Archived: Hail - Great North Road

About the service

HAIL- Great North Road is a residential care home providing accommodation and personal care for up to 5 people who have a learning disability. At the time of the inspection, there were 4 people living at the home which is in 1 adapted building.

People’s experience of using this service and what we found

Right Support

People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests, the policies and systems in the service did not support this practice.

Staff supported people to take their prescribed medicines, but this was not consistently managed safely and in people’s best interests. People could not always choose how they wanted to spend their time, whether they wanted to be with other people or in their own space. Although most people had support to go out and enjoy their choice of activity during the day, there were less opportunities in the evenings and at weekends. People sometimes went to bed early and spent the evening alone in their room when it was not clear whether this was their choice.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

Right Care

There were some positive caring interactions where staff were kind and supportive to people. Some staff were very caring to people living in the home. There was a lack of assurance that staff were trained in understanding learning disability and people’s rights.

One person spent an afternoon and evening in bed with no personal care and staff did not recognise that this was unacceptable care. Staffing did not always meet people’s needs and preferences. Care was sometimes delivered in a routine and task-centred rather than person-centred way.

Right Culture

There was a lack of evidence of a positive person-centred culture which promoted people’s rights and autonomy. The service was not able to demonstrate they were meeting the underpinning principles of right support, right care, right culture. Staff were not aware of the right support, right care, right culture guidance.

Management oversight was ineffective, and although systems were in place to monitor the quality of care provided by the service, we found concerns their systems had not effectively improved. There was a lack of formal engagement with people, staff, professionals and relatives.

Recruitment practices were not consistently safe as some required checks had not been completed before staff worked at the service however the provider advised that no new staff had been employed since the last inspection and they would be operating safe recruitment going forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

At the last inspection we rated this service inadequate (published 27 April 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for HAIL -Great North Road on our website at www.cqc.org.uk

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 COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to providing safe care, medicines management, person-centred care, staffing and the overall management of the service at this inspection. We served a warning notice in relation to safe care and medicines management.

Please see the other action we have told the provider to take at the end of this report.

We have made 2 recommendations. We recommended the provider improve their recruitment practice and in line with best practice and ensure people have opportunity to make end of life care plans.

Follow up

Due to the seriousness of our concerns, we have requested an urgent action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Hail Great North Road is a residential care home providing personal care to up to five people within one adapted building. The service provides support to people with learning disabilities and/or autistic people. At the time of the inspection there were four people using the service.

People’s experience of using this service and what we found

Risks to people were not well managed. The premises were not being properly maintained, areas of the service were found to be unclean and in disrepair. Maintenance and repairs were not being actioned in a timely way.

Management oversight was ineffective, and systems were not in place to monitor the quality of care provided by the service. Management were not completing audits in areas where we found concerns and there was a lack of formal engagement with people, staff and relatives.

Risks to people were not always assessed, monitored and managed with appropriate guidance in place for staff. Staff training had not been completed or refreshed in several mandatory topics.

Staff recruitment records were not available to evidence that people were supported by staff who had been safely recruited. People’s medicines were not being managed in line with national guidance and risks to people relating to infection, prevention and control were not being safely managed.

Our interactions with and observations of people using the service indicated that people felt safe living within the service. Staff had completed safeguarding training and were aware of their responsibilities to report any concerns.

Support staff were committed to their role and felt supported by the Registered Manager. We observed kind and caring interactions between people and staff.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the key questions of safe and well led the service was not able to demonstrate they were meeting some of the underpinning principles of right support, right care, right culture.

Right support

The provider did not always ensure people received care and support in a safe, clean and well-maintained environment. People's specific support needs and risks were not always clearly identified, supported and managed.

Right care and right culture

People received kind and compassionate support from staff. The service was not gathering people’s feedback and people’s support plans were not always up to date to ensure staff were aware of their needs and information to ensure their wellbeing and enjoyment of life. Management oversight was poor, issues potentially impacting people’s safety and experience of the service had either not been identified or sufficiently addressed. The provider told us they were taking action to address the issues identified during the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 14 December 2018).

At our last inspection we recommended that the service seeks advice and guidance from a reputable source about safe recruitment practice. At this inspection we found the provider had not acted on the recommendation, evidence of safe recruitment procedures was not in place.

Why we inspected

As part of CQC's response to the COVID-19 pandemic we are looking at how services manage infection control and visiting arrangements. Initially we undertook a targeted inspection looking at the infection prevention and control measures the provider had in place. We inspected and found concerns, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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 COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make significant improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Following our inspection, the provider began to address some of the issues we had raised, in order to mitigate immediate risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hail Great North Road on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We found several breaches of regulation and issued the provider and registered manager with warning notices in relation to premises and good governance.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

At our last inspection we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, maintenance of the building and equipment, staff recruitment and governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. We found the service had made improvements in the key questions and were no longer in breach of the regulations.

Hail – Great North Road is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates five people in one adapted building, at the time of our inspection four people were using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

People were protected from the risks of abuse as staff knew how to identify abuse and where to report it to. Staff told us they would whistleblow if they thought the registered manager and senior management at the service were not taking their concerns seriously.

People received their medicine on time and staff at the service administered medicines safely. Staff told us they would report missed medicine to the registered manager or the on-call service and complete an incident form. The registered manager audited medicines and checked them daily to support safe handling of medicines.

People had risk assessments that mitigated against known risks and were reviewed regularly.

Staff were recruited safely and checks were carried out ensure they were suitable to work with people at the service which included criminal records checks, references and right to work.

People were protected from the risks of infection as staff wore personal protective equipment.

People were supported by staff who had the skills and knowledge to do the role. People were observed to receive good care from staff.

Staff were supported through regular supervision, appraisal and observations by the registered manager to check people were receiving good care.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and to support people to make their own decisions. Where people lacked capacity for health decisions people had advocates to support them in making best interest decisions.

People had a choice of healthy meals and drinks at the service. Staff were observed making people their favourite drink at the service and following guidelines from health professionals to support healthy eating.

People were supported to maintain good health at the service and attend health appointments and screening appointments.

People were looked after by staff who were kind and caring. People’s privacy and dignity was respected at the service and people’s preferences were well known by the service.

Care plans were individual and person centred. People’s needs were known by staff and staff were always observant in a change in people’s health or wellbeing.

People participated in a number of activities of their choice and feedback was sought by staff to see whether people had any complaints.

Staff spoke positively about the registered manager and changes they had implemented. People were happy around the registered manager who asked people how they were.

The registered manager had systems in place to monitor the quality and audit the service.

We have made two recommendations in relation to safe recruitment and supporting people with end of life wishes.

Hail – Great North Road is a care home registered to provide accommodation and personal care for up to five adults with learning and physical disabilities. At the time of our inspection there were five people using the service.

At our last inspection in August 2015 the service was rated as overall Good.

At this inspection we found the provider had not maintained that level of service and there were a number of concerns.

The service did not have a registered manager in post. A new manager had been appointed in September 2017 and told us they would submit an application to become the 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.

We found the equipment used to provide care and the upkeep of the building had not been maintained. Annual servicing of equipment was last carried out in 2015.

Medicines were not always managed safely; we found gaps in recording on medicine administration records and procedures for management of medicines were not always followed.

Systems for recording incidents and accidents did not always provide details of the outcomes and learning from these.

People were protected from abuse as staff knew the signs to look for and the action to take to ensure that people were safe.

Staff treated people with dignity and respect. People received individualised care in accordance with their plan of care and by staff who understood their needs and preferences; however, care records were not always accurate and up to date. People had choice and their likes and dislikes were taken on board.

Risk assessments provided staff with guidance on how to manage risks to people. Staff understood risks and how to manage these. However, we found conflicting information in the risk assessment for one person whose behaviour challenged the service.

Some staff received training relevant to their role and were supported to effectively carry out their role. However, we found gaps in training for some staff.

We have made a recommendation about staff training.

Staff recruitment practices were not always safe; we found a number of gaps in records relating to references and employment.

The service was not organised in a way that promoted safe and quality care through effective monitoring systems.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, maintenance of the building and equipment, staff recruitment and governance. You can see what action we asked the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At the time of the inspection there were five people living at the home. Two were out when we arrived at the home, but we had the opportunity to meet with them later during the day. One person was unwell and did not wish to speak with us and some people had complex communication needs. We also spoke with the service director, deputy manager and four staff working in the home.

People appeared to feel safe and relaxed at the home, with support from staff who knew their needs well. Staff had undertaken safeguarding training and understood their role in safeguarding the people they supported. Accidents and incidents were recorded appropriately, and the home internal environment was safe, clean and hygienic. However the home had failed to take sufficiently prompt action to deal with a build-up of clinical waste bags in the front garden which may have placed people living in the home and members of the public at risk. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to protecting people from the risk of infection.

Is the service effective?

People indicated that their care and support needs were met effectively. We saw people receiving their medicines on time and having care needs met promptly and discreetly. Care plans and person centred plans were reviewed regularly to ensure that staff met people's needs consistently. However health action plans contained some inaccurate information about the frequency of people being weighed, and having blood pressure and glucose checks which might lead to insufficient monitoring of their health needs.

Staff received some support and supervision to enable them to deliver care and support to people to an appropriate standard. However insufficiently regular supervision and appraisals meant that not all staff felt supported and that gaps in training were not always addressed promptly. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to supervising staff appropriately and ensuring health care records are accurate.

Is the service caring?

People we spoke with indicated that staff were caring and responsive to their needs. We observed staff interacting with people warmly and patiently, treating them with respect, and maintaining their dignity. Staff showed concern and provided encouragement and support to one person who was unwell during the inspection and had remained in bed. Staff we spoke with showed that they understood the needs of individual people they cared for. People's preferences, interests, aspirations and diverse needs had been recorded to ensure that care and support were provided in accordance with their wishes.

Is the service responsive?

We saw that staff had identified people's cultural and religious needs, and people were supported to attend a place of worship if they wished to.

However there was insufficient evidence of suitable arrangements in place for recording people's consent or best interest decisions made on behalf of people unable to consent to the care provided to them. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to involving people in planning their care.

Is the service well-led?

The acting manager for the home had left since the previous inspection and the provider was in the process of recruiting a new manager.

Monthly audits were taking place but the findings had not been shared with staff or the deputy manager at the home. No service user survey had been undertaken in the last two years and there were gaps in some fire safety records. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing rigorous systems to identify, assess and manage risks to the health, safety and welfare of people who use the service.

We found that people were provided with care which met their needs. They were treated with dignity and respect. We saw that people had up to date care plans and risk assessments which reflected their personal needs. There was information available to people in different formats, such as pictorially, which made it easier for people to understand. Some people were not receiving regular physical health checks as specified in their care plans.

Staff attended regular and appropriate training and felt supported by the organisation. Some staff had not received supervision and appraisals as frequently as the provider specified that they would be. The provider had systems in place to ensure that people had an opportunity to provide feedback about their service.

People were relaxed and at ease within the home, and indicated that they were provided with the care that they needed. We saw people being given choices, and noted that they had formed good and supportive relationships with staff.

People's privacy and dignity were respected within the home, and they received respectful and appropriate support to meet their needs, including personal and health care needs, and support to engage in a variety of activities.

The home environment was maintained appropriately, and was clean, and comfortable.

Staff working in the home were trained and supervised, and appropriate quality assurance procedures were in place to ensure that people received appropriate care and support.