Archived: Hempstead Care and Respite Centre

Updated 18 November 2017

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 26 and 27 September 2017 and was unannounced. The inspection was carried out by one inspector.

Before the inspection, we looked at notifications about important events that had taken place in the service which the provider is required to tell us by law. We also looked at the action plans the provider sent us following the last inspection. We looked at Fire service enforcement and advice notices that had been issued to the provider. We used this information to help us plan our inspection.

We spoke with two people who lived at the service and four relatives, to gain their views and experience of the service provided. We also spoke to the provider’s nominated individual and three staff. We asked two health professionals and one local authority staff for their views of the service.

We spent time observing the care and support provided and the interaction between staff and people. We looked at four people’s care files, medicine administration records, two staff recruitment records as well as six staff training records, the staff rota and staff team meeting minutes. We spent time looking at the provider’s records such as; policies and procedures, auditing and monitoring systems, complaints and incident and accident recording systems. We also looked at residents and relatives surveys.

We asked the provider to send information following the inspection. They did not send this in a timely manner as we had to request the information on six separate occasions and did not receive all the information we asked for.

Updated 18 November 2017

The inspection took place over two days, 26 and 27 September 2017. The first day of the inspection was unannounced. We told the provider when we were going to return for the second day of inspection.

Hempstead Care and Respite Centre is registered to provide accommodation for people who require personal care for up to seven people. There were four people living permanently at the home and one person staying for a short period of respite care at the time of the inspection. A respite service provides care for people who do not require a permanent stay in the care home. For example, when people’s circumstances meant they needed to have a break from their home, or when their day to day carers required a break. People had varying needs, some people were cared for in bed and others were independently mobile with support. Some people were living with dementia.

The accommodation was spread over two floors with bedrooms on the ground floor and the first floor. A stair-lift was in place for people to access the first floor if required. Some rooms had en-suite facilities and all rooms had a washbasin. At the previous inspection, on 21 and 23 February 2017, the provider was also running a small established day centre from the back of the same premises and the two services shared facilities such as the kitchen area. The day centre was now closed so no longer operated from the premises.

At the last comprehensive inspection, the service was rated Inadequate overall and was therefore placed in to special measures.

We previously carried out an unannounced comprehensive inspection of this service on 21 and 23 February 2017 when we found three continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to; Regulation 12, adequate risk assessments were not in place to keep people who use services and others safe, accidents and incidents were not investigated appropriately and fire safety precautions were not adequate to keep people safe. The management, administration and the recording and storage of medicines were not safely maintained; Regulation 17, the provider did not have a quality monitoring process in place to ensure a safe and good quality service was being provided and Regulation 18, staff had not received adequate supervision and training. An assessment process to determine the numbers of staff required to meet the needs of people was not in place. We also found a further three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to; Regulation 9, the provider had failed to give people the opportunity to engage in meaningful activity; Regulation 11, the basic principles of the Mental Capacity Act 2005 had not been complied with; Regulation 13, a best interests process was not followed in relation to the use of restraint when people may lack capacity to make a decision and give their consent.

We asked the provider to take action to meet Regulations 9, 11 and 13. We took enforcement action against the provider and told them to meet Regulation 12 by 26 May 2017, Regulation 17 by 30 June 2017 and Regulation 18 by 26 May 2017.

The provider sent us a report of the actions they were taking to comply with Regulations 9, 11 and 13 on 15 May 2017. They told us they would be meeting Regulation 9 by 22 May 2017, Regulation 11 by 18 May 2017 and Regulation 13 by 15 May 2017.

At this inspection on 26 and 27 September 2017we found the provider had made minimal improvements to the service and standard of care. Staff were now recording their interactions with people although people were still not engaged in meaningful activity. A safer process was in place for the administration and storage of medicines, although there were still areas of concern. Staff had received one to one supervision meetings with their manager and staffing levels were adequate to meet the needs of people.

Many improvements had not been made and we found continuing breaches of regulations from the last inspection. These related to Regulation 9, 11, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to; Regulation 15, the premises were not kept to a clean and suitable standard and Regulation 16, complaints had not been investigated and outcomes had not been recorded or informed to the complainant.

At the time of our inspection a registered manager was not employed at the service. The last registered manager had deregistered with the Care Quality Commission on 22 July 2015 and there had been no registered manager in post since then. A registered manager is a person who has registered with the Care Quality Commission (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.

We were told a member of staff was managing the service and was applying for registration with CQC. They were not available during the inspection as they were on annual leave. The provider’s nominated individual was present throughout the inspection. A nominated individual is a person involved with the service that the provider has informed CQC is the individual they have nominated to provide information on their behalf.

Risk management was not effective. Individual risk assessments had not been undertaken to detail the guidance required to keep people safe. Individual risks were observed and risk assessments had not been undertaken to prevent harm.

Although the management of people’s medicines had improved, this needed to be developed further.

The premises were not kept clean, this was evident through observations and the lack of recording in the cleaning schedules. Environmental hazards around the premises had not been identified to protect people, staff and visitors from harm. The premises were in need of refurbishment to provide the facilities people needed. Further improvements to fire safety systems and procedures were required to ensure people were protected in the event of a fire.

Staff did not have the training required to carry out their role. Many staff had not completed the mandatory training required. Some important training had not been undertaken by any staff.

People had not been supported appropriately to make decisions and choices when they may lack the capacity to do so. Gaining consent to care had not been explored and recorded in accordance with the Mental Capacity Act 2005. Restraining practice was used without the necessary consent or processes being followed.

People were not supported to maintain their well-being and avoid social isolation by being encouraged to take part in activities to suit their interests. Assessments and care plans did not provide the detail required to be assured people’s needs and wishes were addressed to deliver the appropriate care and support. People and their relatives were not involved in reviewing their care.

Evidence was not provided that complaints received had been investigated and responded to as the complaints procedure stated.

The provider had not developed a monitoring system to ensure the quality and safety of the services they provided. Daily documents were not consistently recorded to evidence that necessary care was provided. The provider had asked people and some relatives to give their views, however systems were not in place to analyse the responses and act on them to drive improvement.

Food was stored in the fridges and freezers without a label to show the date the food was opened to ensure food safety standards. We have made a recommendation about this.

The provider’s service user guide was unchanged from the previous inspection when we made a recommendation to review it as the information was hard to follow and there was conflicting advice. We have made a recommendation about this.

Staffing levels had improved, there were enough staff to provide the care and support people needed. Staff were now receiving one to one supervision with their line manager and most staff had the opportunity to have an annual appraisal to support their development. Regular staff meetings were now held.

The provider continued to use safe recruitment practices to make sure only suitable staff were employed to work with the people living in the service.

The provider now had a business continuity plan in place to provide guidance and information for staff in the event of emergency situations.

Staff knew people well and were able to give examples of people’s likes and dislikes and the care they received. People were supported to be as independent as possible and their privacy was maintained.

People were happy with the food provided and they were given a choice of what they liked to eat. As this was a small service, menus were flexible to suit people’s needs and wishes. People were supported to seek advice from health care professionals when needed to maintain their health.

Staff were complimentary about the new manager and felt they had made some improvements. Staff said they worked well as a team and supported each other.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the registered provider to take at the back of the full version of the report.

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

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

Full information about CQC's regulatory response to any concerns found during