23 March 2017
During a routine inspection
Highcroft Manor accommodates and provides care, including nursing, for up to 30 older people mostly with dementia care needs. There were 23 people in residence on the first day of our visit and 22 on the second day because one person had been admitted to hospital.
The provider is a partnership; one of the partners is also the registered manager. The registered manager also managed another location. 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 registered manager had not fulfilled their requirements to the Commission as they had not provided notifications of all incidents or deaths that had occurred in the home.
There had been a systematic failure in all areas of assessment and monitoring of people’s care resulting in risks to people’s health and well-being. People did not always have their risks assessed or completed plans to mitigate their known risks. Staff did not always have access to plans of care that would provide instruction on how to provide care that met people’s needs.
People received care from nursing staff that required more clinical supervision and training to meet people’s needs. People were not sufficiently monitored for their health and nursing staff did not always act promptly on abnormal clinical observations. People could not be assured that they would receive all of their medicines as prescribed or their wounds managed appropriately.
People were not protected from potential harm as staff did not have strategies or plans to follow to protect people when people had behaviours that challenged others. Staff did not understand their responsibilities to report all incidents. Staff were not always kind; there was insufficient supervision of staff to ensure that they were supported to carry out their roles.
There were not always enough staff deployed to meet people’s needs. People did not always have the ability to call for assistance and staff had little time to talk or support people with activities or socialising. Care was mainly task focused and did not take account of people's individual preferences and did not always respect their dignity. People were not always supported to have sufficient to eat and drink to maintain a balanced diet.
People were not protected from the risks associated with a poorly maintained environment. There was a failure to assess the environment for potential risks to health and safety or implement changes to protect people from potential risks.
People could not be assured that their verbal and written complaints would be addressed. There were no adequate systems in place to receive and act on complaints. People’s records of care had not been maintained and all records in the home were disorganised.
We identified that the provider was in breach of nine of the Regulations of the Health and Social Care Act 2008 (regulated activities) Regulations 2014 (Part 3) and two Regulations of the Care Quality Commission (Registration) Regulations 2009 (Part 4). We took urgent action to impose a condition on the location’s registration to prevent the service taking any new packages of care.
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 complete our enforcement action of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
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.