Background to this inspection
Updated
13 March 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by an inspection manager and an inspector on day one and the same inspector on day two.
Service and service type
Keep Hill is a ‘care home’. 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager was also the provider.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection-
We spoke with three people who used the service and one relative about their experience of the care provided. We spoke with six members of staff including the registered manager, deputy manager, shift leader, two care staff and the activity coordinator. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included seven people’s care records and nine medicine administration records. We looked at three staff files in relation to recruitment and seven staff supervision records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. Information requested was not responded to in a timely manner and some information was not provided. We spoke with two relatives by telephone and informed the Local Authority and the fire service of our concerns about the service.
Updated
13 March 2020
About the service
Keep Hill is a residential care home registered to provide personal care and accommodation to nine people over 65. However, at the time of the inspection the service was providing care to a person under 65. The Statement of Purpose had not been updated to reflect the change in the service user band and we were not notified accordingly of the change in the service user band.
The service is owned and managed by an individual and is one of two homes run by the same provider.
At the time of the inspection nine people were living at the service. People’s bedrooms were both on the ground and first floor. Five bedrooms have en-suite facilities and four people share shower rooms. People have access to communal facilities of the sitting /dining room.
People’s experience of using this service and what we found
A person told us their experience of living at the service was “okay”. Another person told us they hated it, felt disliked and had nothing in common with the people living there. A relative was happy with the care their family member received, although acknowledged the service looked “tired”.
Safe care and treatment was not provided. People were not safeguarded from abuse and risks to them were not managed. Safe medicines practices were not promoted. Accident and incidents were not appropriately managed and there was no system in place to learn from incidents and prevent reoccurrence.
The staffing levels were not sufficient to ensure staff were not working excessive hours and changes in people’s needs had not resulted in a review of the staffing levels. Staff were trained but the training was not effective to enable them to deliver safe and effective care. Staff were not supported in line with the provider's policy and daily practices were not monitored and poor practice was not addressed.
The environment of the service was not fit for purpose. The service was not suitably maintained and furniture and furnishings were broken, and unhygienic. People were assessed but the assessment failed to identify their needs and how they could be met. Person centred care was not provided and people’s communication needs were not identified and met. Activities were provided but access to community-based activities was limited. The service had not established community links to benefit people.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People's privacy and dignity was not consistently upheld.
People’s health and nutritional needs were identified but records were not suitably maintained to show how these were met. Records were not suitably maintained or secure.
The service was not effectively managed or audited. The registered manager failed to make the required notifications to CQC to inform us of events and changes within the service. They failed to bring about the required improvements to the service and had not identified other improvements were required.
The service had a consistent staff team and they knew people well. Some staff were generally kind and caring but their engagement with people was not always appropriate and show the required level of respect.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was requires improvement (published 14 February 2019). The service has been rated requires improvement for the last four consecutive inspections. At this inspection the rating had deteriorated further.
The provider has been in continued breach of Regulation 17 for the past three inspections and in breach of Regulation 12 for two inspections, in 2016 and 2019. At the previous inspection in February 2019 positive conditions were imposed on the providers registration in respect of breach of Regulations 17. The provider/registered manager sent us monthly updates on the progress within the service, which was an overview of what had taken place in the service each month. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
Enforcement
We have identified breaches in relation to the management of risks, medicines, staffing levels and their training and support, the environment, level of cleanliness, consent, dignity and respect, person centred care, records, governance and notifications.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.