Honister

Honister is residential care home providing personal and nursing care to 18 people at the time of the inspection. The service can support up to 19 people in 1 adapted building.

People’s experience of using this service and what we found

There had been improvements since the last inspection. Work had been completed to minimise risks and use governance systems more robustly. Good progress had been made with embedding this practice. Risk management and fire safety was more effective.

People and their relatives told us they were happy with the care provided and living at the service. They told us they felt safe. Infection control was promoted, and medicines were managed well.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported to eat and drink well and choose how they spent their days. People’s bedrooms were personalised, and people were using the communal areas.

Activities were available and people told us they enjoyed these. There were systems in place to aid communication between people and staff.

Complaints systems were used, and people and their relatives told us they could speak up. There were meetings and contact with people, relatives and staff to get their views. Feedback was collated and shared.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for this service was requires improvement (published 23 October 2019).

Why we inspected

This was a planned inspection based on the previous rating.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Honister on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Honister provides accommodation, personal and nursing care to older people, some of whom live with dementia. The care home accommodates up to 19 people in one adapted building. At the time of the inspection 13 people were living there.

People’s experience of using this service

Since the last inspection systems had been implemented to help address the shortfalls, promote safety and improve the quality of care in the home. We found that some of these systems had been effective and some were still ‘a work in progress.’ However, the atmosphere in the home had changed for the better and staff told us they felt things had improved.

Feedback about the management of the home from people and staff was positive and everyone felt the new manager had a positive impact on the home. People told us that their care needs were met and that there were enough staff. Staff told us that there were enough staff.

Care plans were detailed and included enough information for staff to be able to support people with their care needs. Mental capacity assessments were in place as needed but best interest decisions needed to be completed for some people.

People enjoyed the activities available. The range of activities had been developed and people’s involvement was documented.

People told us that they received their medicines when needed. However, medicine guidance needed to be adhered to consistently. There were systems in place to promote safe practice and the manager checked and supervised staff to help ensure these were used appropriately. People told us that they enjoyed the food and people received the support they needed to maintain a healthy diet. However, staff did not always complete food and fluid charts appropriately.

There were systems in place to help ensure staff were trained and received regular supervision and staff felt supported by the management team.

The service met the characteristics for the rating of "Requires Improvement" in three key questions and “Good” in two key areas.

We have made recommendations in relation to completion of capacity assessments and best interest decisions.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was Requires Improvement published 12 April 2019). At this inspection the rating had improved. However, enough improvement had not been made and the service remained rated as requires improvement.

This service has been in Special Measures since 12 April 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate in well led or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safety at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will ask the provider to send us an action plan stating how they will make the required improvements. We may meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People’s medicines were not always managed safely. Staff did not always administer people’s medicines in accordance with good practice, medicines were not always stored securely when staff were not present. Staff had received training in infection control however, we noted repeated instances where a staff member did not demonstrate good infection control practice.

There were limited activities on offer and people were not supported to go out and about on trips as they had previously. The deputy manager was looking at how they could develop this area further and encouraged staff to explore things of interest to individuals.

People were not always treated with respect and dignity. Staff did not always consider people’s opinions and individual rights in relation to their home environment.

People’s relatives told us that they thought the management team were responsive and they dealt with any concerns promptly. However, some relatives said they were unsure who to raise a concern to as they were unaware who the current manager or owners were.

The provider had failed to achieve improvements identified during the previous inspection in August 2018.

Relatives praised the staff for promoting people’s safety and wellbeing and said there were enough staff available to meet people’s needs. People appeared relaxed and comfortable with staff and management. People’s relatives said they felt people were safe living at Honister.

People enjoyed the meals and their dietary needs had been catered for. People’s care plans were being developed to provide more personalised information about people and their care needs. The provider had undertaken significant refurbishment work in the home creating a brighter environment however, further consideration was needed to support the needs of people living with dementia. There was no signage to support people to orientate the building and encourage their independence.

The deputy manager had a visual presence in the home and staff felt supported by them. Staff had received training to support their role and received ongoing supervision to continue this support. People had good health care support from external professionals. Staff identified when people were unwell and raised this with relevant health professionals.

Relatives told us the staff team were pleasant, kind and caring and took good care of people.

The provider had made the latest inspection report and rating available at the home albeit inside a folder in the communal entrance hall. The provider does not have a website. When required notifications had been completed to inform us of events and incidents, this helped us the monitor the action the provider had taken.

More information is in the detailed findings below.

Rating at last inspection:

At the previous inspection in August 2018 the service was rated as Requires Improvement with Well-led rated as Inadequate. The provider had failed to support or encourage staff to undertake the training they needed to care for people safely. Quality monitoring had been inconsistent and the provider had failed to act on advice given by external health and social care professionals. Risk assessments did not help mitigate risks to people’s safety and the environment was not always appropriate to promote people’s safety or dignity. Shortfalls with medicines management meant we could not be confident that people’s medicines had been administered in line with prescriber’s instructions and people’s records were not always maintained in a manner that promoted confidentiality. Care plans were not sufficiently detailed to guide staff to provide their individual care needs or end of life wishes. People’s relatives had not been involved in developing people's care plans even where people did not have the capacity to make their needs and wishes known themselves. There were no activities taking place at the home during the course of the inspection.

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: At this inspection we identified three repeated breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around governance, safe care and treatment and dignity and respect. As a result, Well-led domain is rated ‘Inadequate’ for the second time and the service is therefore in ‘special measures’.

Follow up: 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.

At our previous inspection of this service undertaken in March 2016 we found the service was meeting the required standards under the previous provider. This was the first inspection under the new registration with the new provider, C & K Healthcare Limited. At this inspection we found that there were serious failings from the provider and management to ensure people received care and support in a safe and effective way.

Honister 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.

Honister is a care home without nursing registered to provide accommodation and personal care in one adapted building for up to 19 older people some of who may live with dementia. At the time of the inspection there were 19 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

The provider had not supported the newly appointed registered manager with mentoring or supervision in their new role. The registered manager did not have any autonomy to manage the service in the best interests of the people who used it which had a negative impact on safety and people’s dignity.

The provider had failed to support or encourage staff to undertake the training they needed in order to care for people safely. The management team did not have protected management time to undertake routine safety audits. Quality monitoring was inconsistent, had not identified risks to people and had not served to mitigate risk to people`s health and wellbeing. The provider had failed to undertake quality checks of the service to satisfy themselves that the service they provided was safe, effective, caring responsive and well-led.

The provider did not have a clear overview of the service provided or actions that were necessary to improve the quality of the service. The provider had failed to act on advice given by external health and social care professionals. Relatives of people who used the service knew the registered manager by name and felt that they were approachable with any problems.

Accidents or incidents were not always managed robustly and not always used as learning to improve the safety of the service. Risk assessments were not always detailed and did not clearly describe the controls in place to help mitigate risks to people’s safety and well-being. The environment was not always appropriate to promote people’s safety. The staff team was not sufficiently knowledgeable to promote people’s safety in the event of a fire. People were supported to take their medicines by trained staff however, we found some shortfalls which meant we could not be confident that medicines had always been administered in line with prescriber’s instructions.

Some of the staff team demonstrated a lack of understanding of infection control matters and some areas of the home required more in depth cleaning. We received mixed feedback about the staffing levels in the home. People told us that they felt safe living at Honister and relatives had no concerns about people’s safety at the home. Staff had been trained in how to safeguard people from avoidable harm and were knowledgeable about the potential risks and signs of abuse. Safe and effective recruitment practices were followed to help make sure that all staff were of good character and suitable for the roles they performed at the service.

Staff had not always received training, subsequent refresher training and supervision to support them to be able to care for people safely. We received mixed feedback about the support provided for the team and not all staff told us they were confident to go to the management for support.

The environment in the home was bland and was not enabling for people who may live with dementia or sensory impairments. People were provided with a good choice of food and they were supported to choose where they wanted to eat their meals. People’s day to day health needs were met in a timely way and they had access to health care and social care professionals when necessary.

People’s records were not always maintained in a manner that promoted confidentiality. Aspects of the maintenance of the environment did not promote people’s dignity. There was a lack of storage for people’s incontinence items which meant their rooms were cluttered with these items. Some aspects of record keeping did not promote people’s dignity. People’s relatives told us they were happy with the staff that provided people’s care and staff members said that they believed people received a good standard of care. Staff had developed positive and caring relationships with people they clearly knew well.

People's care plans were not sufficiently detailed to be able to guide staff to provide their individual care needs or end of life wishes. People’s relatives said they had not been involved in developing people's care plans even where people did not have the capacity to make their needs and wishes known themselves. There were no activities taking place at the home during the course of the inspection.

There were regular meetings scheduled for people who used the service and their relatives to share their opinions about the service and facilities provided at Honister however, these meetings were not well attended. The provider had a complaint policy and procedure however, just one complaint had been received this year. There was no system in place to capture verbal dissatisfaction of people who used the service and visitors to the home.