Archived: Highnam Hall

Updated 16 November 2015

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 over five days. The inspection took place on 14 and 16 September and 2, 5 and 8 October 2015 and was unannounced which meant the provider and staff did not know we were coming.

The inspection team consisted of four adult social care inspectors, a specialist advisor in electrical installation and emergency lighting and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Fire Service also conducted an inspection on the 8 October 2015.

Prior to the inspection we reviewed information we held about the home, including the notifications we had received from the provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales.

During this inspection we spoke to nine people who live at Highnam Hall and four relatives. We also spoke with the registered manager, the deputy manager, three senior care staff, the cook, the activities co-ordinator, the area manager and nine care staff. We also spoke with the buildings manager and the contracted electricians.

We carried out an observation using the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We undertook general observations of how staff interacted with people as they went about their work.

We looked at five people’s care records and six people’s medicines records. We examined six staff files including recruitment, supervision and training records. We also looked at other records relating to the management of the home including building safety, health and safety, quality assurance and complaints.

Updated 16 November 2015

This inspection took place on 14 and 16 September and 2, 5 and 8 October 2015 and was unannounced. We last inspected the service on 5 May 2015.

We completed an unannounced comprehensive inspection of this service on 27 January 2015 and found the provider was failing to meet legal requirements. Specifically the provider had breached Regulations 9, 12, 13 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

During our January 2015 inspection we concluded people who use services and others were not protected against the risks associated infection because of inappropriate standards of cleanliness and hygiene relating to the premises. People were not fully protected against the risks associated with medicines because the provider did not manage medicines appropriately. People who use services and others were not protected against the risks associated with unsafe or unsuitable premises because of inadequate emergency procedures. People were not protected against the risks of receiving care that is inappropriate or unsafe because care was not planned and delivered to meet their individual needs or ensure their safety and welfare.

We undertook an unannounced focused inspection on 5 May 2015 as part of our on-going enforcement activity and to confirm that they now met legal requirements but we found continued breaches of legal requirements. We found the provider was now meeting requirements in relation to infection control but all other regulations were still in breach.

Highnam Hall is registered to provide residential care to 37 people some of whom are living with dementia. At the time of our inspection there were 30 people living at the service.

The home had a registered manager. 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.

The provider had failed to ensure the safety of the building and the premises. There were significant deficits in the electrical safety and fire safety of the building which had not been addressed over a significant period of time leaving people, staff and visitors at risk of significant harm.

We observed a fire alarm activation, which was lacklustre and complacent in that staff did not respond. There was no urgency in the response to ensure people were safe. Staff did not fully check the area of the building where the potential fire was, they left people sitting in the affected zone and made no attempt to evacuate them to a safe area. Fire precautions failed as fire doors were compromised and self-closing doors failed to operate. Fire escape routes were locked; one fire door was locked with a mortice lock which staff took eight minutes to find the key for, fire escape routes through the garden were barred by padlocked gates. This meant vulnerable adults were living in an unsafe building with limited means of escape and staff who were ill equipped to deal with emergency situations.

The provider failed to mitigate risk to the health and wellbeing of people as risk assessments were not robust. They did not identify the risk or the control measures to reduce and manage the risk. Care plans did not provide staff with sufficient detail on strategies to follow to provide people with the care they needed. There were no specific strategies to support people who were living with dementia and may present with behaviour that challenged the service.

Staff observed changes in people’s health but we found they did not always refer people for advice and support form health care professionals such as doctors and district nurses.

We observed staff responding to people in an undignified, disrespectful and an infantilised manner when they were distressed and disoriented. Sensitive and confidential information about people’s health and welfare was discussed in front of other people during handover which showed a lack of respect for people’s privacy. We found staff had not received training in privacy and dignity or in challenging behaviour.

The provider failed to follow the Mental Capacity Act (2005) Code of Practice. We found that where people had lasting powers of attorney there was no paper work to support this and inform staff of what this meant in relation to the care people received. Consent forms had been signed by family members giving care staff the right to act in people’s best interests in emergency medical situations. These had no regard to the person’s wishes, capacity or whether emergency health care plans or Do Not Attempt Cardiovascular Pulmonary Resuscitation (DNACPR) orders were in place.

The provider failed to ensure robust checks of staff fitness and criminal record check (Disclosure and Barring Service) before they worked with vulnerable people. This meant people were exposed to the risks of being cared for by inappropriate staff.

Complaints were not fully investigated or recorded and we saw no evidence that complainants had been informed of the outcome or resolution to their concerns.

The registered manager failed to ensure an effective system was in place to assess and monitor the quality of care people received. They failed to provide the Commission with information they are required to by law in relation to the notification of incidents of harm. The provider had previously provided the Commission with an action plan saying works would be completed to ensure the safety of the premises by June 2015 however they provided inaccurate information as the Commission found this work had not been completed.

The provider had an effective system for the safe storage, administration and recording of medicines which was led by the deputy manager and senior care staff.

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. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

You can see what action we told the provider to take at the back of the full version of the report.