Archived: Hesketh House Care Home

Updated 24 December 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 28 October and 9 November 2016 and was unannounced. This meant the provider was not aware we were intending to inspect the home.

The inspection team consisted of one inspector and an Expert by Experience (ExE). An ExE is a person who has personal experience of using or caring for someone who uses this type of service.

Before the inspection, the registered provider completed a provider information return (PIR). This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed the information we held about the home, in particular notifications about incidents, accidents, safeguarding matters and any deaths.

Not everyone who lived at the home was able to speak directly with us. We spoke with three people who used the service and one relative, to obtain their views on the care and support they received. Additionally, we spoke with the registered manager, deputy manager, two nurses, four care workers, the cook and a member of the domestic team. On the second day of the inspection we spoke with the regional manager for the home and one of the provider’s project managers.

We observed care and support being delivered in communal areas and viewed people’s individual accommodation. We reviewed a range of documents and records including; four care records for people who used the service, eight medicine administration records (MARs), four records of staff employed at the home, meeting records, accidents and incident records, care record charts and a range of other quality audits and management records.

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 us not all had been completed due to change in the system used by the provider.

People’s health and wellbeing was monitored, with regular access to general practitioners and other specialist health or social care staff. Specialist advice from health professionals was not always followed or detailed in care plans.

Staff demonstrated an understanding of people’s particular needs and personalities. However, people were not always treated with respect and dignity as some care staff talked inappropriately about them and in front of them. Dignity was maintained during the provision of personal care.

Care records contained some good information about people as individuals. However, assessments did not always take into account available information and care plans did not always reflect professional advice. Reviews of care plans and risks associated with the delivery of care were not always detailed. There was evidence of some activities at the home, although a sensory room had not been available to people for over a year, as it had been used for storage. There had been no recent formal complaints. A relative told us they knew how to raise a concern, if necessary.

Audits and checks had not always been undertaken or identified the short falls highlighted at the inspection. The previous regional manager had not undertaken any checking visits and the provider’s quality team had not followed up required actions. Daily records were not up to date or well kept. There were gaps in important records such as those monitoring people’s weight.

The registered manager and registered provider had failed to notify the CQC of certain events at the home they are legally required to do so.

We found seven breaches of regulations. These related to person centred care, dignity and respect, need for consent, safeguarding, safe care and treatment, good governance and staffing. We also found the provider in breach of the regulation that requires them to notify the CQC of events at the home.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to 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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.