George Hythe House

George Hythe House is a residential care home that can accommodate up to 43 people across four separate wings, each of which has separate adapted facilities. They are registered to provide personal care to people aged 55 years or over with a range of physical and/or mental health needs including dementia. On the day of our inspection there were 23 people who were living at the service.

People’s experience of using this service and what we found

Care plans provided enough guidance to staff to keep people safe. People received enough food and drink, however we saw one person did not always receive the correct consistency diet.

Staff were not always safely recruited to ensure they were of good character. They had received recent training and had the skills to provide safe care. Lessons had been learnt when things went wrong.

Staff did not always wear personal protective face masks to keep people safe from COVID-19 transmission. However, other infection control procedures were followed. External health and social care professionals had been contacted as needed to help guide effective care.

There were enough staff to support people at the service. We observed some mixed quality of staff interactions. There were some caring staff interactions, other interactions were less caring.

The service had undergone refurbishment since the last inspection. The provider had plans to further improve the physical state of the service. People received activities at the service and the refurbishment allowed people to use more areas of the home than the last inspection.

People were provided with end of life care, and staff were trained to do this. Care plans for end of life care were holistic.

People’s ability to make decisions were not always clearly recorded in required mental capacity assessments. People were suitably referred for deprivation of liberty safeguard referrals when needed

Staff, people and relatives spoke about the improved quality of service. There was no registered manager, but the acting manager was in the process of registering as the manager. We received positive feedback about the quality of their work.

The last inspection report was rated inadequate. The provider had created an action plan and many areas of the service has improved, however governance had not improved: recruitment safety, choking risks and mental capacity assessments. The provider has advised that further changes will be made to make improvements in these areas.

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 Inadequate (published 12 January 2022). At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

At the last inspection, we rated the service inadequate. We received positive feedback from the Local Authority that the service had improved. We also received regular action plans from the provider, suggesting that changes had been made. We decided to inspect the service to see what changes had been made.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for George Hythe House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safe recruitment, consent, and good governance.

Please see the action we have told the provider to take at the end of this report. 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

The last inspection resulted in the service being 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.

At this inspection, the overall rating for this service is now ‘Requires improvement’. We found significant improvements have been made since the last inspection. However, we have identified some ongoing breaches of regulation, which the provider has told us they will take action to resolve.

Due to the improvements made, the service is therefore no longer in 'special measures'. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

George Hythe House is a residential care home that can accommodate up to 43 people across four separate wings, each of which has separate adapted facilities. They are registered to provide personal care to people aged 55 years or over with a range of physical and/or mental health needs including dementia. On the first day of our inspection there were 32 people who were living at the service.

People’s experience of using this service and what we found

Care plans did not provide enough guidance to staff. Staff did not have the required skills to provide safe care. People’s risks related to choking were not always safely met. Lessons had not always been learnt when things went wrong. Infection control procedures were not always followed to keep people safe from COVID-19 transmission. External professionals had been contacted, but their advice was not always clearly recorded or followed by staff.

Staff were not suitably deployed around the service. Staff were kind in their approach, but the poor staff deployment caused a task focused approach to care.

The service had undergone refurbishment since the last inspection. The provider had plans to further improve the physical state of the service.

People received activities at the service, but we received mixed feedback about the quality of these activities. Care plans recorded people’s life history but there was not always clear guidance for staff to use this information in a responsive way. Relatives had made complaints, but these had not resulted in improvements in care.

People were provided with end of life care, and staff were trained to do this. Care plans for end of life care were not always holistic.

The last inspection highlighted concerns with: care records, staff recruitment, infection control, staffing levels, task focused care and auditing. This inspection found ongoing concerns in these areas. The provider has failed to oversee the required improvements. Therefore, there has been ineffective governance at the service.

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 6 March 2021). At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

At the last inspection, we had concerns about staffing levels and poor-quality care plans. Since the last inspection, we had received ongoing concerns about these areas. As a result of these ongoing concerns, we used our direct monitoring approach. This approach involves requesting documents from the provider and talking to the registered manager. After this process, we did not feel assured that the service safety had improved. We therefore brought the inspection forward.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for George Hythe House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safe recruitment, consent, and good governance.

Please see the action we have told the provider to take at the end of this report. 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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

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 of the provider’s 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.

George Hythe House is a residential care home that can accommodate 43 people across four separate wings, each of which has separate adapted facilities. They are registered to provide personal and nursing care to people aged 55 years or over with a range of physical and/or mental health needs including dementia.

At the time of our inspection there were 39 people who were living at the service.

People’s experience of using this service and what we found

Care plans and risk assessments were not always reviewed and updated regularly or when there had been changes to a person’s care needs. Staffing numbers were insufficient to fully meet people’s needs and keep them safe. Robust recruitment checks had not always been completed to ensure only suitable people were employed to work at the service.

There were some areas of infection prevention and control that needed to be strengthened, particularly in the time of the current pandemic.

The acting manager informed us that there were lessons learnt protocols in place so the provider could learn from incidents and accidents, safeguarding concerns and complaints to improve the quality of the service. However, these were not always recorded, and themes not always identified.

People's needs were assessed before starting with the service, however the assessments lacked detail about people’s diverse needs and how these should be met. Records showed that some staff training was out of date. The acting manager told us they were addressing the shortfalls in staff training and they were booking dates for further training to be completed by staff.

People provided us with mixed feedback about the quality of the food. People’s dining experience needed to be enhanced to ensure there were sufficient staff to support people with their meals. People’s dietary needs were not always reviewed regularly and support with nutritional needs did not always follow best practice guidance.

People were supported to access a range of healthcare support; however, we saw that for one person the relevant health care professionals had not been contacted for advice and support following two incidents.

People were not always 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.

Some parts of the home were poorly maintained. It needed redecorating in most areas. The acting manager said this was being addressed as part of the providers improvement plan which we received following the inspection.

People's records were not always kept securely. We saw care plans in the dining room on one wing that had been left unattended.

People’s care and support was often task focused rather than person centred care. Care plans lacked person centred information to ensure people received care in line with their preferences. People gave mixed feedback with regards to meaningful activities available at the service. Some told us they were bored and spent long periods of time in their room with little to do.

There was a pictorial end of life care planning policy in place to meet people's wishes for end of life care, however these plans had not been put in place for everyone at the time of our inspection.

There was a lack of effective quality assurance processes in place to monitor the quality and safety of the service. Feedback from people was not used effectively to drive improvement at the service. People, relatives and staff felt that communication had been poor from the provider during the transition of George Hythe House and during the COVID-19 pandemic.

People who lived in the service told us they felt safe living at the service and staff understood how to recognise and report any concerns they had about people's safety and well-being. Systems in place to ensure the proper and safe management of medicines were followed consistently and ensured that people received their medicines as prescribed.

People told us staff were kind and treated them well. Staff we spoke with were knowledgeable about people's individual needs and preferences and took account of this when they provided support and assistance.

There was a complaints policy in place and people told us they would feel comfortable to raise any concerns they had and were confident their concerns would be dealt with.

There was a manager who was registered with the Care Quality Commission (CQC) and an acting manager who was going to take over as the registered manager. We found they worked well together and shared the same vision for the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 17/07/2020 and has not been inspected.

The last rating for this service was Good (published 26 January 2018). Since this rating was awarded the registered provider of the service has changed. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

We received concerns in relation to insufficient staffing numbers, poor practices regarding infection control, a lack of staff training, poor and unsafe environment and poor leadership and management. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

The provider took action following our inspection to mitigate the risks to people’s safety and their welfare.

You can see what action we have asked the provider to take at the end of this full report.

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 alongside the provider and 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.