Archived: Asmall Hall Care Home

Updated 23 June 2016

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 on 27th April 2016, and was unannounced. The inspection team composed three adult social care compliance inspectors, a specialist advisor 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.

Prior to this inspection, we looked at all the information we held about this service. We reviewed notifications of incidents that the provider had sent us. Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed notifications of incidents that the provider had sent us. We received feedback from three social work professionals and one community nurse. Their feedback is included within this report.

At the time of our inspection of this location, 47 people used the service. We spoke with a range of people about the service; this included 12 people who used the service and two relatives. We also spoke with five care workers, two registered nurses and the registered manager of the service. This enabled us to determine if people received the care and support they needed and if any identified risks to people’s health and wellbeing were appropriately managed.

We also looked at a wide range of records. These included; seven care records, five staff personnel records, a variety of policies and procedures, training records, medicines records and quality monitoring systems.

Updated 23 June 2016

Asmall Hall is a 17th century manor house, situated in five acres of grounds within a rural green belt area on the outskirts of Ormskirk. Accommodation is provided for up to 56 people, who require help with personal or nursing care needs. There is also a small unit for people who are living with dementia. The home has a minibus and trips out are arranged to local places of interest. Asmall Hall is not on a bus route, but Southport and Ormskirk are only a short drive away.

We last inspected this location on 25 March 2015 and we found several breaches of the Health and Social Care Act (2008) Regulated Activities Regulations. These related to care and welfare, assessing and monitoring the quality of service provided, safety, availability and suitability of equipment, safety and suitability of premises, management of medicines and cleanliness and infection control.

That unannounced inspection was conducted on 25th March 2015 This inspection took place on 27 April 2016, and was unannounced. During this inspection we checked if action had been taken to address the outstanding breach of regulations from the previous inspection. We found that whilst some improvements had been made, not all actions identified on the action plan submitted by the provider had been completed.

The registered manager of the service was present throughout our 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.

We checked to see if medication was handled safely within the home. We found there were no care plans for "as and when medication". People's medicines were not stored and administered safely.

We found systems for identifying and managing risks at service level were present, however these were not robust and not effectively put into practice, which meant that the systems did not help to anticipate risks within the service.

We observed poor infection control practice within the home; staff failed to remove protective clothing at point of care. The home was generally unclean throughout, the décor was tired and contents and fixtures were in need of replacement.

Safeguarding procedures were in place and provided staff with guidance about reporting any potential or suspected abuse of people who used the service. However, we found that some reports of suspected abuse had not been dealt with adequately. The registered provider had a specific plan in place detailing the arrangements to deal with emergency situations including fire.

We looked at how the service gained people’s consent to care and treatment in line with the MCA. We found that the service did not have sufficient systems in place to enable assessment of a person’s mental capacity prior to completing any best interest decisions.

The dining experience differed across the two units for people who used the service. We found inconsistencies in staff support for people who required assistance. Food was served luke warm and the dining experience was not person centred.

We found that although staff displayed a good understanding about how to treat people with privacy, dignity and respect, this was not being put into practice during their interactions with people who lived at Asmall Hall.

Care files contained informative life histories and were person centred, however these were not used to inform care planning. It was evident that not all of the care plans viewed reflected the person’s current needs and individual preferences.

We found that the registered person had not protected people against the risk of unsafe care or treatment, because systems for assessing and monitoring the quality of service provided were not always effective.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, governance, staffing, consent, dignity and respect, safeguarding service users from abuse and improper treatment, premises and equipment and meeting nutritional and hydration needs.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

Ensure that providers found to be providing inadequate care significantly improve.

Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.