Archived: Hartlands Rest Home

Updated 2 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection team consisted of two inspectors on each day.

Service and service type

Hartlands Rest Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Hartlands Rest Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

The inspection was unannounced.

What we did before the inspection

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We contacted the local authority and Healthwatch for feedback about the service.

Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We used all this information to plan our inspection.

During the inspection

We spoke with 4 people living at Hartlands Rest Home and observed care and support being given in communal areas of the home. We spoke with 5 friends and relatives. We spoke with 7 members of staff including the Nominated Individual, Registered Manager, Deputy Manager, Nurses, Care Assistants, Cleaners and Cooks. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a wide range of records, such as care plans, medication administration records, staff records, quality assurance documents, policies, and procedures.

Updated 2 March 2024

About the service

Hartlands Rest Home is a residential home providing accommodation and personal care for up to 21 people aged 60 and over. At the time of the inspection 14 people were living there, some of whom were living with dementia.

People’s experience of the service and what we found:

People were exposed to risks from the environment including fire, following our inspection we made referrals to the fire service who have taken action. Management of medicines was not safe. People were not always safeguarded from the risk of abuse. Lessons were not learned after adverse incidents. Infection prevention and control measures were not robust, and people were placed at risk of Legionella and food poisoning.

The provider did not have a clear system to ensure there were enough staff to support people safely. Staff did not receive appropriate training to ensure they could deliver safe and effective care. Staff were not always recruited safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not have good oversight of the quality and safety of care, their governance systems were ineffective. People and relative described the registered manager as supportive. The registered manager felt unsupported by the provider and was planning on leaving their post following our inspection. There were no clear systems in place to proactively seek feedback from people, relatives and staff about the running of the service and how quality could be improved.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement 9 June 2023.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, training and safety of people. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

During the inspection we found there was a concern with people being given maximum choice and control of their lives, so we widened the scope of the inspection to include effective.

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

Enforcement

We have identified breaches in relation to the need for consent, safe care and treatment, safeguarding service users from abuse, governance of the service, staffing and training.

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

Follow Up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.