Archived: Hornbeam House

Updated 12 October 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.

The inspection took place on 15 August 2018 and was unannounced. The inspection was carried out by one inspector.

Prior to the inspection, we looked at the information we held on the service including notifications of significant events and safeguarding. Notifications are for certain changes, events and incidents affecting the service or the people who use it that providers are required to notify us about. We also contacted the local authority’s safeguarding team and quality assurance team to gather further information about their views of the service.

During the inspection we spoke with one person using the service, two care workers and the manager. We viewed the care records of one person using the service and five care workers files that included recruitment and supervision records. We looked at training records for all care workers. We also looked at medicines management for the person who used the service and records relating to the management of the service including service checks and audits.

Updated 12 October 2018

This comprehensive inspection took place on 15 August 2018 and was unannounced.

The last comprehensive inspection took place on 31 January 2018. The service was rated inadequate in the key question, ‘is the service Safe?’ and requires improvement in the key questions, ‘is the service Effective? Responsive? and Well Led?’ We found six breaches of regulations relating to the need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance and staffing. Following the inspection, we asked the provider to complete an action plan to show what they would do and by when they would improve the key questions of ‘Is the service Safe, Effective, Responsive and Well Led?’ to at least good. At this inspection we found the provider had made some improvements but not enough to fully meet the regulations.

Hornbeam House is a residential care home for up to three people with learning disabilities. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection one person was living at the service. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The provider, Eton Care Limited, is a private organisation and currently has two locations in London.

At the time of the inspection, there was not a registered manager in post. However, someone had been appointed to the role of manager and were starting work at Hornbeam in September 2018, at which time they would apply to become the 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.

During the inspection, we found incident and accident forms were not always completed as required. We found body maps with no explanation as to what had occurred to cause an injury and with no corresponding incident forms. The action plan attached to the fire risk assessment for the home was not completed until after the inspection. This meant the risks associated with people’s care and well-being were not always identified so these could be appropriately mitigated.

In addition, safe recruitment procedures were not always followed as robustly as they could have been to ensure staff were suitable to work with people as one staff member was missing a second reference.

Medicines were not always managed safely as the medicines administration records (MAR) were signed for by two staff, although most of the time, staff were lone working which meant someone was incorrectly signing. Medicines competency testing had been completed for all staff, however only two staff were observed administering medicines. This meant the provider was not always following their medicines procedures.

We found that consent to care was not always sought in line with the principles of the Mental Capacity Act (2005) as mental capacity assessments were not decision specific and we saw a relative had signed consent forms when they did not have the legal right to do so. A best interests decision meeting was held after the inspection. We recommended the provider follow the principles of the Mental Capacity Act (2005) to make sure people’s rights are respected.

The person received personalised care that was responsive to their needs and staff involved them and their relatives as appropriate. However, we did not see the initial assessment for the person and the file did not include end of life wishes, although the manager emailed a completed form to us after the inspection.

We saw a complaints procedure but not a policy and complaint forms were not in an accessible format. There were no recorded complaints, although we were aware a complaint had been made. This meant there was no evidence of how the provider addressed complaints, learned from them and improved the service.

The service had systems in place to monitor, manage and improve service delivery and to improve the care and support provided to people. However, these were not always effective as not all risks had been assessed and mitigated. Additionally, checks carried out on care records had not identified the way in which some of the consent forms had been completed.

Staff we spoke with knew how to respond to safeguarding concerns and there were procedures for reporting and investigating allegations of abuse and whistleblowing.

The premises were well maintained and there were systems in place to identify any repairs needed. Staff we spoke with understood how to manage infections and wore appropriate protective equipment to reduce the risk of the spread of infection.

Staff had completed relevant courses and received supervision which helped to provide staff with the skills and knowledge required to deliver effective care

The person’s dietary and health needs had been assessed and recorded and were met.

The person was treated with dignity and respect and we observed staff communicated with care and encouragement.

Staff told us the manager was available, listened to them and took action where necessary to act on their suggestions or concerns.

The provider received feedback and shared information through team meetings and completed satisfaction surveys.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, receiving and acting on complaints and good governance. You can see what action we told the provider to take at the back of the full version of the report.