Archived: Hilcote Hall

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.

We inspected Hilcote Hall on 19 November and 24 November 2015. The inspection was unannounced. This was the first inspection since the provider had registered with us (CQC).

The service is registered to provide accommodation and personal care for up to 44 people. People who used the service were over 65 years old and have physical and/or mental health diagnoses. At the time of our inspection there were 39 people who used the service.

At the time of the inspection the registered manager had left the service and was in the process of deregistering with us (CQC). The service had another manager in place and they were in the process of registering with us (CQC). 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 and associated Regulations about how the service is run.

Risks to people’s health and wellbeing were not identified and managed by staff safely. We found there were not enough staff available to deliver people’s planned care or keep people safe.

People were not protected from the risks of harm because staff did not recognise when people’s safety was compromised and incidents of possible abuse were not reported as required.

We found that medicines were not administered in a consistent and safe manner at a time when people needed them.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was not identified and rectified by the manager and provider.

Systems in place to monitor accidents and incidents were not being followed or managed to reduce the risk of further occurrences.

People did not always get the support they needed to eat. Staff were not always available to monitor people were eating sufficient amounts. This meant some people’s nutritional needs were not met.

Staff told us they received training. However, we found that some of the training they had received was not effective. There were no systems in place to ensure that staff understood and were competent to support people safely and effectively.

People were not always consistently treated with dignity in an environment that protected their privacy and dignity.

People and their relatives were not involved in the planning of their care. People’s preferences had been sought, but staff had a varied knowledge of people’s care preferences. This meant that people were at risk of receiving inconsistent care.

Advice was sought from health and social care professionals when people were unwell. However, we saw that people were not always referred to specialist health professionals to ensure their health needs were met effectively.

People told us they were treated with care and given choices. However, we saw that improvements were needed to ensure that staff were able to interact with people in a way that met their needs.

Some people were given the opportunity to be involved in social and leisure based activities. However, improvements were needed to ensure that everyone had the same opportunities.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. We found that assessments had been completed with the involvement of other health professionals and representative, which ensured that decisions were made in people's best interests.

People knew how to complain about their care and the provider had a complaints policy available for people and their relatives.

We identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. We identified both continued and new Regulatory breaches. CQC is now considering the appropriate regulatory response to the problems we found.

The service is registered to provide accommodation and personal care for up to 44 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 32 people were using the service.

The service did not have 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 and associated Regulations about how the service is run. A peripatetic home manager was managing the service. They had not yet applied to register with us.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not managed safely and people were not always protected from the risk of abuse. This meant people’s safety, health and wellbeing was not consistently promoted.

There were not enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

Safety incidents were not always analysed effectively, which meant the risk of further incidents was not reduced.

People’s health and nutritional needs were not always consistently monitored and managed effectively to promote their health, safety and wellbeing.

The requirements of the Mental Capacity Act 2005 were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves.

We found staff did not always have the knowledge and skills required to meet people’s individual care needs and keep people safe. Staff did not show they understood people’s individual needs and behaviours that were linked to their diagnosis of dementia.

People were not always treated with dignity and compassion and their privacy was not always promoted. Staff did not always show they respected and understood people’s rights to make choices about their care.

Effective systems were not in place to ensure people received effective and comfortable end of life care.

People and their representatives were not always involved in the planning of care which meant people could not be assured that their individual care preferences were recorded and consistently met.

Leisure and social activities were promoted, but people did not get the support they needed to engage in meaningful activity when they needed to. People did not always receive the right care at the right time.

Relatives felt able to approach staff to complain about the care, but they were unsure who the manager of the service was. This meant there was a risk that complaints would not be made to the right member of staff.

Systems were in place to ensure people’s liberty was only restricted when this had been legally authorised. The provider was now informing us of notifiable incidents in a timely manner.