Background to this inspection
Updated
2 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
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
Consisted of two inspectors.
Service and service type
Heath Farm House Care Centre is a care home that provides nursing and personal care.
The service had a manager in post, but they were not registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
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.
We reviewed information we had received about the service since the last inspection. This included details about incidents the provider must notify us about. We liaised with third party stakeholders, including local social care services before the inspection site visit. We used all this information to plan our inspection.
During the inspection
We spoke with the regional manager and new manager, a contractor and observed care and support provided in communal areas. We looked at three people’s care and support records and four people’s medicine records, as well as a sample of medicines, and observed some of the medicines round in progress. We looked at staff files as well as records relating to the management of the service, recruitment, policies, training and systems for monitoring quality. We requested provision of additional information that was sent to us after the inspection visit.
After the inspection
We completed telephone interviews with two people living at the service and two members of care staff. We liaised with the local health and social care services. We also requested provision of further information and clarification from the regional manager and new manager.
Updated
2 July 2021
About the service
Heath Farm House Care Centre is a care home, providing personal and nursing care for up to 10 people living with complex mental health conditions and or learning disabilities. At the time of the inspection, seven people were receiving care. The service has been set up collaboratively with the local authority to reduce the risk of delayed discharge from hospital or for those who require hospital avoidance due to deterioration in their mental health and wellbeing. The service provides short term, residential support.
People’s experience of using this service and what we found
We identified significant concerns in relation to the safe running of the service, which raised questions about the standards of care being provided. There was a lack of managerial and provider level oversight, which had resulted in multiple incidents including safeguarding concerns, which had not been handled in line with their own policies and procedures, to maintain people’s safety and wellbeing.
People told us they sometimes felt unsafe living at the service, and would spend time in their bedrooms, rather than in communal areas to alleviate those feelings. We identified concerns in relation to infection, prevention and control standards at the service, which was of concern as the service was inspected during a national lockdown.
The provider had not implemented enough changes to practice and approach to ensure that people received good standards of care and support and was reinforced by repeated and new breaches of regulation being identified at this inspection.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. At the last inspection, it was identified that the service did not fully meet the requirements to meet the needs of people with autism and learning disabilities in line with best practice guidance.
Following the last inspection, the decision was made to close the service and support people to move to more suitable alternative accommodation. However, in consultation with the local authority, the decision was made to alter the purpose of the service. As an outcome, the service was being refurbished at the time of our inspection visit, but the size, layout and suitability had not changed to be more in line with right support, right care, right culture as set out in the guidance. Whilst most people living at the service had complex mental health support needs, there remained people living at the service with autism and learning disabilities.
Right support:
• Model of care and setting maximises people’s choice, control and independence
Right care:
• Care is person-centred and promotes people’s dignity, privacy and human rights
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives
Rating at last inspection
The service was rated requires improvement with breaches at the last inspection, completed 17 October 2019, published 09 January 2020.
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 sustained and the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to management changes, staffing levels and training, and received anonymous whistleblowing concerns. There had also been a serious incident that had happened a few days prior to our site visit. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
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 coronavirus and other infection outbreaks effectively.
Enforcement
We have identified repeated breaches of regulation in relation to provision of safe care and treatment, trained and skilled staffing and good governance arrangements. We have also identified new breaches in relation to keeping people safe from risk of harm and abuse, and in relation to notifying CQC of incidents that have occurred at the service, during this inspection.
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 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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk