Archived: Harker Grange Nursing Home

Updated 27 July 2016

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.

This inspection took place on the 23 and 24 May 2016 and was unannounced.

The inspection was carried out by two adult social care inspectors.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed the information we held about the service, such as notifications we had received from the registered provider. A notification is information about important events which the service is required to send us by law. In addition we spoke with representatives from adult social care and the clinical commissioning group for Cumbria. We planned the inspection using this information.

We spoke with four of the people who used the service and 12 members of staff including the temporary manager, the business manager, two nurses, care staff and auxiliary staff.

We looked at eight written records of care and other policies and records that related to the service. We looked at six staff files which included supervision, appraisal and induction. We saw a record of training. We looked at quality monitoring documents.

Updated 27 July 2016

This unannounced inspection took place on 23 and 24 May 2016. At the last inspection on 24 February 2015, we asked the provider to take action to make improvements in the way it carried out suitable background checks on staff, this action had not been completed.

Harker Grange Nursing Home is registered with CQC to provide accommodation for up to 26 people who may require nursing or personal care. The home is also registered to provide the following regulated activities: diagnostic and screening procedures and treatment of disease, disorder or injury.

The accommodation consists of 12 single bedrooms, one of which has en-suite facilities and seven twin bedded rooms. The home has a variety of communal facilities such as lounge areas, bathrooms and toilets.

The service did not have a registered manager. 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 previous registered manager had left in February 2016. A new manager had been appointed and was due to start work in June 2016. In the interim a temporary manager had been appointed.

People who used the service told us that they liked the people who supported them and thought they were caring and polite.

The service had a complaints policy and procedure in place.

The service regularly sent questionnaires to people who used the service and their relatives to ascertain they were satisfied with the service.

Staff had not been subject to sufficient robust checks to ensure they were of good character and the provider had not deployed sufficient staff to meet all of people’s needs. Staff were not receiving appropriate training to enable them to carry out their duties.

The service was not assessing risks to the health and safety of people who used the service and were not doing all that was reasonably practicable to mitigate risks. This included the nutritional and hydration needs of people who used the service.

Topical medicines were not being managed and monitored correctly.

The premises required repair and refurbishment and infection control was not being managed efficiently.

Care and treatment of people was not being provided with the consent of the relevant person and people’s right under the Mental Capacity Act 2005 were not being upheld. The service was not treating people with dignity and respect and was not ensuring people’s right to privacy.

Care being provided was not person centred and care files we looked at were not written in a person centred manner to ensure care and treatment of people was appropriate, met their needs and reflected their preference.

The service did not have effective systems in place to assess monitor and improve the safety of services provided. In addition they failed to assess, monitor and mitigate the risks relating to the health, safety, and welfare of people who used the service and others who may be at risk of harm. Furthermore they had failed to notify the CQC of incidents which is a statutory obligation.

We found breaches of the following Regulations:

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 19 (1) (a) (b) (c) (2) (a) (b) (3) (a) (b) – Fit and proper persons employed.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 18 (1) – Staffing.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 12 (1) (2) (a) (b) (c) (d) (g) (h) - Safe Care and Treatment.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 18 (2) (a) (b) – Staffing.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 11 (1) - Need for Consent.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 14 (1) – Meeting nutritional and hydration needs.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 10 (1) (a) – Privacy and Dignity.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 9 (1) – Person centred care.

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 17 (1) (2) (a) (b) (c) (d) - Good governance.

Care Quality commission (Registration) Regulations 2009 Regulation 18 (1)– Notification of other incidents.

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 key questions it will no longer be in special measures.