The inspection took place on 13 and 24 August 2015 and was unannounced. Hoylake Cottage is a three storey, purpose-built care home that is registered to provide accommodation and nursing care for up to 62 people. The ground floor unit provided nursing care for up to 20 people; the first floor unit provided intermediate care for up to 20 people; and the second floor unit provided nursing care for up to 22 people who had dementia.
The home had 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.
All of the people we spoke with said they felt safe at Hoylake Cottage. We observed that the premises were clean and people had spacious and well-appointed bedrooms with en-suite facilities. Records showed that services and equipment were maintained in safe condition. On the second floor, we found many aspects of a dementia friendly environment, for example low windows in the lounges enabled people sitting in chairs to see the garden and courtyard areas.
We found a number of breaches of the regulations relating to safeguarding arrangements, staff training and support, consent and capacity and quality assurance processes. You can see what action we told the provider to take at the back of the full version of this report.
We found that there were enough staff to meet people’s needs and the staff we spoke with were friendly and helpful. We looked at the personnel files of six staff. All except one of the files included evidence of a formal, fully completed application process and checks in relation to criminal convictions and previous employment. This meant that the provider had ensured staff were safe and suitable to work with vulnerable people prior to employment. One person did not have an employer reference and their previous employment history was unclear.
Training records showed that a number of staff had not completed training in a range of subjects to ensure that they knew how to keep people safe, and a number of other staff had not updated their training for several years. The home’s induction programme for new starters did not reflect the ‘Skills for Care’ Care Certificate programme for new staff. Staff did not have one to one supervision meetings with their line manager and had not had a recent appraisal of their work performance. This meant that their training and development needs had not been identified and planned for.
Where people were identified as being at risk of harm, assessments were in place and action had been taken to mitigate the risks. We saw where people were at high risk of falls, timely referrals were made to the Community Therapy and Falls Prevention Team. We saw that accident records were completed in full and were summarised monthly. Personal emergency plans were in place to advise how people should be evacuated safely in the event of an emergency situation.
We inspected medication storage and administration procedures in the home and found that people’s medication was being managed safely.
The care records we looked at indicated the actions to comply with the requirements of the Mental Capacity Act 2005 had not always been fully followed. Care staff had a good understanding of matters relating to restraint, but this was not under-pinned by a robust policy or staff guidance document.
We saw evidence in written records to show that staff worked with various agencies and made sure people accessed other services in cases of emergency, or when people's needs had changed. This included GPs, hospital consultants, community nurses, specialist nurses, physiotherapists, speech and language therapists, dieticians and dentists.
We observed staff interaction with people throughout the day. The staff were gentle, patient and respectful. All of the staff interactions with people that we observed were friendly and caring. We saw people who lived at the home and staff had developed positive relationships with each other, and staff had an understanding of people’s likes and dislikes. However, in one care plan we looked at we found some inappropriate language used. Also, we observed that the confidentiality of people’s records was not always maintained.
People we spoke with were able to name members of staff who would they would speak to if they had any concerns. The home’s complaints procedure was displayed in the entrance area. It did not give the name or contact details, for example telephone number or email address, of anyone within the organisation who people could contact if they wished to make a complaint or raise a concern.
Care plans we looked at on the dementia care unit contained information about the support people needed. On the ground floor, we found that the system in place was not person-centred, nor was it based on an assessment of people’s needs and preferences. There were no signatures to show who had made entries on the care notes and ensure accountability.
On the ground floor we looked at the plan of care for a person who had leg ulcers. We found that the knowledge, training and skills of the nurses were effective in the care and treatment of this person’s wound care needs.
All of the staff we spoke with said that they enjoyed working at Hoylake Cottage and some had been there for a number of years. They told us that the manager was very supportive and they could go and speak to her and she would listen, however staff meetings did not take place regularly. We looked at records of the quality assurance system and found that the audits lacked detail and evidence. At the end of our visits we discussed the issues we had found with the registered manager. We found that the manager was not open and receptive to our feedback or to suggestions made by the specialist professional advisor as to where the service could improve.