Archived: Harecombe Manor Nursing Home

Updated 24 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.

The inspection took place on 7 and 9 September 2015 and was unannounced. The inspection was undertaken by one inspector 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.

Before our inspection we reviewed the information we held about the home, including previous inspection reports. We contacted the local authority to obtain their views about the care provided. We considered the information which had been shared with us by the local authority and other people, looked at safeguarding alerts which had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We reviewed the provider information return (PIR) and used this information when planning and undertaking the inspection. The provider also sent us some information immediately after the inspection.

We met with 25 people who lived at Harcombe Manor and observed their care, including the lunchtime meal, medicines administration and activities. We spoke with 7 people’s relatives and visitors. We inspected the home, including people’s bedrooms, sitting rooms, dining room and bathrooms. We spoke with eleven of the staff, including registered nurses, care workers, a domestic worker and the chef. We met with the registered manager and the provider. We also spoke with two visiting external professionals.

We ‘pathway tracked’ six of the people living at the home. This is when we looked at people’s care documentation in depth, obtained their views on how they found living at the home and made observations of the support they were given. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

During the inspection we reviewed records. These included staff training and supervision records, staff recruitment records, medicines records, risk assessments, accidents and incident records, quality audits and policies and procedures.

Updated 24 November 2015

This inspection took place on 7 and 9 September 2015. It was unannounced. There were 36 people living at Harecombe Manor Nursing Home when we inspected. People cared for were all older people who needed nursing care and were living with a range of care and treatment needs, including stroke, heart conditions, breathing difficulties, diabetes and arthritis. Many people needed support with all of their personal care, eating and drinking and mobility needs. Some of the people were also living with dementia. The registered manager reported they provided end of life care at times. No one was receiving end of life care when we inspected.

Harecombe Manor Nursing Home is a large manor house which has been extended. People’s bedrooms were provided over two floors, with a passenger lift in-between. There were a sitting and dining room on the ground floor, with an additional sitting room on the lower ground floor. Support facilities such as the laundry and training room were also provided on the lower ground floor. There was a wheelchair accessible terrace overlooking the extensive garden areas. Harecombe Manor Nursing Home was close to the middle of Crowborough. The provider for the service was Mr and Mrs Ollivier.

Harecombe Manor Nursing Home had a long standing 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.

Harecombe Manor Nursing Home was last inspected on 2 and 4 December 2014. They were rated as inadequate at that inspection. The Care Quality Commission (CQC) issued a Warning Notice after the inspection in respect of assessing and monitoring of the quality of the services. The provider sent us an action plan which detailed when different areas would be addressed. This stated all matters would be addressed by 31 May 2015.

We found the provider had not met the Warning Notice or addressed most of their action plan by their due dates.

As at the last inspection, systems to regularly assess and monitor the quality of the service were not effective and failed to identify and manage certain risks to the health, welfare and safety of people. This included ensuring they had met the areas they needed to address identified in the previous report and ensuring they followed their own policies and procedures.

As at the last inspection we continued to find people did not have a full assessment of all their needs carried out and did not have their care planned and delivered in such as way so as to meet their individual needs. This included systems for prevention of pressure damage and risk of injury to people from falls. As at the last inspection, people were not supported with engagement by the provision of meaningful recreational activities, which met their preferences.

People were still not protected against the risks associated with unsafe management of medicines. This was particularly in relation to ‘as required’ (PRN) medication and appropriate support for people who wanted to take their medicines independently.

People were still not protected from the risks of inadequate nutrition and hydration. People who needed assistance did not receive the support they needed to drink sufficient amounts. Records relating to amount of diet people ate were not adequate to show people had received the nutrition they needed.

The provider continued not to have suitable arrangements for ensuring the consent of people. This was particularly where people remained in bed all the time. Relevant referrals had not been made to external bodies to ensure people were not deprived of their liberties. Referrals had also not been made to relevant professionals to develop such people’s care plans.

At this inspection both people and staff told us about lack of staff availability, particularly a slow response time to call bells. People also did not have support from staff for extended periods of time when they were in the sitting room, because of staff availability. The provider had not done an analysis, such as a dependency assessment or assessment of response times when call bells were used, to assess if the number of staff on duty were enough to meet people’s needs.

We received mixed comments from people about how they raised issues and were consulted about the service they received. Several people told us about issues which had concerned them. Records of matters raised formally were documented but informal issues, such as those raised with us during the inspection were not documented, so the provider was not made aware of them to ensure they took relevant action.

The provider had taken action in some areas. At the last inspection, we identified systems to assess the risk of infection were not effective and appropriate standards of cleanliness and hygiene were not maintained. At this inspection, the provider had ensured this had been addressed and all areas were clean and necessary equipment to reduce risk of infection was available.

At the last inspection, we identified issues relating to a range of areas, including ensuring safe bed rails. This had been addressed and all bed rails were being safely used in accordance with guidelines. New hoists to support people with their mobility had also been provided. Action was being taken to ensure the safety of windows and of fire doors.

At the last inspection, we identified recruitment procedures were not satisfactory. The one member of staff employed since the last inspection had relevant documents on their file to demonstrate their suitability to work with people.

The provider had developed a training plan and staff had been trained in relevant areas such as fire safety. Plans were in place to ensure staff were trained in other key areas such as the Mental Capacity Act 2005. Staff showed an awareness of actions they needed to take to ensure people were safeguarded from risk of abuse. Systems for supporting staff by supervising them in their roles had commenced.

Staff supported people in a caring way, including during medicines rounds. People said they could choose, for example what clothes they wore. Staff, including an agency care worker, knew the individual needs of the people they were caring for. Visitors said they could come and go as they wanted to.

People spoke positively about the meals. The lunchtime meal was given to people in attractive surroundings and the meal smelt appetising.

Staff said they could raise issues with the management of the home. They reported positively on the philosophy of care to ensure people “Came first.”

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

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.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

CQC are taking enforcement action to ensure that Mr and Mrs Ollivier provide safe and effective care.