21 September 2016
During a routine inspection
1– 3 The Hollies is a purpose built care home comprising of three separate bungalows providing personal care and accommodation for up to nine people who have a physical disability. Each bungalow has three bedrooms, separate lounge, kitchen dining room and bathroom and toilet. The premises are equipped and adapted to meet the needs of the people who live at the home. There is level access to each property and tracked ceiling hoists have been installed where required. Each bungalow has its own garden area and off road parking is available for several vehicles. Staff and the people who use the service have the use of a small office which is located adjacent to bungalow 3.
The home is located in a residential area of Runcorn and is within easy access of the local amenities. There were nine people living in the home.
When we carried out our last comprehensive inspection of the home in October and November 2015 the registered persons were found not to be meeting all the requirements for a service of this type. We identified breaches of the relevant regulations in respect of the need for consent, safe care and treatment, nutrition, good governance, and staffing and an overall rating of Requires Improvement was awarded. We carried out a further focused inspection of the home on 19 February 2016, and found further breaches of the relevant regulations in respect of the need for safe care and treatment, good governance, and staffing and an overall rating of Inadequate was awarded.
Because the overall rating for this service was 'Inadequate' the service was placed in 'Special measures' following our last inspection. The provider undertook a service review and subsequently developed extensive action and recovery plans designed to bring about the required improvements in the provisioning and delivery of safe and effective care. The management team including a team leader, registered manager and area manager was replaced with interim managers and in August 2016 a new team leader, manager and area manager were appointed. This inspection was carried out to check if the required improvements had been made.
At the time of our inspection the new manager was in the process of applying for registration as “registered manager “of the services. A registered manager is a person who has registered with the 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.
Before our inspection we received feedback from the local authority contract monitoring team. They told us that, whilst they did not have a contract with SCOPE they had a duty to the people who lived at the home to ensure they received safe and effective care. The home had been subject to an improvement plan since November 2015 and there was on-going monitoring by the contracts monitoring team. Significant improvements had been identified and whilst there was still more to be achieved managers and staff were said to be working collaboratively with the contracts and monitoring team and other health and social care professionals to ensure that the people who lived at the home received safe and effective care.
Prior to this inspection we met with the provider’s representatives including a senior manager and the nominated individual. They told us that their internal enquiries had found that the home had been poorly managed for a number of years. The consequences of ineffective management had resulted in poor outcomes for the people who lived at the home and a disempowered staff team who had lacked the required confidence and skills to carry out their duties and responsibilities effectively. To address these longstanding failings the provider’s recovery plan was designed to bring about the required improvements in care practice and to ensure that staff received the guidance, training, support and leadership they required to conduct the service in accordance with the provider’s values and beliefs. Senior managers told us that whilst much had been achieved since February 2016 they were aware that there was still room for improvement.
The people who lived at the home told us that things had improved. They said they were happier because there were more staff which meant there were more opportunities to get out of the house and take part in ordinary activities such as shopping, going to the cinema and local cafés.
We found that the atmosphere in each of the three bungalows had much improved and at times was positively vibrant with fun and people engaged in a range of activities, or coming and going from activities in the community. There were times when the atmosphere was more relaxed reflecting the moods and temperament of the people who lived there but was always welcoming and sociable. We saw staff reinforcing people’s rights, involving them in decision making and empowering them in all aspects of daily living.
We found that the provider had made significant improvements in the management of the home and the delivery of care. We could see from their quality assurances processes that they were continually striving to improve the service and provide safe and effective care and support for the people who lived at the home. However, it was clear that there was still much work to be done to ensure people received safe and effective care and support. We identified further breaches of the relevant regulations in respect of safe care and treatment, eating and drinking, good governance, staffing training and development, person centred care, safeguarding vulnerable people from abuse and consent to care.
The overall rating for this service remains as ‘Inadequate’ and the service will therefore remain 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. 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.