Archived: Lickey Hills

Updated 4 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions.This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 30, 31 August and 1 September 2017 by two inspectors. The first day of our inspection was unannounced and included a Specialist Advisor in general nursing care for people and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The inspection team consisted of two inspectors on the subsequent two days.

The inspection was prompted in by information and concerns received from the local authorities, health professionals and relatives of people who lived at the home. We looked at the information we held about the provider. This included statutory notification’s received from the provider about deaths, accidents and safeguarding incidents. A notification is information about important events which the provider is required to send us by law.

We spoke with 11 people who lived at the home and spent time looking at the care people received in the communal areas of the home Many people lived with dementia and we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people living at the home. We also spoke with nine relatives of people who lived at the home by speaking with them when they visited their family member. We did this to gain people's views about the care and to check standards of care were being met.

We spoke with the registered manager, the deputy manager, the Quality Lead, the Clinical Lead, two registered nurses, two agency registered nurses, three care staff, one activities co-ordinator, senior housekeeper, the provider’s Operations Director, the provider’s Managing Director and the provider’s Group Director in Performance and Regulation.

Updated 4 November 2017

This inspection took place on 30 August 2017 and was unannounced, on the subsequent dates 31 August and 1 September 2017. This inspection was in response to information of concern received, and raised by members of the public, relatives, health and social service professionals.

The provider of Lickey Hills is registered to provide accommodation with personal and nursing care for up to 82 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining rooms. At the time of this inspection 63 people lived at the home.

There was a registered manager in post who was present during the three days 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our inspection in May 2017 we found two breaches in regulation 9 Person Centred Care and regulation 17 Good Governance. At this inspection we found the provider had not made significant and sustained improvements. Therefore there were continuations in breaches Regulation 9 and Regulation 17.

People's daily records were not completed promptly. They did not monitor people’s fluid intake to ensure they were not at risk of dehydration. People were not always given a choice of food. The monitoring of people’s fluid and food intake was not always completed in a timely manner. Relatives were concerned their family member did not have sufficient drinks offered throughout the day.

We found medicines were not being managed safely. We found medicines not stored securely and left in a corridor which could put people at significant risk of harm. Although medicines were stored in medicine trolleys we found on two occasions either the door was left open or the medicine keys were left on top of the trolley so anyone could have accessed them.

Staff reported accidents and incidents to the office however; the management team did not review them to ensure appropriate action had been taken and to reduce the risk of incidents happening again.

Accurate records of people’s care were not always maintained. People's care plans did not contain the detail needed to keep people safe including guidance for staff about how to reduce the risk of pressure sores. photographs of the wounds had not been taken to record the healing progress.

People were not supported to maintain their hobbies and interests. There was a lack of specialist activities available for people living with dementia.

People were asked for their consent for care and were provided with care that protected their freedom and promoted their rights. Staff asked people for their permission before care was provided. Staff were well meaning and had good relationships with those they supported. However interactions were largely based around the completion of tasks.

Care plans did not provide sufficient guidance to staff on people's needs. We identified gaps in how people's needs were monitored in order to help people maintain their health and wellbeing.

People were kept safe from potential abuse and harm by staff who understood how to identify the various types of abuse and knew who to report any concerns. Although these incidents had been reported to the local authority the provider had failed to notify safeguarding incidents to the Care Quality Commission.

Auditing systems in place to monitor the quality of services provided were not robust and effective.

The provider had failed to ensure there was sufficient and sustained improvement following our last inspection. During this inspection we found significant shortfalls in the quality of the care being provided. We found the registered provider to be in breach of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 questions it will no longer be in special measures.