Archived: Hesketh House Care Home

Hesketh House is located on an old hospital site within a residential area of Wavertree, Liverpool. There are fourteen single bedrooms available for people with a learning disability, who require assistance with personal or nursing care. Communal areas include a dining room, a lounge, sensory area and a large garden with a terrace. At the time of the inspection there were 13 people using the service.

A registered manager was registered for the location and our records showed he had been formally registered with the Care Quality Commission (CQC) since October 2010. 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.

Staff had received training with regard to safeguarding issues and demonstrated an understanding of potential abuse. They told us they would report any concerns to the registered manager. We noted one potential safeguarding incident, raised by a trainee, had not been formally recorded as being investigated. We could not be sure the matter had been dealt with in an appropriate manner. Easy read information about safeguarding was not always available. Risk assessments in people’s care plans were not comprehensive and it was not clear they had been effectively reviewed. Personal evacuation plans, to support people in an emergency, had not been reviewed and updated.

Staff told us they felt there were not always enough staff to meet people’s individual needs and keep them safe. There was no formal assessment of people’s dependency and no available system to determine how staffing levels should alter to meet people’s changing needs.

Where people were supported with their medicines we found care plans for “as required” medicines were not always available and some creams were out of date or were not labelled with people’s name, to ensure they were used appropriately. One person’s fluid thickener had been left on an open trolley posing a potential risk that other people may use it inappropriately.

Suitable recruitment procedures and checks were in place, to ensure staff had the right skills to support people at the home. The home was generally clean and tidy and free from odours.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager told us some people had been subject to DoLS but these had lapsed in April 2016 and had failed to be renewed or reviewed. Where people did not have capacity to make decisions for themselves there were no clear best interests decisions recorded, as required by the MCA.

Kitchen staff had knowledge of specialist dietary requirements and supported people to make choices through the use of picture cards. People were not always supported with meals appropriately and in line with professional guidance, putting them at potential risk of choking. Records relating to food and fluid in take were not completed contemporaneously or by the staff who had directly supported people, meaning we could not be sure they were up to date and accurate.

Staff confirmed they had access to a range of training and records showed mandatory training was up to date. More specialist training to support people’s particular needs was not in date. Staff told us, and records confirmed regular supervision took place. Some annual appraisal documents were available and the regional manager told us not all had been completed due to change in the system used by the provider.

People’s health and wellbeing was monitored, with regular access to general practitioners and other specialist health or social care staff. Specialist advice from health professionals was not always followed or detailed in care plans.

Staff demonstrated an understanding of people’s particular needs and personalities. However, people were not always treated with respect and dignity as some care staff talked inappropriately about them and in front of them. Dignity was maintained during the provision of personal care.

Care records contained some good information about people as individuals. However, assessments did not always take into account available information and care plans did not always reflect professional advice. Reviews of care plans and risks associated with the delivery of care were not always detailed. There was evidence of some activities at the home, although a sensory room had not been available to people for over a year, as it had been used for storage. There had been no recent formal complaints. A relative told us they knew how to raise a concern, if necessary.

Audits and checks had not always been undertaken or identified the short falls highlighted at the inspection. The previous regional manager had not undertaken any checking visits and the provider’s quality team had not followed up required actions. Daily records were not up to date or well kept. There were gaps in important records such as those monitoring people’s weight.

The registered manager and registered provider had failed to notify the CQC of certain events at the home they are legally required to do so.

We found seven breaches of regulations. These related to person centred care, dignity and respect, need for consent, safeguarding, safe care and treatment, good governance and staffing. We also found the provider in breach of the regulation that requires them to notify the CQC of events at the home.

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.

As part of this inspection we spoke with two relatives of people using the service and two staff as well as the registered manager and the administration manager. We observed staff interacting with people using the service and although we spoke with two people, we were not able to ask them complex questions due to the nature of the service. We reviewed records relating to the safety of the premises and management of the home which included care plans for three people, staff training records, safety inspections and quality audits. Below is a summary of what we found. The summary describes what people using the service, their relatives and other people told us, what we observed and the records that we looked at.

Is the service safe?

We saw that an assessment had taken place before people had gone to live at the home and was followed by a comprehensive risk assessment after people had lived at the home for about a few days. The premises were appropriate and safe: regular maintenance and safety inspections had taken place and recommendations or issues had been addressed promptly. Staff knew how to deal with emergency situations but not all staff knew the specific actions to take in the event of a fire at the service. All staff had received general fire safety training. We discussed this with the manager who assured us that all staff will have updated fire safety training in the next few weeks.

Staff had been supported to receive appropriate training to care safely for the people using the service. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications had needed to be submitted, but the manager understood how and when to do so.

Overall we found that the service was safe, although improvements to staff awareness about fire safety at the home was needed.

Is the service effective?

The service was effective. Relatives told us that they were happy with the care people received and felt that all their needs had been met. A relative said, 'I can't fault it (and) couldn't ask for more.' Another said that they had been very impressed by the level of care and that supporting the person to move to the home had been, 'The best thing I ever did for (them).'

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff told us that a person had recently been supported through an effective plan of care, to leave the home and move to living independently.

One member of staff told us that they enjoyed, 'Making a difference' by helping people to settle into the home and helping them to maintain physical mobility as long as possible. Care plans reflected assessed risks, were reviewed and updated appropriately.

Staff understood mental capacity to consent issues. They talked about the ways that different people communicated and methods of helping them to understand information in order to make their own decisions.

Is the service caring?

The service was caring. A relative described the staff as, 'Very caring and absolutely wonderful.' They told us that they had observed the caring way that staff treated people who did not have visitors. Another said that all of the staff were, 'Brilliant and very caring.'

A 'thank-you' card that had been sent to the service referred to,'The loving care and kindness shown by staff to them and the person who used the service.' We spoke with staff who knew people's needs and spoke enthusiastically about the work that they did. We observed them interact with different people in a kind, patient and gentle way.

Is the service responsive?

The service was responsive to the changing needs of people using the service, to comments and suggestions and to recommendations made in reports about the safety of the premises. We saw that assessments of people's needs resulted in care plans that staff read. The care plans helped staff to know the needs and care that individual people required. Care plans were changed if people's needs changed.

A relative told us that they were always involved in discussions about any new problems or changes in care for the person using the service. They gave us examples of suggestions they had made that had been acted on. Staff told us that the manager was always responsive to new ideas and gave us an example: they had suggested producing a magazine about the activities people had enjoyed and that was now being produced.

Is the service well led?

The service was led by a registered manager who we met. People said the manager was, 'Great, and a good communicator', and that they thought the home was well led. Another relative said that both the manager and deputy manager were very good. Staff said the manager was, 'Nice and very supportive.'

The service had a system in place to monitor and assess the quality of the service. The manager was supported by the provider's regional manager and health and safety department to analyse trends and act to improve quality and safety at the home.

Staff were supported to complete a comprehensive induction program and on-going training to meet the needs of people living at the home. Records were accessible, relevant and legible, stored safely and archived after an appropriate time.

The detailed evidence supporting our summary please can be read in our full report.

We saw people's needs were assessed and care plans were personalised to the individual. Care plans contained information about individual preferences and promoted the person's independence where possible. People's progress was monitored monthly and relatives kept fully informed of any changes. We found people received the support they required and had agreed to.

During the inspection, we spoke with an independent professional who visits the service regularly, they told us that the service always had a lovely atmosphere and that staff really seemed to care for the people living there. The provider had a complaints procedure in place that was in easy read language and pictures.

We saw people were treated with respect, their dignity being protected and they looked very comfortable in the presence of the staff team. Those able to maintain some independence, such as, feeding themselves, were supported to do so, but staff supervision was always at hand, if needed.