Background to this inspection
Updated
14 February 2019
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 commenced on 04 September 2018 and was unannounced. We also visited on 05 September 2018 which was announced. The inspection was prompted due to concerns being received from the public and the local authority about the quality of care being provided at this service. The inspection team consisted of two inspectors, a Specialist Advisor 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. The Specialist Advisor was a qualified nurse with experience working with older people and people living with dementia.
As part of the inspection we reviewed the information we held about the service. We looked to see if statutory notifications had been sent by the provider. A statutory notification contains information about important events which the provider is required to send to us by law. They can advise us of areas of good practice and outline improvements needed within their service. We sought information and views from the local authority. We also reviewed information that had been sent to us by the public. We used this information to help us plan our inspection.
During the inspection we spoke with eight people who used the service and two relatives. We spoke with the two proprietors of the service, the acting manager, the deputy manager, the cook, the assistant cook and nine care staff. We also spoke with one healthcare professional who had raised concerns about the care provided to one person living at the service. We carried out observations across the service regarding the quality of care people received. We reviewed records relating to people’s medicines, 12 people’s care records and records relating to the management of the service; including recruitment records, complaints and quality assurance records.
Updated
14 February 2019
The inspection site visit took place on 04 and 05 September 2018 and was unannounced. At the last inspection completed 09 November 2016 the provider was meeting all legal requirements and the service was rated as ‘good’. At this inspection we found widespread and significant concerns about the care being provided with multiple legal requirements not being met.
Holme Bank is a ‘care home’. People in care homes receive accommodation and personal care as a 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 up to 20 people in one adapted building. At the time of our inspection there were 15 people living at the service. Most of the people living at the service were older people living with dementia.
The provider had failed to ensure a registered manager was in post. 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. A manager remained registered with CQC although they had left their post in 2017. A new manager had been appointed although had left prior to registering with CQC. An ‘acting manager’ was in place during the inspection who had recently taken on this role.
There were widespread and significant concerns identified about the management of risk within the service. People were exposed to multiple risks including those connected with choking, challenging behaviour and skin integrity without appropriate mitigation being in place. People were not protected from potential abuse due to safeguarding incidents not being recognised and reported. People were exposed to the risk of harm due to the poor management of medicines within the service.
People were not supported by sufficient numbers of suitably skilled and experienced care staff. There were widespread issues with the lack of training and supervision of care staff.
People’s rights were not being upheld as the Mental Capacity Act (MCA) was not being used effectively. Decisions were being made about people’s care without the required legal steps being taken under this Act.
People’s nutritional needs were not always met. Advice and intervention from healthcare professionals was not always sought in a timely manner which exposed people to the risk of harm.
While people recognised individual staff members as being kind and caring, they did not always feel the support they received was caring. We found the lack of staff numbers, training and supervision resulted in care standards being poor. Support provided was not always caring. People’s dignity was not always upheld and their independence was not actively promoted.
People were not always fully involved in the planning of their care. People’s needs were not always appropriately assessed and the care and support people received did not always meet their needs. People did not have access to sufficient leisure opportunities.
People’s complaints were not always actively sought and listened to. These complaints were not always responded to appropriately and they were not used to drive improvements across the service.
People were being supported by a staff team who were demoralised and under supported. The culture within the service had become closed and care staff had become afraid to speak out about concerns they had.
People were exposed to significant risks due to the inadequate governance and management arrangements in place. We found there were no auditing and quality control systems in place which had resulted in the provider not identifying the significant issues present within the service.
Due to concerns being identified during the inspection about people’s immediate safety, we contacted the local safeguarding authority and commissioners to raise concerns. As a result the local authority were present during the final part of our inspection and took immediate action to safeguard people living at the service.
We found the provider was not meeting the regulations around providing person-centred care, obtaining appropriate consent, safeguarding, staffing, safe care and treatment, nutrition, complaints and the overall governance of the service. The provider had also failed to send CQC certain statutory notifications which are required by law. You can see what action we told the provider to take at the back of the full version of the report. 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.
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.
Following the completion of our inspection, the local authority decided to move all people living at the service to alternative homes due to concerns about the standards of care being provided. The provider had also announced their intention to close the service. At the time of publication of this report nobody was living at Holme Bank and receiving care.