Background to this inspection
Updated
9 April 2021
The inspection
This was a focused inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 good governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and to follow up concerns that had been shared with us in relation to people’s safe care and treatment, infection control practices and the oversight within the home.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team consisted of two inspectors.
Service and service type
Haversham House Limited is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. There was a consultant in place during our inspection working with the provider to make improvements at the home.
Notice of inspection
We gave a short period notice of the inspection. This was because it is a small service and we needed to be sure that the nominated individual would be in the office to support the inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with two people who used the service and five relatives about their experience of the care provided. We spoke with 11 members of staff including the nominated individual, consultant, deputy manager, senior care workers, care workers and domestic staff. We reviewed a range of records. This included five people’s care records and multiple medication records. We also looked at a variety of records relating to the management of the service, including policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with three professionals who regularly visit the service.
Updated
9 April 2021
About the service
Haversham House Limited is a residential care home providing personal and nursing care to 32 people aged 55 and over at the time of the inspection, some of which were living with dementia. The service can support up to 49 people.
People’s experience of using this service and what we found
People did not always have care plans and risk assessments in place or reflective of their needs, to enable staff to meet these. People were not consistently supported by staff trained in all of their healthcare needs to enable them to meet these effectively. People were not supported in a clean and well maintained environment and there were not sufficient staff to maintain a clean environment. There were areas of the home that were unsafe with exposed hot water pipes and uncovered radiators.
People's medicines records were not always complete and did not consistently contain guidance where they were prescribed medicine on an 'as required' basis. People's medicines were not always disposed of in a timely way where these were no longer prescribed.
People were not always supported by staff to isolate in line with government COVID-19 guidance on admission to the service. The provider had failed to act on concerns raised by external professionals around infection prevention and control practices.
Quality assurance tools were not effective at identifying areas of concern in relation to people's care files, infection control, the environment, medicines and staffing and ensure action was taken to implement improvements in a timely way. The provider had failed to ensure lessons were learnt when things went wrong and improvements were made at the home where these were required.
People were supported to access medical professionals as they required these. People were supported by staff that understood safeguarding and had raised concerns appropriately as required.
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 27 January 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service is now rated inadequate. This service has been rated less than good for the last four consecutive inspections.
Why we inspected
We undertook this focused inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We had also received concerns from external professionals about people’s safe care and treatment, infection control practices and the governance and oversight of the home. We reviewed the information we held about the service and as our concerns were within the domains of Safe and Well led we inspected these domains only.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to people’s safe care and treatment, the cleanliness and maintenance of the home, staffing and oversight.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.