The inspection took place on 16 and 17 August 2016 and was unannounced.Halvergate House provides nursing care for up to 50 older people, some of whom may be living with dementia. At the time of our inspection there were 37 people living within the home, 34 of which were on a permanent basis. Accommodation is over two floors and the second floor is served with a lift. All bedrooms have en-suite facilities and there are a number of communal areas as well as gardens.
At the time of the inspection, Halvergate House had a manager who had been in post for 12 months but had not yet registered with the Care Quality Commission (CQC). 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. Shortly after our visit, we received a manager application for this service.
We last inspected this service on 3 and 11 November 2015 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of three regulations relating to consent, dignity and respect and good governance. Following the inspection in November 2015, the service failed to send us a plan to tell us about the actions they were going to take to meet the above regulations.
At this inspection in August 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to dignity and respect, meeting nutritional and hydration needs and good governance.
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.
Effective systems were not in place to monitor the quality of the service and drive improvement. Where issues had been identified by the provider, there were no clear plans in place to rectify those concerns. Not all the issues highlighted in this report had been identified by the service.
Some people experienced a poor service at mealtimes. People were left waiting for their meal and did not receive the assistance they needed at a time they required. Equipment was not always available in a timely manner to assist people to remain independent in eating their meal. People were not offered a choice or explanation of what was being served at the time it was received.
People were not always treated with dignity and respect and their privacy was not consistently maintained. Staff were observed to speak across people they were assisting and talk openly about confidential matters in communal areas. People’s consent wasn’t always gained before assisting them and inappropriate language was used by some staff in relation to the people they supported.
People did not always receive the care and support they required at a time they needed it. Some people told us there were not enough staff to meet their needs. Staff, and some relatives, agreed and told us this impacted on the level of service people received. The provider confirmed that this has been identified and was currently being addressed.
The service had processes in place to help ensure that only those staff suitable to work in health and social care were employed. These included references from previous employers and completing criminal police checks. The staff we spoke with, and the records we viewed, confirmed these were in place prior to staff starting in post.
Processes were in place to help protect people from the risk of abuse. Staff had an understanding of what constituted abuse and how, and where, they could report any concerns they may have.
The risks to individuals had been identified, assessed and managed. These were individual to each person and covered areas such as health conditions, risk of malnutrition and dehydration and pressure areas. Although not all risks associated with the building had recently been recorded, checks were in place to ensure the premises were in good working order and regular maintenance was undertaken as appropriate.
All accidents and incidents were recorded and appropriate immediate action taken to ensure the person’s health and wellbeing. However, the analysis of accidents and incidents did not fully identify all trends and therefore mitigate all future risk of reoccurrence.
Medicines administration and management followed good practice and people received their medicines as the prescriber intended.
People told us that they had confidence in the skills and ability of most staff who supported them. Staff told us they had received training and most told us they felt supported although staff had not received regular supervisions or appraisals.
The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had assessed people’s capacity to make decisions and submitted appropriate applications to legally deprive people of the liberty where required. However, these assessments were not decision or time specific as required by the MCA. Staff had a basic knowledge of this legislation and how it impacted on their role and those they supported.
Where needed, people received the specific diets they required to maintain their health, safety and wellbeing. The service made prompt and appropriate referrals to health professionals and the people who used the service were involved in this. Activities took place within the home although some people told us they felt lonely or unstimulated at times.
People’s care plans were person-centred but not always accurate and up to date. However, staff had a good understanding of people’s needs, likes, dislikes and preferences. Some had been reviewed on a regular basis but this was variable. People had been involved in the decisions around the care and support they received and wished for.
The people who used the service told us that most of the staff were kind, caring and patient. We saw that they worked well as a team and staff told us they helped and supported each other. Staffing levels impacted on the morale of staff and they told us that, when staff numbers were as required, morale was generally good.
The manager was visible and approachable and available to speak with people should they need to. People told us they found the manager to be caring and receptive and that they would feel comfortable discussing any concerns or complaints they may have with them.
Not all legal requirements were met by the service at the time of the inspection visit and we found that they were not displaying their last inspection rating as required by law. This was rectified within the premises before our visit was finished and the rating was displayed on the provider’s website shortly after the inspection.