Background to this inspection
Updated
12 January 2018
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 unannounced inspection took place on 2 and 6 November 2017. The inspection on 6 November commenced at 8pm to give us an understanding of staffing and how people’s needs were being met during the evening and night. The inspection team was made up of two inspectors and a pharmacy specialist.
Before the inspection we reviewed information we had received about the service such as notifications. This is information about important events which the provider is required to send us by law. We also looked at information sent to us from other stakeholders, for example the local authority and members of the public.
We spoke with five people living at the service and one relative. We also observed the care and support provided to people and the interaction between staff and people throughout our inspection.
We spoke with the registered manager, the assistant director, six other members of staff and an agency worker.
To help us assess how people’s care and support needs were being met we reviewed nine people’s care records and other information, for example their risk assessments and medicines records.
Updated
12 January 2018
The Harvey Centre is an 18 bedded nursing home for people living with mental health illnesses. There were 14 people in the service when we inspected on 2 and 6 November 2017. We carried out this unannounced, comprehensive inspection to check that the provider had made the improvements required following our inspection on 16 and 21 February 2017.
During our inspection in February 2017 we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed into Special Measures and we told the provider to take action to address and improve medicine management, infection control practices, risk management, care records and governance and management systems. We received an action plan from the provider and we have kept the service under review, with the expectation that significant improvement is to have been made within a six month timeframe.
There was a registered manager in post. 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.
At this inspection we again found widespread and significant shortfalls in the way the service was managed and regulations continued to not be met. Despite our previous concerns the provider continued to fail to ensure that there were robust systems in place for effective oversight and governance, to ensure people were living in a safe environment, supported by adequate numbers of staff, competent in their roles and deployed in a way which met people’s needs effectively.
There was not an effective system in place to ensure there were sufficient numbers of staff on duty to support people and meet their needs. There were not enough staff to provide adequate supervision, stimulation and meaningful activity. This had a direct impact on people’s safety and welfare.
People’s care had not been co-ordinated or managed to ensure their specific needs were being met. Risks to people injuring themselves or others were not appropriately managed. There was a lack of oversight to identify and manage risks associated with infection control, environment and equipment. Improvements were seen in the management of people’s medicines but care records gave conflicting information regarding the support people required with these.
The provider had not ensured the service was being run in a manner that promoted a caring and respectful culture. Although some staff were attentive and caring in their interactions with people, they were not supporting people in a consistent and planned way. They did not always respond appropriately and in a timely manner to all of people's needs.
Care documents remained inconsistent and did not demonstrate a planned approach to support people. There was a lack of clear guidance and key information for staff to enable them to support people with their emotional and mental health related needs. There was a lack of understanding and appropriate resources to support people with physical or mental stimulation appropriate for people living with dementia or other mental health conditions.
Additional training had been provided to staff but the provider had failed to ensure this learning was being put into practice. Staff were aware of their responsibilities with regard to safeguarding people from abuse. However, they did not recognise or understand the wider aspects of safeguarding people from risk as identified in this report.
Staff demonstrated an understanding of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) but the principles of the MCA were not always followed by staff. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.
The provider had failed to promote a positive culture within the service and there was an institutional approach to the delivery of care and support. Quality assurance systems had failed to identify the issues we found during our inspection.
Failures in the service continued to be widespread and demonstrated the provider’s inability to make and sustain improvements following our previous inspections in February 2017 and May 2016. This resulted in continued non-compliance with regulations and poor outcomes for people.
We identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following this inspection we took immediate enforcement action to restrict admissions and force improvement. We were also made aware of an ongoing police investigation in connection with the Harvey Centre and will continue to liaise with the police and local safeguarding authority. The Commission is further considering its enforcement powers. This includes taking action in line with our enforcement procedures to begin the process of cancelling the provider’s registration.
On 10 November 2017 the provider advised us that they would not be challenging the Commission’s urgent action. They also advised a decision had been made to close the service by 12 December 2017.