This inspection was undertaken on 13 August 2018 and was unannounced. This inspection was undertaken in response to concerns the Care Quality Commission (CQC) had received from local authority monitoring and commissioning teams. At our previous inspection of this service undertaken in March 2016 we found the service was meeting the required standards under the previous provider. This was the first inspection under the new registration with the new provider, C & K Healthcare Limited. At this inspection we found that there were serious failings from the provider and management to ensure people received care and support in a safe and effective way.
Honister 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.
Honister is a care home without nursing registered to provide accommodation and personal care in one adapted building for up to 19 older people some of who may live with dementia. At the time of the inspection there were 19 people living there.
The service had a manager who was registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.
The provider had not supported the newly appointed registered manager with mentoring or supervision in their new role. The registered manager did not have any autonomy to manage the service in the best interests of the people who used it which had a negative impact on safety and people’s dignity.
The provider had failed to support or encourage staff to undertake the training they needed in order to care for people safely. The management team did not have protected management time to undertake routine safety audits. Quality monitoring was inconsistent, had not identified risks to people and had not served to mitigate risk to people`s health and wellbeing. The provider had failed to undertake quality checks of the service to satisfy themselves that the service they provided was safe, effective, caring responsive and well-led.
The provider did not have a clear overview of the service provided or actions that were necessary to improve the quality of the service. The provider had failed to act on advice given by external health and social care professionals. Relatives of people who used the service knew the registered manager by name and felt that they were approachable with any problems.
Accidents or incidents were not always managed robustly and not always used as learning to improve the safety of the service. Risk assessments were not always detailed and did not clearly describe the controls in place to help mitigate risks to people’s safety and well-being. The environment was not always appropriate to promote people’s safety. The staff team was not sufficiently knowledgeable to promote people’s safety in the event of a fire. People were supported to take their medicines by trained staff however, we found some shortfalls which meant we could not be confident that medicines had always been administered in line with prescriber’s instructions.
Some of the staff team demonstrated a lack of understanding of infection control matters and some areas of the home required more in depth cleaning. We received mixed feedback about the staffing levels in the home. People told us that they felt safe living at Honister and relatives had no concerns about people’s safety at the home. Staff had been trained in how to safeguard people from avoidable harm and were knowledgeable about the potential risks and signs of abuse. Safe and effective recruitment practices were followed to help make sure that all staff were of good character and suitable for the roles they performed at the service.
Staff had not always received training, subsequent refresher training and supervision to support them to be able to care for people safely. We received mixed feedback about the support provided for the team and not all staff told us they were confident to go to the management for support.
The environment in the home was bland and was not enabling for people who may live with dementia or sensory impairments. People were provided with a good choice of food and they were supported to choose where they wanted to eat their meals. People’s day to day health needs were met in a timely way and they had access to health care and social care professionals when necessary.
People’s records were not always maintained in a manner that promoted confidentiality. Aspects of the maintenance of the environment did not promote people’s dignity. There was a lack of storage for people’s incontinence items which meant their rooms were cluttered with these items. Some aspects of record keeping did not promote people’s dignity. People’s relatives told us they were happy with the staff that provided people’s care and staff members said that they believed people received a good standard of care. Staff had developed positive and caring relationships with people they clearly knew well.
People's care plans were not sufficiently detailed to be able to guide staff to provide their individual care needs or end of life wishes. People’s relatives said they had not been involved in developing people's care plans even where people did not have the capacity to make their needs and wishes known themselves. There were no activities taking place at the home during the course of the inspection.
There were regular meetings scheduled for people who used the service and their relatives to share their opinions about the service and facilities provided at Honister however, these meetings were not well attended. The provider had a complaint policy and procedure however, just one complaint had been received this year. There was no system in place to capture verbal dissatisfaction of people who used the service and visitors to the home.