Archived: High Habberley House

This inspection took place on 18, 22 and 23 January 2018. The 18 January 2018 visit date was unannounced, which means the provider did not know we were coming. The 22 and 23 January 2018 we had arranged with the provider to return to the home to conclude our inspection visit. We found the service required improvement with five breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We were contacted by the provider a week after our inspection had finished. They notified us that a decision had been made to close the home. They told us this decision would be communicated with people who lived there and the staff who supported them.

Following the last inspection in July 2017, we asked the provider to complete an action plan to show what they would do and by when to improve in all of the key questions. This was because we found three breaches in regulation, for Regulation 9, Person-Centred Care, Regulation 10, Dignity and Respect and Regulation 17 Good Governance. At this inspection we found the provider continued to remain as Requires Improvement, with a continued breach of Regulation 9 Person-Centred Care, with further breaches in Regulation 12 Safe Care and Treatment, Regulation 17 Good Governance, Regulation 18 Staffing and Regulation 19 Fit and Proper Person's Employed.

There was a registered manager in place at the time of our inspection visit; however the registered manager was no longer working at the home and was in the process of de-registering with us. An operations manager had been managing the home for almost two weeks at the time of our visit. A new manager had been appointed who told us they would be applying to register with us.

A registered manager from the providers other service came to support the inspection visit. 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 2008 and associated Regulations about how the service is run.

Staff recognised signs of abuse and knew how to report this. Risk assessments were not always completed properly, which meant that actions needed to keep people safe and minimise risks were not always identified and acted upon. People felt that more staff were needed to meet their needs in a timely way. The provider had recognised that further review of people’s care was required as they could not be assured there was sufficient staffing to meet people’s individual needs. People’s medicines were managed in a way that kept people safe.

Staff supported people with their consent and agreement. However staff did not always understand the importance of this. We found that where Mental Capacity Assessments had taken place these were did not clearly demonstrate how staff were to support people, or whether other health care professionals had been involved in decision making around a person’s care. We found people were supported to eat a healthy balanced diet and were given enough fluids to keep them healthy. We found that people had access to their doctor when they required them.

People told us that the provider had not listened to them, and they continued to receive care that was not always in line with their preferences. People told us that staff treated them kindly and respected their privacy. People told us that their wishes were not always met as staff did not always listen to them.

People did not always receive care that was reflective to their individual needs. Where people had specific individual needs, staff had not always recognised this to ensure their care reflected their personal preferences.

Information on how to raise complaints was provided to people, and people knew how to make a complaint if they needed to. We looked at the providers complaints over the last 12 months and found that two complaints had been received and responded to with satisfactory outcomes.

The provider had identified that their plans to improve the service were not on target, and had brought additional management resources in to support the service. The operations manager had been working at the home for less than two weeks prior to our visit. We saw the operations manager during that time had begun to make positive improvements to people’s safety. However, throughout our inspection we found other areas of concern that had not been identified by the provider, however the provider responded to these concerns promptly. People and staff felt positive about the new general manager and while they recognised there was further hard work to do, staff felt positive this would improve with the new manager’s support.

You can see what action we told the provider to take at the back of the full version of the report.

The home provides accommodation with personal and nursing care for up to 45 people. At the time of our inspection 20 people were living at the home. Bedrooms and communal facilities were situated over the ground and first floor. A ‘bungalow’ area was not in use at the time of the inspection. At the last comprehensive inspection in March 2015 the service was rated as Good overall. We rated the effective question as Requires Improvement and a breach in regulation was identified. We carried out a focused inspection concentrating on this area only in December 2015. We found the breach was met however the rating in this one area remained the same.

The rating following this inspection has changed to Requires Improvement.

There was a registered manager in post at the time of our inspection. 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 2008 and associated Regulations about how the service is run.

The leadership of the home was not effective in recognising shortfalls to the health and safety of people who lived at the home and others. Systems in place to monitor the quality of the service were not always effective in highlighting shortfalls and identifying where improvement was needed.

Staff received training to enable them to have the skills and knowledge needed to care for people. This knowledge was not consistently put into practice by all members of staff. The care and support provided was not always personalised in order to meet the individual needs of people who lived at the home. Care practises were not always consistent with providing people with dignity and respect.

People told us they liked the food provided however people did not consistently receive the support they required.

Staff felt there were insufficient numbers on duty to enable them to provide the care and support people needed. Staff felt there was a reliance on a staffing tool and were unable to speak with us about its application. People did not have access to hobbies and interests due to a lack of staff to support them. When people needed support and used the call bell this was not always responded to in a timely way.

People received support and were able to access healthcare provision such as their doctor to maintain their wellbeing. People had there medicines administered as prescribed. Cream and ointments were not always applied in line with instructions

People felt safe at the home and liked the staff. Staff knew of the action needed in the event of them having to report abuse or any concerns. People were offered choice and consent was obtained before care and support was provided.

We found a number of breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is Requires Improvement.

You can see what action we told the provider to take at the back of the report.

After our comprehensive inspection on, 23 March 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. They sent us an action plan setting out what they would do to make the improvements and meet the legal requirements and when their actions would be completed by.

We undertook this focused inspection on 9 December 2015 to check the provider had followed their plan and to confirm they now met the legal requirements. This report only covers our findings in relation to those requirements.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for High Habberley House on our website at www.cqc.org.uk.

The provider of High Habberley House is registered to provide accommodation and nursing care for up to 45 people who have nursing needs. At the time of this inspection 31 people lived at the home.

There was a registered manager at the home who was present at the time of this inspection. 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 2008 and associated Regulations about how the service is run.

At our focused inspection on the 9 December 2015, we found that the provider had taken action and legal requirements had been met. This is because where people were unable to give their consent and make specific decisions either verbally or in writing about their care and treatment, actions had been taken in people’s best interests. This was with the involvement of people who had the authority to do so and knew people well in order to protect people’s rights as outlined in the Mental Capacity Act 2005.

People were encouraged and supported to make their own decisions and choices about their care and treatment which were respected by staff. Staff made sure people’s right to consent was upheld as they assisted and supported people. This was achieved by staff checking and making sure people understood what was said to them.

Staff used their knowledge around the MCA by supporting people to meet their needs as safely as possible in the least restrictive way.

We will review our rating for this service at our next comprehensive inspection to make sure the improvements made and planned, continue to be implemented by staff in a consistent way.

The manager of High Habberley House had submitted an application for registered manager status to the Care Quality Commission (CQC).A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We observed the care and support that people received to meet their different needs over the course of the day. We also looked at a sample of the care records of four people who lived at the home and various management records. These records were used to review, monitor and record the improvements made to the quality of care and support that people received.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found '

Is the service safe?

People who lived at the home told us that they felt safe and staff responded to their needs with minimum delays. One person told us, 'I feel safe and comfortable here.' A relative felt that their family member was safe and had no concerns about how staff treated them.

There was a focus on people's safety and we saw that staff assessed, identified and had taken action to reduce risks so that people were protected as much as possible from harm.

We saw that people who lived at the home had their medicines as prescribed at the right time and in the right way. This supported people's health needs so that these were effectively met.

Staff showed an awareness of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We saw that consideration of the Mental Capacity Act was evidenced in care plans where people gave their consent to their care and treatment. We also found that the manager and staff were aware when levels of intervention or supervision may represent a deprivation of a person's liberty.

People had their own rooms which were private and personal to them. One person who lived at the home told us, 'My room is nice and I like it. I like my door to be open but if I want it closed I can.' There were regular checks being completed to ensure that the premises were safe.

Is the service effective?

People told us they were happy with the care they received and that their needs were met by care staff. One person who lived at the home told us, 'It is okay here.' Another person said, 'Staff know me well, this is comforting as I get the help that I need.'

Each person had a range of care plans in place which provided information about how people preferred care and support to meet their daily routines. The plans also included information about people's health needs and interests and wishes for the future.

When we spoke with care staff they were able to tell us the care and support people needed which showed they understood their needs. However, some care plans did not have the most up to date information about people's needs. Staff took immediate action so that these were updated.

Staff worked in partnership with other professionals that supported people to receive appropriate care, treatment and support to meet their different health and social care needs.

Is the service caring?

People, who lived at the home and a relative that we spoke with, told us that they thought staff were caring. During the day we saw staff treated people in a kind and caring way. A relative told us, 'They (the staff) are kind, doing the very best they can.'

We saw that people received personalised care in an attentive and patient manner to meet their different needs. One member of staff told us, 'Caring for residents is not just about getting them up, dressed, washed and fed. It is the whole package of life, loves and interests.'

We saw that staff treated people with respect and dignity when they supported people with their challenging behaviour. However, we saw that staff sometimes struggled to maintain the support in a respectful and dignified way. The registered manager was made aware of this and assured us that they would address these issues immediately.

Is the service responsive?

There was evidence of unplanned engagements with people, such as, staff chatting with people. We also saw that entertainers came into the home. However, there was a lack of planned activities at the time of our inspection. The manager was aware of this and had recruited a person who would be responsible for activities. This showed that continual improvements were being made so that people had fun and interesting things to do.

People told us that staff listened to their views and supported them to keep in touch with people who were important to them by way of visits.

We observed staff encouraged people to be as independent as possible and to make their own decisions.

Is the service well led?

The provider had an effective quality assurance system in place and identified actions had led to improvements in the service that people received. The manager carried out a regular programme of audits and checks to make sure the quality of the service was maintained.

Where investigations had been required, for example in response to accidents, incidents or safeguarding concerns, the manager had completed a detailed investigation. This included information such as the actions that had been taken to resolve them.

Staff told us they were able to speak with the manager about any concerns they had. They felt they were treated fairly and supported by them.

The manager sought the views of the people who lived at the home and their relatives. We saw meetings were held with people and their representatives so that they could give their opinions on the service provided. The manager listened to people and had identified actions they would take to resolve any issues and/or suggestions people made. This helped to support people to receive a good quality service at all times.

We found that people or when necessary their relatives had given consent for care. The staff understood what people had consented to and provided care that met their wishes.

We found that staff knew about the needs of the people they cared for in most cases. We looked at care records for three people. We found that in two cases these contained guidance for staff on how to meet their needs. We saw that people's needs had been reviewed regularly. However, the third care plan we read did not meet essential standards. We also found that sometimes support and care did not meet this person's needs.

People had been protected from the risk of harm and abuse because staff had received training and understood their roles and responsibilities. Staff had been supported and trained to meet the needs of most of the people who lived at the home.

In this report the name of one registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still registered managers on our register at the time.