You are here

Ingham Old Hall Care Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 27 November 2018

The inspection took place on 13 and 14 June 2018 and was unannounced.

Ingham Old Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC (Care Quality Commission) regulates both the premises and the care provided, and both were looked at during this inspection.

The service provides accommodation and care to a maximum of 25 people. At the time of the inspection 22 people were living at the home, some people were living with dementia. One person was staying for temporary respite care.

There was a manager in post, who had applied to CQC to complete the registration process, but was not registered at the time of the inspection. 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.

At our last comprehensive inspection on 3 and 4 May 2017 we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for safe care and treatment and good governance. A follow up focussed inspection was completed 25 July 2017 to review medicines management in relation to the breach of regulation for safe care and treatment. The service was found to no longer be in breach of regulation.

During this inspection we identified that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of the regulations for safe care and treatment including the condition of the care environment and equipment used, protection of people’s privacy and dignity, adherence to the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards, management of people’s nutritional and hydration needs, good governance and safe staffing.

During this inspection, we identified areas of concern in relation to staff competency in safe management of medicines, cleanliness of the environment and infection prevention control impacting on the care people received.

The service did not have robust governance processes in place for monitoring standards and quality of care provided. Staff did not complete clinical audits in areas such as medicines management and the condition of the environment and this was reflected in our findings during the inspection.

Staff were not up to date with the provider’s mandatory training or annual performance appraisals. Staff did not receive regular supervision to review their performance and areas of improvement. The management team did not have robust oversight of staff performance. We saw examples of where training and good practice was not being implemented in the care and treatment of people living at the service.

People’s records demonstrated a lack of adherence to the Mental Capacity Act and Deprivation of Liberty Safeguards. It was unclear if people’s movement was lawfully restricted and this was a potential infringement of their human rights.

Low staffing levels impacted on people’s access to meaningful activities and maintenance of hobbies and interests. There was not a daily activity timetable, and people told us they often felt “bored”.

People were not consistently treated with care and compassion, and their privacy and dignity was not routinely protected. We saw examples of people being hoisted in communal areas, resulting in their underwear and continence products being on show to others.

Due to level of risks identified from this inspection, we wrote to the provider under Section 31 of the Health and Social Care Act 2008, to request for provision of an action plan to address our concerns. An action plan, with clear dates for completion of

Inspection areas

Safe

Inadequate

Updated 27 November 2018

The service was not safe.

Staff did not monitor or follow guidance in relation to infection, prevention control and the care environment was unclean. This increased the risk of spread of infection.

Medicines were not robustly audited with low completion of staff competency checks. Medicinal creams were not stored safely in people’s bedrooms.

Significant environmental safety concerns were identified throughout the service, with no environmental risk assessments in place.

Effective

Requires improvement

Updated 27 November 2018

The service was not consistently effective

Staff were not up to date with all the necessary training for their roles.

Staff did not receive annual performance based appraisals.

Staff did not assess people's mental capacity or document best interests decisions.

Staff did not know if people had authorised Deprivation of Liberty Safeguards in place to lawfully restrict their movements. This was a potential infringement on people’s human rights.

Caring

Inadequate

Updated 27 November 2018

The service was not caring

The condition of the care environment was not conducive to provision of high quality care.

We observed people were not consistently treated with kindness, respect, dignity and compassion during the inspection.

Responsive

Inadequate

Updated 27 November 2018

The service was not responsive

Care plans did not consistently link to risk assessments, with guidance for staff to follow in relation to the management of risks such as choking and prevention of sore skin.

Staffing levels impacted on people’s engagement with meaningful activities onsite and in the community.

Well-led

Inadequate

Updated 27 November 2018

The service was not well-led

There was a lack of managerial oversight and quality audits in relation to areas such the condition of the care environment, administration of medicines, consistent completion of people’s daily written records.

No staff had up to date performance appraisals.

The management team did not actively encourage feedback from staff, people or relatives to drive improvement within the service.