The inspection took place on 13 June 2018 and was announced. This meant the registered manager or registered provider didn’t know we would be visiting. At our last inspection in December 2017 we found the service was not meeting all our fundamental standards and was rated as ‘requires improvement’ and following this comprehensive inspection due to further breaches of our regulations the service was rated inadequate overall.
At the last inspection there were issues regarding staffing levels, person centred care, and staff training and equipment. We asked the provider to send us a report on their actions and they completed the outstanding issues raised. At this inspection we found some improvements however, further issues were found and in some areas the service had deteriorated.
The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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. Feedback from staff and relatives regarding the registered manager was positive.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures 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 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.
Hollyacre Bungalow is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hollyacre Bungalow accommodates 10 people in one building.
The care service provided at Hollyacre Bungalow at the time of our inspection was not 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 to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.
People were not protected from the potential risk of harm due to a lack of preventative measures in place at the home. We found a lack of fire safety procedures including; poor maintenance of fire safety doors and exits and an inadequate fire safety risk assessment.
Maintenance checks were not always carried out at the home and we found that there was no gas safety check in place at the time of our inspection.
Peoples medicines were not managed safely, we found medicines administration was not always recorded correctly and policies in place for staff were inadequate. When people were administered ‘as and when required’ medicines and topical creams, directions were not clear and the records to support this type of administration were not adequate.
Medicines were not audited regularly and stock counts were not taken and issues were not always found or addressed. Audits were not effective therefore didn’t highlight issues found regarding medicines administration and recording.
People were not supported to have choice and control over their own lives and were not receiving person centred care. Person centred care is when the person is central to their support and their preferences are respected.
Care plans were not person centred and were task orientated. These were written in a style that was not person first but more focussed on the medical model of disability which is an outdated view point and focusses on the person’s disability and not as an individual person.
Care plans were reviewed regularly by the registered manager however were not updated or improved.
Support for people was not person centred this meant their preferences and dislikes were not respected always. People did not have any planned goals to achieve.
Peoples nutrition and hydration needs were not always met, tools such as recording and monitoring systems to support people were not available and people were not regularly weighed.
Peoples dignity was not always protected by staff supporting them or by facilities available to them to support people with their personal care.
Audits carried out by the registered manager were not always effective at highlighting issues or improving the service.
People who used the service were asked for their views about the support through resident’s meetings however actions were not put into place following the meetings. Peoples relatives and other healthcare professionals were not asked for their views via questionnaires or feedback forms.
People were not supported to take risks safely and personalised risk assessments were not in place to ensure people were protected against a range of risks. Where they were in place they were not robust.
Staff had received safeguarding training, and were able to describe signs of abuse however, they were unclear of what they would do to report concerns to protect people.
People who displayed behaviours that can be seen to challenge others were not supported adequately as staff were not trained. Ineffective records were kept and a lack of oversight of incidents showed a lack of understanding and meaningful support for people.
Staff recruitment was carried out with safety checks in place for new staff however, there was no photo identification within some staff files to prove their identity.
There was not always sufficient staff to meet people’s needs safely and in an individualised way.
People were not supported by staff who were trained to meet their individual needs, Staff were trained in for example; safeguarding and first aid. Additional training was not in place or planned for areas specific to people’s individual needs.
Staff received regular supervision and support from the registered manager.
People were not always supported to maintain their independence by staff that understood and valued the importance of this.
Notifications of significant events were not submitted to us in a timely manner by the registered manager.
Health care professionals, including GP, district nurse or specialist consultants were Involved in people's care as and when this was needed and staff supported people with any appointments as necessary.
The home was tidy and free from malodours however kitchen facilities were not maintained to a working standard. The outside of the building was unkempt and not inviting.
Staff, relatives and other professionals told us the registered manager was approachable. We found they had a good knowledge of the needs of people who used the service.
People and their relatives could complain if they wished and were knowledgeable of how to complain or raise minor concerns.
People were not supported to access information in a variety of formats to suit their needs and no evidence was presented that had been made to suit individuals.
People were not always supported to take part in a wide range of activities at home and in the wider community as active citizens and to suit their individual preferences.
We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and good governance. You can see what action we told the registered provider to take at the back of the full version of the report.