Archived: Hilcote Hall

Updated 19 October 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 was 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 19 November 2015 and 24 November 2015 was unannounced.

The inspection team consisted of two inspectors and an expert by experience. An expert by experience is someone who has had experience of this type of service.

Prior to the inspection we had received concerning information from local authority commissioners about the service. During the planning of our inspection we reviewed information we held about the service. We reviewed information that we held about the provider and the service which included notifications that we had received from the provider about events that had happened at the service. For example, serious injuries and safeguarding concerns. We also had concerns about the way safeguarding and serious injuries were being managed at the service.

We spoke with eight people, five relatives, five care staff and the manager. We observed care and support in communal areas and also looked around the home.

We viewed ten records about people’s care and records that showed how the home was managed. We also viewed six people’s medication records.

Updated 19 October 2016

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.

We inspected Hilcote Hall on 19 November and 24 November 2015. The inspection was unannounced. This was the first inspection since the provider had registered with us (CQC).

The service is registered to provide accommodation and personal care for up to 44 people. People who used the service were over 65 years old and have physical and/or mental health diagnoses. At the time of our inspection there were 39 people who used the service.

At the time of the inspection the registered manager had left the service and was in the process of deregistering with us (CQC). The service had another manager in place and they were in the process of registering with us (CQC). 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 and associated Regulations about how the service is run.

Risks to people’s health and wellbeing were not identified and managed by staff safely. We found there were not enough staff available to deliver people’s planned care or keep people safe.

People were not protected from the risks of harm because staff did not recognise when people’s safety was compromised and incidents of possible abuse were not reported as required.

We found that medicines were not administered in a consistent and safe manner at a time when people needed them.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the manager and provider.

Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.

People did not always get the support they needed to eat. Staff were not always available to monitor people were eating sufficient amounts. This meant some people’s nutritional needs were not met.

Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff understood and were competent to support people safely and effectively.

People were not always consistently treated with dignity in an environment that protected their privacy and dignity.

People and their relatives were not involved in the planning of their care. People’s preferences had been sought, but staff had a varied knowledge of people’s care preferences. This meant that people were at risk of receiving inconsistent care.

Advice was sought from health and social care professionals when people were unwell. However, we saw that people were not always referred to specialist health professionals to ensure their health needs were met effectively.

People told us they were treated with care and given choices. However, we saw that improvements were needed to ensure that staff were able to interact with people in a way that met their needs.

Some people were given the opportunity to be involved in social and leisure based activities. However, improvements were needed to ensure that everyone had the same opportunities.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. We found that assessments had been completed with the involvement of other health professionals and representative, which ensured that decisions were made in people's best interests.

People knew how to complain about their care and the provider had a complaints policy available for people and their relatives.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.