Archived: Hornegarth House Care Home

The service was registered to provide nursing for up to 37 people. At the time of our inspection 33 people were using the service.

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, it 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.

The service did not have 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 2008 and associated Regulations about how the service is run.

There were not enough staff to offer support to people in a timely manner. The lack of staff within the home meant people had to wait for personal care, meals and medicines. As the rota was left uncovered we could not be assured there were the recommended amount of staff available for people. The provider used a dependency tool to work out staffing levels however we could not be assured this was accurate as it did not always reflect people’s individual needs.

People did not receive medicines as prescribed because we found medicines from previous days in blister packs. When people were prescribed medicines for agitation we did not see any evidence that people had been agitated when these medicines had been administered. When people needed pain relief they did not always receive this in a timely manner.

People were at risk as there were not enough staff to keep them safe. Injuries had occurred within the home due to the lack of staff available. Risks to people were not managed in a safe way. We saw no evidence after incidents had occurred that action had been taken to reduce the risk reoccurring. Staff did not demonstrate an understanding of safeguarding and so we could not be sure people were protected from potential abuse. When potential safeguarding incidents had been recorded we did not see these had been reported in line with the provider’s procedures.

People did not always receive adequate fluids to remain hydrated. Drinks were often left out of reach for people. When people needed support to eat and drink they had to wait due to the lack of staff within the home. We had to alert staff when people had not been offered anything to eat or drink. People were put at risk as they received foods that were not in line with recommendations made by health professionals.

People were not treated in a dignified way as staff were rushing to complete tasks. People were not offered choices and staff did not have time to encourage them to be independent. Staff felt the induction and training they received was inadequate to equip them with the skills they needed to support people effectively. People did not always receive individualised care or appropriate support when needed. People felt there could be more to do and relatives felt the home lack stimulation for people.

Capacity assessments were not always in place and we could not be assured how decisions had been made. Not all restrictions that had been put on people had been considered. Staff did not demonstrate an understanding of capacity and gaining consent from people.

There was a lack of leadership and we were concerned about the culture within the home. Staff did not feel listed to and when they raised concerns no action was taken. Staff told us they felt bullied and intimidated. Relatives also raised concerns about the lack of leadership and management of the home.

The systems that were in place were not always effective in identifying concerns. When action was needed to reduce risks reoccurring we did not see this had been taken. We could not be assured the provider understood their registration with us and significant events which occurred in the home had not been reported to us.

People and relatives were happy with the staff. And the provider ensured staffs suitability to work within the home. Visitors felt welcomed and were free to visit anytime.

During the inspection we contacted senior managers to raise our concerns. We did not leave the inspection until we were assured measures had been put into place to keep people safe. We asked the provider to produce an urgent action plan within 72 hours of the inspection and we are liaising with them in relation to this.

We found 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 the report.

The service was registered to provide nursing for up to 37 people. At the time of our inspection 32 people were using the service, a further three people were in hospital.

The service did not have a registered manager. There was a new manager in post. The new manager confirmed they had started with the organisation the previous week. They confirmed they had started the process to register with us and showed us evidence of this. 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.

There were not enough staff available to ensure people were safe, we observed that people had to wait to be provided with support. Risks to people were not manged to ensure people were safe from avoidable harm. Medicines were not stored in a safe way and therefore we could not be sure they were safe to administer. We found that medicines were not administered as prescribed. People’s rights to privacy and dignity were not always upheld. There were limited opportunities for people to participate in activities they enjoyed.

When people were unable to consent to their care, capacity assessments had been completed and decisions had been made and recorded in people’s best interests. When people were being restricted in their best interest, this had been considered and applications and authorisations for this were in place.

Staff received an induction and training which was relevant to meeting people’s needs. We saw when specialist equipment was used; it was maintained and used in a safe way. People had individual plans for emergency situations and staff were aware of these.

People were offered food and drinks which they enjoyed. People were offered choices at mealtimes and about their day. We saw drinks and snack were offered throughout the day. When people required specialist diets we saw this was provided for them. We saw that staff interactions with people were caring and staff knew people well.

Quality monitoring systems were in place. The provider sought the opinions of people who used the service and relatives to bring about changes. There was a new manager in post. There were a complaints procedure in place and when complaints were made the provider dealt with these in line with their policy.

We found 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 the report.

Below is a summary of our finding based on our observations, speaking to people who used the service, their relatives, the staff supporting them and from looking at records.

Is the service safe?

Systems were in place to ensure that the premises were safe and secure. The required health and safety checks and servicing were completed.

Staff were provided in sufficient numbers to deliver people's care needs and they received the training they needed to provide the necessary care and support.

Is the service responsive?

People's health, social and support needs were assessed and reviewed at regular intervals.

The service had a complaints procedure for people to use where they were unsatisfied with the care provided. People told us and we saw the manager took all concerns and complaints very seriously and acted swiftly to resolve issues.

Is the service caring?

Relatives involved with Hornegarth House told us the staff were very good at providing care and support to their loved ones.

People who were unable to comment or did not wish to speak with us looked comfortable, well groomed and cared for.

Relatives who were involved with the service had the opportunity to complete an annual satisfaction survey. The home had relatives meetings and the manager took action to address any concerns.

Is the service effective?

People's health and care needs were assessed. People's nutritional, personal care and mobility needs were identified in their plans of care. Monthly reviews of care were completed to make sure that care remained appropriate.

Is the service well led?

Relatives who were involved with the service and staff all told us that the current manager was helpful, welcoming and responsive. One relative told us they felt they could speak with the manager if they had concerns and that they felt 'listened to'.

We previously had concerns about the care and welfare of people, the recruitment checks for employees and the monitoring of the quality and safety of the service. We saw that improvements had been made in all these areas.

We spoke with the new manager who had recently come into post and three members of staff.

The new manager told us they were in the process of applying to register as a manager of the service.

In this report the name of the last registered manager appears. They were not in post and not managing the regulatory activities at this service at the time of this inspection. Their name appears because they were still a registered manager on our register at the time of the inspection.

As part of the inspection we spoke with three people who used the service and four relatives.

We found that people's privacy, dignity and independence were not consistently respected. We found that people's views and experiences were not always taken into account in the way the service was provided and delivered in relation to their care.

We found that the care and welfare needs of people who used the service were not consistently met. People told us that there were not enough activities to support their community involvement and emotional welfare.

We found that appropriate checks had not always been undertaken before staff began working at the home.

We found that the provider did not have a consistently effective system to regularly assess and monitor the quality of service that people received.

We found that people's records were accurate and were stored confidentially.

After this inspection we asked the provider to complete an action plan setting out how they were going to achieve compliance.

We wanted to check the progress of those actions and to establish that the needs of people living in the home were being met.

The responsive review we recently completed was unannounced which meant the provider and the staff did not know we were coming.

During our visit we spoke with the manager, staff, people living at the home and their relatives.

One person told us, "There is nothing I don't like. People come quickly when I need them".

A relative told us, "It's absolutely brilliant. My relative is happy here".

Staff told us they received regular training to meet the care and welfare needs of the people they supported.

We found that the home had taken the appropriate steps to complete assessments and regular reviews to ensure that each person living at the home received appropriate and safe care.

We found that the planning and delivery of care and treatment met people's individual needs and ensured the welfare and safety of people living at the home.

We found that Hornegarth House Care Home was compliant with outcome 4: care and welfare of people who use services.