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Archived: Hesketh House Care Home Inadequate

Inspection Summary


Overall summary & rating

Inadequate

Updated 24 December 2016

This inspection took place on 28 October and 9 November 2016 and was unannounced. This meant the provider was not aware we were intending to inspect the home. A previous inspection, undertaken in July 2014, found there were no breaches of legal requirements.

Hesketh House is located on an old hospital site within a residential area of Wavertree, Liverpool. There are fourteen single bedrooms available for people with a learning disability, who require assistance with personal or nursing care. Communal areas include a dining room, a lounge, sensory area and a large garden with a terrace. At the time of the inspection there were 13 people using the service.

A registered manager was registered for the location and our records showed he had been formally registered with the Care Quality Commission (CQC) since October 2010. A registered manager is a person who has registered with the CQC 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.

Staff had received training with regard to safeguarding issues and demonstrated an understanding of potential abuse. They told us they would report any concerns to the registered manager. We noted one potential safeguarding incident, raised by a trainee, had not been formally recorded as being investigated. We could not be sure the matter had been dealt with in an appropriate manner. Easy read information about safeguarding was not always available. Risk assessments in people’s care plans were not comprehensive and it was not clear they had been effectively reviewed. Personal evacuation plans, to support people in an emergency, had not been reviewed and updated.

Staff told us they felt there were not always enough staff to meet people’s individual needs and keep them safe. There was no formal assessment of people’s dependency and no available system to determine how staffing levels should alter to meet people’s changing needs.

Where people were supported with their medicines we found care plans for “as required” medicines were not always available and some creams were out of date or were not labelled with people’s name, to ensure they were used appropriately. One person’s fluid thickener had been left on an open trolley posing a potential risk that other people may use it inappropriately.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home. The home was generally clean and tidy and free from odours.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager told us some people had been subject to DoLS but these had lapsed in April 2016 and had failed to be renewed or reviewed. Where people did not have capacity to make decisions for themselves there were no clear best interests decisions recorded, as required by the MCA.

Kitchen staff had knowledge of specialist dietary requirements and supported people to make choices through the use of picture cards. People were not always supported with meals appropriately and in line with professional guidance, putting them at potential risk of choking. Records relating to food and fluid in take were not completed contemporaneously or by the staff who had directly supported people, meaning we could not be sure they were up to date and accurate.

Staff confirmed they had access to a range of training and records showed mandatory training was up to date. More specialist training to support people’s particular needs was not in date. Staff told us, and records confirmed regular supervision took place. Some annual appraisal documents were available and the regional manager told

Inspection areas

Safe

Inadequate

Updated 24 December 2016

The service was not safe.

We could not be sure potential safeguarding matters had been formally and appropriately dealt with. Risk assessments were not detailed or effectively reviewed. Personal evacuation plans had not been reviewed.

Systems to assess people�s dependency needs and staffing levels were not effectively in place. Medicines were not always managed effectively and safely.

Appropriate recruitment processes were in place to ensure staff had the right skills. Checks on equipment had been undertaken and the home was clean and tidy.

Effective

Inadequate

Updated 24 December 2016

The service was not effective.

Previously granted Deprivation of Liberty Safeguards (DoLS) orders had lapsed and not been renewed. There was limited evidence appropriate best interests decisions had been undertaken, where required.

A range of food and drink was available at the home and specialist diets were supported. Note had not been made of people�s likes and dislikes. People were not always supported appropriately with food and drink. People had access to health professionals although their advice and guidance was not always included in care plans.

Staff mandatory training was up to date. However, some more specialist training to support people�s particular needs had not been updated. Supervision sessions had been undertaken and annual appraisals were in the process of being completed.

Caring

Requires improvement

Updated 24 December 2016

The service was not always caring.

Staff talked over people�s heads during meal times and some staff spoke inappropriately about people. At other times there were good relationships between people and staff. Personal care was delivered in a way that maintained people�s dignity.

Staff had a good understanding of people as individuals and the non-verbal signals that indicated their needs and feelings. A relative said they were involved in their relation�s care, although no relatives� meetings had taken place within the last 12 months.

Responsive

Requires improvement

Updated 24 December 2016

The service was not always responsive.

Care plans did not always reflect the advice and guidance from professionals, or other available information. Reviews of plans were limited and it was not always clear that risks had been reassessed as part of the review process. Some care plans had not been reviewed on a regular basis, despite there being a potential risk.

Staff told us there were activities for people to participate in. Staff said people would benefit from access to a sensory room. The sensory room had been out of action for over a year, despite an action point from a quality visit that it was to be brought back into use.

There had been no formal complaints recorded in the previous 12 months. A relative told us they knew how to raise a complaint.

Well-led

Inadequate

Updated 24 December 2016

The service was not well led.

Effective audits on the quality and standard of care at the home had not been undertaken. Self-audits by the registered manager did not reflect the situation found at the inspection. Oversight by a regional manager and the provider�s quality team had not been robust.

Records were inappropriately completed and not well maintained.

The registered manager had not notified the CQC of certain events at the home they were legally required to do so.

The registered manager had not notified the CQC of certain events at the home they were legally required to do so.