This inspection was unannounced and took place on 19 April 2016 by two adult social care inspectors. Hendford Care Home with Nursing is registered to provide accommodation and nursing care for up to 41 people. The home is organised into three units. On the ground floor is Greenwood providing support for people with dementia. On the first floor Silver Birch is mainly for people requiring nursing care. On the top floor is Pine View. People with residential needs and those requiring respite are usually, although not exclusively offered a room on Pine View.
At the time of this inspection there were 24 people living at the home. Twenty one people were living there permanently Three people were having short term respite care.
The previous inspection of the home was carried out on the third of August 2015. The service was rated as Requiring Improvement. The domains safe, effective, responsive and well led required improvement.
A breach of Regulation 11 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014 : Need for Consent. was identified. This related to the failure of the service to fully comply with the requirements of the Mental Capacity Act 2005. We received an action plan including timescales when actions would have been completed. At this inspection these had been addressed.
Prior to the inspection some concerns had been raised about the staffing levels in the home and how this was affecting the care provided to people.
There were insufficient staff to meet each person’s needs safely. On the afternoon of the inspection there was one nurse and three care staff on duty to meet the needs of the 24 people living there. The demands on the care staff were high and this meant staff were unable to meet some people’s needs fully. Staff had insufficient time to provide adequate care and support to people with complex nursing needs and those living with a dementia.
There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. Interim management arrangements were in place.
Action was taken promptly following the inspection to increase the staff allocation during the day and at night. However time is needed to embed the improved staff ratios and to ensure the staff numbers are managed effectively so that improvements to care are obtained. Key appointments such as registered manager, clinical lead, registered nurse and care assistants still need to made.
Until the full staff complement is in place at all levels people may still be at risk of receiving poor care.
There was no thorough induction programme in place to ensure staff had the skills to care for people safely and were orientated into the ways of working in the home. Staff training was available in the home however a quarter of all staff had completed all the training expected of them.
People’s mealtime experience was not pleasant. For some people it was unsafe and for others it did not take into account their needs and preferences. People were not complimentary about the food.
Concerns had been raised by staff and relatives about the cleanliness of the home. Some bedrooms were very clean and attractive. Others required deeper cleaning. There was dirt on top of beds. In the en-suite facilities some toilets and mirrors needed attention. There had been problems with the laundry equipment which had not been working.
Whilst we observed some caring interactions between staff and people living in the home some aspects of care and support needed to improve to promote people’s dignity. People found staff to be kind but they were often rushed and "too busy" to spend time with them.
At this inspection the provider had failed to effectively monitor the quality of the service being provided to people and take action to improve it. This had resulted in the provider being unaware the issues we identified during the inspection. For example, the provider failed to be aware of the impact on the care people received because of the reduction in staffing. The provider had also failed to recognise the poor mealtime experience for people. The provider had failed to know people’s views about the food.
The provider had quality assurance systems in place to monitor care and plan on-going improvements but this had not been effective. At the last inspection we identified some specific areas of practice in the service that needed to be improved. For example the orientation boards in Greenwood, poor food service and the experience of people receiving poor respite care. These had not been addressed and in some cases had deteriorated further.
The day after the inspection we received a detailed recovery plan from the regional manager. The regional manager had taken immediate action to improve the staffing levels and keep people safe. Action had also been taken by the local authority and clinical commissioning team to review people’s care needs in detail and ensure they were being met.
A whole service safeguarding meeting was held immediately after the inspection. At the meeting it was confirmed that neither the Local Authority or the Clinical Commissioning Group were commissioning care at the home. Further meetings have been planned to monitor the progress of the home.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see some of the action we are taking at the back of the report, we are considering other action we are taking for the other breaches of Regulations.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in
special measures.