We carried out this inspection in response to concerns we had received about Hinstock Manor Residential Home.A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?
As part of this inspection we spoke with three people who used the service, a relative, two care staff, the acting manager, deputy manager and the registered provider. We also reviewed records relating to people's care.
Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
We carried out this inspection in response to concerns we received from a person who wished to remain anonymous. It was alleged that there were insufficient staffing levels to safely meet people's care and support needs. Concerns were also raised about the management of people's prescribed medicines.
One person who used the service told us, 'I feel safe here and well looked after.' 'There is always someone around when you need them.' The acting manager confirmed that they were four care staff vacant posts which, equated to 144 hours per week. The acting manager said that these hours were covered by existing staff and agency staff. The rotas we looked at also confirmed this. We saw that staff were always nearby to assist people when needed. The acting manager confirmed that four care staff had been recruited and were awaiting the appropriate safety checks prior to commencing employment.
We found that the management of people's prescribed medicines was not robust to ensure they received their treatment. For example, it was difficult to determine whether people had received their medicines as medication administration records (MAR) were not consistently maintained. A MAR is a record of people's prescribed medicines that should be signed by staff to show when medicines have been administered. One MAR showed that the person had not received their prescribed treatment. However, discussions with the person confirmed that they had received their medicines. We were unable to find out whether other people had received their prescribed treatment because they were unable to tell us due to their health condition. The inadequate recording of medicines placed people at risk.
The room where medicines were stored was unclean and placed people at risk of cross contamination. Surfaces, floor and the washbasin were unclean and sticky. On the day of the inspection we found that the room where medicines were stored was warm. There was a thermometer in place that showed a reading of 23 Celsius. Discussions with the acting manager and the records we looked at confirmed that the room temperature was not consistently monitored. One record showed temperature of 29 Celsius. Medicines stored above 25 Celsius could affect the potency of medicines and make them less effective.
The acting manager confirmed that an audit of the management of medicines had not been carried since June 2014. We looked at the last audit that was carried out and found that no discrepancies had been identified. The poor management of medicines placed people at risk of not receiving their prescribed treatment.
The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that appropriate policies and procedures were in place. Mental capacity assessments had been carried out and records were maintained where DoLS were in place. One out of two care staff we spoke with confirmed that they had received Mental Capacity Act (MCA) training. However, both demonstrated a good understanding about MCA. The acting manager demonstrated a good understanding about when a DoLS application needed to be submitted.
Is the service effective?
We found that where people were at risk of falls appropriate action had been taken to reduce further risks. For example, one care record showed that a person had a history of falls. A falls risk assessment was in place that provided staff with information about the support the person required to reduce the risk. The doctor had been involved to ensure that there was no medical reason for the frequency of falls. A referral to a falls clinic had also been made. This meant the person could be assured that they would be provided with the relevant support.
Is the service caring?
One person who used the service said, 'It is very nice living here and I do get to go out.' 'The food is very good and we have a choice.' 'We have access to drinks at all times.'
Another person told us, 'The staff do look after you but you get use to the staff and then they leave.'
One person who lived there said, 'I have no moans or grumbles.'
We saw that one person was agitated and a care staff reassured them in kind and gentle manner. This meant that people were provided with support when needed.
Care plans were in place and these provided staff with information about people's care and support needs. We spoke with two care staff who demonstrated a sound understanding of people's care needs and how to support them. This meant that people could be confident that staff would know how to care for them.
Is the service responsive?
One person who used the service told us that they were fairly independent with managing their personal care needs. However, they told us that they had recently required support from staff. They said, 'The care staff was very kind and helpful.' This meant that staff were proactive in meeting people's changing needs.
Is the service well-led?
The acting manager had been in post for eight months and had not applied for registration. The provider has a legal obligation as part of their condition of registration to appoint a registered manager. The acting manager assured us that they would apply for registration.
The acting manager demonstrated a sound understanding of people's care and support needs. However, we found that they were aware that the management of medicines was not entirely robust and immediate action had not been taken to address this. The acting manager informed us that they had recently implemented competency assessments for staff to ensure that they had the skills and competence to safely manage medicines and we saw these assessments.