a result of concerns raised about other locations operated by the provider, the provider is currently subject to a police investigation.The police investigation is ongoing and no conclusions have yet been drawn. There have been no specific criminal allegations made about Horncastle House at the time of our inspection. Since May 2017, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find. Our findings from inspections of other locations operated by the provider also informed the planning of the inspection of Horncastle House.

There was no registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run. The former registered manager had left in September 2017 and their deputy had taken over the management of the service. They had applied to the CQC to become registered but had then left the service in April 2018. A peripatetic manager had been in place for 11 weeks prior to our inspection. A new manager was started work at Horncastle House on 13 August 2018 but had yet to apply to become registered with the CQC.

Horncastle House was last inspected in August 2018. At that inspection it was rated as 'Inadequate' overall and ‘Requires Improvement’ for Caring and Responsive domains. These were the same ratings as had been applied following an inspection in March 2018. There had been little improvement between the inspections of March and August and we had continued to find that risks to people’s safety and well-being had not been adequately monitored or reduced. We had been sufficiently concerned during the August inspection, to request immediate action was taken by the provider and that confirmation of these actions was confirmed in writing.

Despite the CQC being given these assurances, at this inspection we found that known risks to people had increased rather than reduced. This had left people exposed to immediate risk of serious harm or death.

The service was unsafe for the people living there, because risks from choking, lack of access to their call bell, from falls, poor hydration management, improper use of pressure-relieving equipment and the environment had not been remedied since our last inspection. We found a level of risk to people that was extreme and required urgent action.

There were not enough experienced and competent staff deployed to meet people’s needs, and a heavy reliance on agency staff remained. Staff practice was observed to be poor but had been unchallenged by managers or the provider.

Information and records about people’s care needs were dangerously inaccurate and conflicting; making them unworkable as guidance to staff, many of whom were from agencies and did not know people well.

There was evidence of a lack of learning from previous CQC inspection findings, feedback and reports to improve the safety of the service.

The service was not well-led. Auditing and oversight by the management team and provider had been ineffective and had not checked that staff practice was keeping people safe.

Assurances had been given to the CQC about improvements which had not been made. Staff culture had deteriorated and inappropriate and unsafe actions were going unchecked and unchallenged.

The provider continued to display the incorrect rating for the service on their website and the CQC had not been notified of the death of a person using the service; which is a statutory requirement.

We found continued breaches of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will publish information about our actions when we are able to do so.

We imposed conditions on the provider’s registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider. The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider’s services and actions to improve, and to inform our inspections.