Archived: Harvey Centre - Mental Health Nursing Home

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.

The service is attached to Connolly House hospital, also provided by Astracare (UK) Limited. Both services are governed by the same management team. The majority of people living at the Harvey Centre had first received treatment at the hospital.

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.

Despite assurances and an action plan stating that improvements would be made following our last inspection in May 2016, the provider had failed to establish effective systems and processes to assess, monitor and improve the quality and safety of the service, to ensure people receive safe and effective care.

The inappropriate management of people’s medicines placed them at risk of harm. People were not protected from the risks associated with the unsafe management of food and ineffective cleaning regimes. The provider had failed to take the necessary actions to ensure that the risks to the health and safety of service users were assessed, mitigated and reviewed appropriately.

Although improvements were seen in some people’s care plans they remained inconsistent and lacked sufficient detail in some areas. Despite the shortfalls within people’s records, people told us that they received personalised care which was responsive to their physical needs.

Activities remained task focussed and there remained a lack of opportunity for people to engage in meaningful activity outside of the planned provision. People lacked opportunities to make an informed choice about their meals and were not always effectively supported with their nutritional needs.

Staff understood the importance of gaining people’s consent and were compassionate, attentive and caring in their interactions with people. They understood people’s preferred routines, likes and dislikes and what mattered to them. People were involved in making decisions about their care.

There were enough staff to meet people’s needs and procedures were in place to safeguard people from the potential risk of abuse. Concerns and complaints had been investigated, responded to, and appropriate action taken.

Staff were trained and received regular supervision however training was limited in assisting staff to meet the specific needs of people living with dementia.

The lack of oversight from all levels of management meant improvements were not being properly implemented, monitored or sustained. This resulted in continued non-compliance with regulations and poor outcomes for people. We recommend that the provider consult current best practice guidelines for the provision of dementia care

During this inspection we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Commission is considering its enforcement powers.

The overall rating for this service is 'Inadequate' and the service is therefore 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, 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 than12 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 is attached to Connolly House hospital, also provided by Astracare (UK) Limited. Both services are governed by the same management team. The majority of people living at the Harvey Centre had first received treatment at the hospital.

There was a new manager in post who had started their employment with the service the day before our inspection. They were in the process of applying to become 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.

Care records included risk assessments to provide staff with guidance on how risks to people should be minimised. However these had not been regularly reviewed and updated and did not record how identified risks should be managed.

There were mixed views whether there were sufficient numbers of staff to care and support people according to their needs. Lack of staff at meal times meant that not everyone had a positive meal time experience.

Professional advice and support was obtained for people when nutritional needs were identified. However, these needs were not regularly assessed. The meal time experience was not always positive and people lacked support to make an informed choice about their meals.

People were provided with their medicines when they needed them however there was a lack of guidance for the administration of certain types of medicines.

People presented as relaxed and at ease in their surroundings and with the staff. Systems were in place to reduce people being at risk of potential abuse. Staff had received up to date safeguarding training and knew how to recognise and report any concerns.

Staff were trained to meet the needs of the people who used the service. The service was up to date with the Deprivation of Liberty Safeguards (DoLS). People were supported to see, when needed, health and social care professionals to make sure they received appropriate care and treatment.

People were positive and complimentary about the care they received. People were treated with kindness by the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner.

Care plans had not been consistently updated to reflect people’s current care needs. They were task focussed and lacked a holistic approach to ensure people’s general well-being. Despite the shortfalls within people’s records, people told us that they received personalised care which was responsive to their physical needs.

There was a lack of resources, time, staff knowledge and motivation to provide people with a range of appropriate activities to ensure all aspects of their physical, mental and emotional well-being were being met.

A complaints procedure was in place. Although some concerns and complaints had been investigated and responded to, there was a lack of confidence that people’s opinions were acknowledged and acted on.

The provider had quality assurance systems in place but audits and monitoring had not been carried out consistently by the management team. Records showed that some areas had not been monitored at all in the last 12 months. These systems had failed to identify shortfalls such as the failure to review and update care records and risk assessments and the lack of appropriate pressure care management.

There was not a culture in the service which promoted a holistic approach to people’s care to ensure all physical, mental and emotional needs were being met. However, there was confidence in the newly appointed manager. Other members of the management team acknowledged where there had been failings and by the second day of our inspection and started taking action to make improvements to the service.

One person who used the service told us: "They look after me well and arrange for me to go out when I want to." We looked at four care plans to ensure that people experienced effective, safe and appropriate care, treatment and support. We spoke with three relatives of people who use the service one of them told us: "The staff members are always friendly and prepared to listen and make any changes to the care they provide to meet our wishes."

We found that medicines were being administered safely, securely, appropriately and at the times when people needed them.

As part of our visit we saw records that showed that staff were appropriately supported to do their job. We also found that the organisation had systems and audits in place to assess and monitor the quality of the service provision.