All inspections: Honister Gardens Care Home

This inspection took place on 6 and 9 May 2016 and was unannounced. At the last inspection on 8 & 9 October 2015 we had found that while some improvements had been made from the inspection of July 2015, there were still breaches of regulations.

Honister Gardens Care Home provides care, support and accommodation for up to five people with learning disabilities. At the time of our inspection there were three people living in the home.

We took enforcement action following the inspection on 8 & 9 October 2015 and imposed conditions on the provider's registration. These conditions restricted the service from admitting new people without the permission of the Care Quality Commission, and required the provider to submit regular information to us as to how they were addressing our concerns. This was in addition to the conditions that were already in place on the provider, which related to the management of people’s finances. The service also continued under special measures.

We carried out this inspection to check what progress had been made to address the breaches we had identified at the July and October 2015 inspections and also carried out a comprehensive ratings inspection.

There was a registered manager in place. 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 improvements had been made in each key question, although we identified some areas that required improvement. We identified the risk assessment of one person was not comprehensive. It did not include a step by step detail of action to be taken to minimise risk to others. Complaints were not always logged or responded to. We also saw that one person did not have a social care plan and there was no evidence of outdoor activities available to meet this individual’s interests and reduce isolation.

People’s relatives felt the service was safe and that staff treated people well. The conditions we had imposed, in relation to management of people’s finances and management of risks to people had been complied with.

Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported. People's medicines were managed appropriately and they received them as prescribed by health care professionals. Risks to people were identified and monitored.

There were appropriate records of people’s finances including their spending. Staff carried out daily and weekly checks of people’s finances to reduce the risk of financial abuse. Risks to people were identified and monitored.

There were sufficient staff to meet the needs of people and the service had conducted appropriate recruitment checks before staff started work. Arrangements were in place to deal with staffing emergencies.

People had been involved in the planning of their care. We also saw that their relatives were involved as appropriate. Support plans and risk assessments provided clear information and guidance for staff on how to support people. This included guidance about meeting people’s nutritional needs.

Staff received adequate training and support to carry out their roles. They asked people for their consent before they provided care and demonstrated a clear understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

Staff told us there had been improvements at the home following our inspection of October 2015. Audits had been carried out to identify any improvements that were needed. Staff felt confident they were heading in the right direction. The registered manager felt the service had recruited the right staff and management team to move the service forward. However, the audits had not been effective enough to identify the shortfalls we saw. For example, we identified areas for improvements in people’s records and that complaints were not always logged or responded to in a timely manner. This had not been picked up through the provider’s audits.

In view of the improvements made in each key question the home is no longer in special measures. The conditions imposed on its registration at the October 2015 inspection have also been lifted.

This inspection took place on 8 and 9 October 2015 and was unannounced.

Honister Gardens Care Home is a nursing home that provides care, support and accommodation for up to five people with learning disabilities. At the time of our inspection there were three people living in the home.

The service had a 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 and associated Regulations about how the service is run.

Our previous inspection of July 2015 identified a breach of Regulations 12, 13, 18 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During our inspection on 8 and 9 October 2015 we acknowledged that, although some improvements had been made in areas we had identified, there were some areas that still required improvement. This meant that there was a continuing breach of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were still some issues related to unsafe care and treatment that had not been identified by the provider’s internal audit system.

Our previous inspection of July 2015 identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During our inspection on 8 and 9 October 2015 we found that improvements were still required in this area. This meant that there was a continuing breach of Regulation12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risk assessments did not contain sufficient detail to guide staff in providing safe care for people.

Our previous inspection of July 2015 identified a breach of Regulation 17 of the Health and Social

Care Act 2008 (Regulated Activities) Regulations 2014). The provider did not have an effective system in place to monitor and assess the quality of service provided to people. Audits and quality assurance monitoring did not identify, assess and manage risks relating to the health and welfare of people in the home.

During this inspection we found that improvements were still required. This meant that there was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider’s systems for monitoring, assessing and improving the service were ineffective and appropriate measures were not being taken to consistently identify and mitigate risks for people living and working in the home.

There was a lack of oversight by the provider with regard to the overall running of the service. The provider also did not demonstrate accountability or effective leadership because they did not ensure that appropriate action was being taken to improve shortfalls, where issues had been identified.

Risks to people’s safety were assessed but records were not all up to date or fully completed. The management of some of the risks identified was not always effective because actions to reduce, remove or improve the risks to people were not always taken or recorded appropriately.

There were appropriate arrangements for the management of people’s medicines and staff had received training in administering medicines.

The provider had put in place adequate controls to manage people's finances.

People had access to various healthcare professionals, according to their needs and regular visits to the home were also made by external practitioners, such as the chiropodist and a diabetes advisor.

Staff received training and they were supported through regular supervision and appraisal. We saw staff had received training in the Mental Capacity Act (MCA) 2005 and people’s capacity was assessed in line with the MCA.

Staff treated people with dignity and respect and we observed care was provided with kindness and compassion.

Overall, we found significant shortfalls in the care provided to people. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. We will publish what action we have taken at a later date.

The overall rating for this service is ‘Inadequate’ and the service will therefore continue in 'Special Measures'. The service 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 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 time frame.

We carried out an unannounced comprehensive inspection of this service on 6 February 2015, at which we found three breaches of legal requirements. This was because the provider did not have appropriate arrangements in place to manage medicines; care plans were not always updated when people’s needs changed; there were ineffective quality monitoring systems and irregular supervision and appraisal of staff.

Following the comprehensive inspection, the provider sent us an action plan to tell us the improvements they were going to make. We undertook a focused inspection on the 1 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements. We found the provider had started to address the shortfalls, but they had not all been completed.

The provider sent us another action plan on 22 July 2015. We undertook another comprehensive inspection on the 24 July 2015 to check that the provider had fully implemented their action plan, to confirm that they met legal requirements and because of safeguarding concerns that had been reported to us.

You can read the report from our last comprehensive and focussed inspection, by selecting the 'all reports' link for ‘Honister Care Home’ on our website at www.cqc.org.uk’.

Honister Gardens Care Home provides accommodation for up to four people with learning disabilities. At the time of our visit there were three people using the service.

The service had a 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 and associated Regulations about how the service is run.

At this inspection we found the provider still did not have effective systems in place to monitor the quality of service delivery.

People were not protected from the risk of financial abuse because the provider did not ensure there were safeguards in place to protect their financial interests.

People were at risks of contracting illness due to inadequate infection control systems.

The provider did not have effective systems in place to ensure there were sufficient numbers of experienced staff deployed in the service. Some staff raised concerns about low staffing levels.

We saw that personal and confidential information about people and their care and health needs were not always kept securely.

People had access to external health and social care professionals; however information provided from these professionals to the service was not always followed up and adhered to

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

We also found that people were not always supported with activities and we have made a recommendation in this area.

There were suitable arrangements for the recording of medicines received, storage, administration and disposal of medicines.

People had access to external health and social care professionals. There was evidence that people were referred to specialist services when required.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We carried out an unannounced comprehensive inspection of this service on 6 February 2015, at which we found three breaches of legal requirements. This is because the provider did not have appropriate arrangements in place to manage medicines; care plans were not always updated when people’s needs changed; there were no effective systems for monitoring the quality of care and staff were not receiving regular supervision and appraisal.

After the comprehensive inspection, the registered provider sent us an action plan telling us how they would meet legal requirements and recommendations. We undertook a focused inspection on the 1 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Honister Gardens Care Home’ on our website at www.cqc.org.uk’.

Honister Gardens provides accommodation for up to four people with learning disabilities. At the time of our visit there were three people using the service.

The service had a 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 and associated Regulations about how the service is run.

At our focused inspection on the 1 July 2015, we found that the provider was in the process of implementing their action plan and some legal requirements had been met.

We found that the provider had started to address the shortfalls, but still needed more time to demonstrate the service was well-led. Although audits had been carried out, including surveys, the information gathered had not yet been subject to an analysis, to inform improvement.

We found that the provider had taken action to ensure medicines were handled and administered to people safely and appropriately. PRN medicines were included on the medicine administration record sheets and there were appropriate guidelines for their administration.

We saw from staff supervision records that formal supervision of care staff had been carried out since our last inspection. Appraisals had been scheduled.

The provider had discussed activities with people who used the service and reviewed staff allocation to facilitate a wider range of community based activities.

This inspection took place on 6 February 2015 and was unannounced. At our last inspection in December 2013 the service had met all the regulations we looked at.

Honister Garden provides accommodation and personal care for a maximum of five people with learning disabilities. At the time of this inspection there were four people using the service.

The service had a 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 and associated Regulations about how the service is run.

There was no effective system in place to make sure that the registered manager and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This increases the risk of harm to people and fails to ensure that lessons are learned from mistakes. We have given a recommendation about this.

There was a lack of a consistent and thorough supervision and appraisal system for staff at the service. This meant that people were not cared for by staff who received effective support and guidance to enable them to meet their assessed needs.

People’s health needs were identified and they had access to relevant health professionals when needed.

However, some aspects of medicines management were not safe. People on medicines prescribed to be used ‘as required’ or PRN did not have protocols to support staff in their use. This meant that people on PRN may not have received their medicines when they needed them.

The staff on duty knew the people they were supporting and the choices they had made about their care and their lives. We observed that people were happy with the care provided by the staff. Interactions between staff and people were caring and respectful. Staff had relevant knowledge regarding people’s routines, and their likes and dislikes.

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans.

The provider did not have an effective quality assurance system. The system did not systematically ensure that staff were able to provide feedback to their managers, which meant their knowledge and experience was not being properly taken into account.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

The registered person had not protected people against the risks associated with unsafe use and management of medicines. This was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered person did not have suitable arrangements in place to ensure staff were appropriately supported to enable them to deliver care to people safely and to an appropriate standard. This was in breach of regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We also found the registered person had not protected people against the risks of inappropriate or unsafe care by means of the effective operation of systems to assess and monitor the quality of services provided. . This was in breach of regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We used a number of different methods to help us understand the experiences of people who used the service. This was because some of the people were not able to tell us how their care was delivered. We saw evidence from four care records that people who used the service had been supported to make decisions about living in the care home. Staff we spoke with were aware of gaining consent for care and treatment with people they were supporting.

We found that care and support was planned and delivered, in line with people's individual care needs and preferences. One person who used the service told us "We are all fine here.' We spoke with one relative who told us 'I am very pleased she is living at Honister Gardens, I think we are very lucky to have found it.' A social worker told us 'Overall they are doing an amazing job." They also told us that the person who used the service "has progressed immensely.' The staff we met demonstrated a very good understanding of the needs of the people who used the service.

The management of medicines was carried out in accordance with safe practices. We saw that there were appropriate arrangements in place to ensure people received prescribed medicines in accordance with their needs.

We found that there was an effective recruitment process in place so people could be confident the right people were employed in the service.

We found that people who used the service and their families were supported to raise any concerns.

At the time of our inspection, there were two people living at the home.

People told us that they were happy living at the home and that the staff supported them. They had their privacy, dignity and independence respected. They were involved in the care they received and their choices were honoured. People were consulted and consent to their care and treatment was sought.

People who use the service were involved in the care they received. They received appropriate care and support that met their individual needs.

There were processes in place to protect people using the service from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

The staff were supported to provide care and treatment to people who use the service and were being trained, supervised and appraised appropriately.

People using the service had opportunities to comment on the service. There were systems to monitor the quality and safety of the service. Records were fit for purpose and held securely.

Archived: Honister Gardens Care Home

All Inspections

6 May 2016

During a routine inspection

8 & 9 October 2015

During a routine inspection

24 July 2015

During a routine inspection

1 July 2015

During an inspection looking at part of the service

6 February 2015

During a routine inspection

20 December 2013

During a routine inspection

30, 31 January 2013

During a routine inspection