Archived: Hempstead Care and Respite Centre

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

Hempstead Care and Respite Centre is registered to provide accommodation for people who require nursing or personal care for up to seven people. There were four people living 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. 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. There was a separate lounge upstairs with tea and coffee making facilities for people to use as a quiet area. The lounge was also available for people to use as a more private area when they had visitors. The provider’s nominated individual told us the room was rarely used and they were planning to change the use.

The premises were in need of refurbishment and we were told there were plans to carry out work where it was necessary.

The provider also ran an established small day care centre from the premises. This was accommodated at the back of the property and had some shared facilities such as the kitchen area.

We last inspected this service on 26 January and 4 February 2016 when we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to Regulation 12, Safe care and treatment, Regulation 18, Staffing, Regulation 17, Good Governance and Regulation 19, Fit and proper persons employed. The provider had failed to have adequate risk assessments in place to keep people who use services and others safe. Medicines recording and storage were not suitably maintained. Recruitment records were not adequate to keep people safe from receiving care from unsuitable staff. One to one staff supervisions were not held on a regular basis to support and develop staff. The provider did not have a quality monitoring process in place to ensure a safe and good quality service was being provided.

We asked the provider to take action to meet Regulations 12, 17, 18 and 19. At this inspection we found that one improvement had been made to address the breaches from the previous inspection although other necessary improvements had not been made and further breaches of regulations were found.

The provider did not send an action plan following the publication of their last report as requested and were sent a reminder. We did not receive an action plan but two emails, one on 5 May and one on 6 May 2016, following our reminder, stating they had carried out all the improvements necessary to meet the requirements of the regulations. We found evidence that the provider had not in fact carried out the actions they said they had undertaken.

At the time of our inspection a registered manager was not employed at the service. 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 was in place and they had made applications to register with the Care Quality Commission, however, the correct application forms had not been submitted and the provider had failed to ensure this was rectified by re submitting the correct forms within an appropriate timescale.

During the inspection, as the manager or the provider was not available, we had access to the nominated individual of the provider to answer any questions we had. The 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.

Specific individual risk assessments continued to have not been undertaken for people living at the home or staying for respite care and therefore control measures were not in place to keep people safe from situations that may place them at harm.

Environmental risk assessments, to manage the risks associated with the premises, had not been undertaken. Fire safety procedures and precautions were not robust enough to keep people, staff and visitors safe in the event of a fire breaking out. We referred Hempstead Care and Respite Centre to the fire service.

Accidents and incidents, although recorded, had not been investigated or monitored to make sure the same incidents were not repeated, putting people at continued risk.

The provider did not have a means of assessing the dependency needs of people living at the home or staying for respite in order to calculate how many staff were needed to ensure the provision of sufficient care and support.

The space to store and administer medicines was unsuitable. Medicines that were no longer in use had not been returned to the pharmacy. The documents used to record when staff administered people’s medicines were not appropriately recorded leading to potential confusion when staff were administering medicines.

The provider had not been guided by the principles of the Mental Capacity Act (MCA) 2005 to ensure any decisions were made in the person’s best interests. Mental capacity assessments had not been undertaken with people living in the home or people staying for a period of respite care before care planning decisions had been made. There was no evidence of best interest’s decisions being made to make sure people’s rights were upheld.

The Deprivation of Liberty Safeguards to protect people who may lack the capacity to give their consent to care and treatment had not been considered.

Individual assessments were not undertaken with people to find out their interests and hobbies in order to offer the opportunity to engage in individual meaningful activity. Although there was an occasional trip out to the local shop down the road, people usually only went out when their families were able to take them.

Staff continued to not be supported appropriately. One to one supervision meetings had not been carried out with staff to discuss their performance and to support their own personal development. No annual appraisals had taken place to check staff progress in their role over the previous year and to set personal targets for the following year. Staff received training and regular updates. However, the training was in the way of workbooks that staff worked through then completed a questionnaire to test their knowledge. We were told by some staff this was not an appropriate and effective method to receive training.

The manager was absent and appropriate measures had not been taken to replace them with someone who had been given the authority to lead the staff team. Roles and responsibilities were not clear leading to gaps and important tasks being missed.

The provider had not introduced any quality audit and monitoring system following the last inspection to be able to check the quality and safety of the service. The many concerns we found had not been picked up in order to plan the action required to improve the service provision.

Although a survey in the way of a questionnaire had been given to people, no record had been kept of who these had been given to and so an analysis of the response rate could not be made. Individual negative comments had been discussed but here was no report or overview of the feedback to enable an improvement plan taking this into account.

People’s care plans were well written and with the detail needed to ensure that staff could support people in the way they wanted, when they wanted. There was no formal process to review the care plans with people and others involved in their care and support. We have made a recommendation about this.

People had a choice of food and could change their minds and request something different if they wished. People were encouraged to drink plenty fluids, although the staff recording of this information was sloppy and therefore difficult to monitor people’s intake of fluids. We have made a recommendation about this.

Recruitment records had improved and the provider was now undertaking safe practices to ensure the staff they employed were suitable to work with vulnerable adults.

Staff worked closely with health care professionals to support people to maintain their health and well-being. Appointments and visits were recorded well, ensuring the communication of advice and guidance given.

Staff knew people well and were able to spend time with people chatting to them without being under pressure. Staff knew how to respect people’s privacy and dignity, knocking on bedroom doors before entering and carrying out personal care in private spaces.

People were supported to maintain their independence by being given the time it took to carry out tasks. People could choose when they had their support from staff, for example, when they got out of bed in the morning.

Although no complaints had been made in the last 12 months, people were given the information how to complain. Relatives confirmed they knew what to do if they had concerns they wished to raise.

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,

The accommodation was spread over two floors with bedrooms on the ground floor and the first floor. Some rooms had en suite facilities and all rooms had a washbasin. Some bedrooms were in the process of being refurbished. There was a separate lounge upstairs with tea and coffee making facilities for people to use as a quiet area. It was also available for people to have as a more private area when they have visitors.

The provider also ran an established small day care centre from the premises. This was accommodated at the back of the property and could be accessed without causing disturbance to the respite care home.

At the time of our inspection a registered manager was not employed at the service. 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. However, a manager had been appointed and had applied to register with CQC. Their application had been successful and they were awaiting their certificate of registration.

Recruitment records were not adequate to keep people safe from receiving care from unsuitable staff. Ongoing supervision and appraisal of the manager was not maintained to enable them to carry out their role effectively. Staff did not have adequate one to one supervisions to support them in their role and ensure their personal development needs were taken care of. Risks were not suitably assessed to keep people, staff and visitors safe. Medicine recording and storage was not managed well enough to keep people safe from harm. The provider did not have systems and processes in place to monitor the quality and safety of the service and therefore make improvements.

People and their relatives said they felt safe at the service and knew who they would speak to if they had concerns. A safeguarding procedure was in place and staff knew what their responsibilities were in reporting any suspicion of abuse. Staff could also describe how to recognise the signs of abuse.

Relevant policies and procedures were in place to support the staff to keep people safe and free from harm. Maintenance and servicing of equipment was carried out at the appropriate intervals to keep people safe within the premises.

Some people administered their own medicines. A locked drawer in their bedroom was provided to support them to do this safely and conveniently. Staff had been trained in how to administer medicines safely.

There were enough staff to ensure that people’s support requirements were well met. This was evident by our own observations as well as feedback from people and their relatives. The staff team had the time to sit and chat with people as well as engage in activities. This was encouraged by the provider who ensured there were enough staff to enable plenty one to one conversation as well as providing care and support.

People were supported to have their care and support needs met by trained staff. The provider employed an in house trainer with many years experience in the care sector. They could be reactive to the needs of individual staff, providing extra training and support when necessary. Induction training was one such need that could be met as and when new staff started working for the service.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager and staff showed that they understood the Mental Capacity Act 2005 and DoLS. People’s capacity to stay at the home and receive care and support had been taken into account. People did not require a DoLS authorisation as they did have the capacity to make that decision.

People’s needs were assessed prior to staying for respite care with the involvement of the person and their family members if appropriate. Care plans contained detailed person centred information and guidance. All aspects of a person’s health, social and personal care needs were included to enable staff to meet their individual requirements. People’s choices about how they spent their day were respected. Some people preferred to spend time in their rooms, watching TV or reading. Others would access the activities on offer within the day centre.

People told us there was plenty to eat and drink as well as lots of choice. Menu’s and meals were flexible as people were able to decide what they would like to eat either from the menu or ask for something different. People’s day to day health needs were taken care of Details were available of the important health professionals used by the person should the need arise.

The staff had a caring approach and spent the time getting to know people. They could have good conversations with people about their families or interests. The respite care home had a friendly and relaxed atmosphere and this was confirmed by people and their relatives.

An easy to follow complaints procedure was in place. Although no complaints had been made to date, people and their relatives told us they would know who to go to if they had a concern.

The management team were visible within the home and were well known by people and staff. They were considered to be approachable and open to suggestions. The people who stayed there and the staff team felt valued and respected.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.