Archived: The Hermitage Charity Care Trust

The Hermitage Charity Care Trust is a residential care home providing personal care to 30 females aged 65 and over in one adapted building. At the time of the inspection 26 people were receiving care and support.

People’s experience of using this service and what we found

Medicines were not always managed in a safe way. People were not protected from risk as incidents that had occurred had not been identified as safeguarding issues and had not been properly investigated.

Known risks to people’s health had not always been assessed and planned for.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice to ensure they supported people in the least restrictive way possible and in their best interests.

The provider had failed to make any improvements since the last inspection. There was a lack of systems in place to monitor the safety and quality of care being provided. Notifications of incidents we should have been notified of had not been sent to us or the local safeguarding team. Lessons were not always learned when things went wrong.

People and their relatives told us they felt well supported. The environment was clean and tidy and was adapted for the people living there. Staff were recruited safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 January 2020)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection improvements had not been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement (27 January 2020). The service has now deteriorated to inadequate. This service has been rated less than good for the past two consecutive inspections. This will be the third consecutive time the provider has failed to achieve a good rating overall.

Why we inspected

We had concerns in relation to some complaints reported to us. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hermitage charity Care Trust on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified multiple breaches in relation to the safe care and treatment of people, safeguarding people from abuse, notifying the CQC of particular incidents and the lack of quality monitoring systems in place.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

The Hermitage Charity Care Trust is a residential care home providing personal care to 30 females aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building.

People’s experience of using this service and what we found

There was a lack of effective systems in place to monitor all areas of people’s care needs and a lack of provider oversight to ensure planned improvements were implemented and sustained. Records were not always up to date and did not contain an accurate account of how people wished their care to be provided.

Medicines were not consistently managed in a safe way. People were not consistently supported to have maximum choice and control of their lives because the policies and systems in the service did not always support this practice. Staff did not always have enough guidance available to ensure they supported people in the least restrictive way possible and in their best interests.

We have made a recommendation about End of Life advance care planning.

Improvements were needed to ensure there was an effective system in place to ensure there were enough staff available to meet people’s needs. Improvements were needed to ensure people were safeguarded from the risk of harm when unexplained injuries and incidents had occurred, which meant lessons were not always learnt when things went wrong.

The provider used safe recruitment practices and people were supported by staff who knew how to support them to lower their risks, whilst promoting their independence. People were supported with their nutritional needs, and advice was sought from healthcare professionals to maintain people’s health and wellbeing.

People were supported by caring staff that supported people with patience. People’s choices were respected and their right to privacy was up-held. People had the opportunity to be involved in interests and hobbies. People understood how to make a complaint and there was a system in place to investigate and respond to complaints received.

People, relatives and staff found the registered manager was approachable and supportive. The registered manager worked with other professionals to ensure people’s needs were met. The provider had a system in place to gain feedback from people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 04 January 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection there were not enough improvements made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

Enforcement

We have identified breaches in relation to the assessment of people’s mental capacity, medicines management, mitigation of people’s risks and the governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Hermitage Charity Care Trust is situated in the market town of Uttoxeter and provides personal care for up to 30 females in one adapted building. The premises have been extended and modernised with all bedrooms now being on the ground floor. The care home was gifted in Trust to the ladies of Uttoxeter and is therefore only for females. At the time of our inspection, there were 28 females using the service.

At our last comprehensive inspection in May 2016, the service was rated as Good with the Key Question Effective being rated as Requires Improvement. The service was found to be not consistently following the principles of the Mental Capacity Act (2005) and people were being unlawfully Deprived of their Liberty. This was a Breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. A focused inspection took place in December 2016 and found that the provider had made the necessary improvements and the Key Question of Effective was rated as Good.

At this inspection, the Key Question of Caring was still rated as Good. The Key Questions of Safe, Effective, Responsive and Well-Led has now changed to Requires Improvement.

There was a registered manager in post. 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.

There were enough staff to meet people’s needs but staff had not received up-to-date training. Care plans were not always personalised and people did not always receive care that was responsive to meet their needs. Risks were not appropriately assessed and planned for.

People’s mental capacity had not always been assessed at the right time meaning people did not have maximum choice and control of their lives which meant that staff could not support them in the least restrictive way possible. There were no systems in place to monitor, learn and improve when things went wrong.

People were not supported to have their end of life care and wishes met but the service had begun working with an agency to develop this practice. Medicines were mostly managed safely and people had access to healthcare as required.

Staff knew people well were able to tell us how they protected people from the risk of abuse and/or harm. People were treated with kindness and people knew how to make a complaint. People were happy with the food and drink that was available to them.

Our inspection found a breach of regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to good governance at the service. You can see the action that we asked the provider to take at the end of this report.

We undertook this unannounced focused inspection on 13 December 2016 to check that the provider had addressed the breach in regulation identified at our last unannounced comprehensive inspection on the 27 May 2016. At our last visit we identified that the registered manager had not made any applications under the Mental Capacity Act Deprivation of Liberty Safeguards for people whose liberty may have been restricted. At our inspection in May 2016 we saw that some people’s capacity had been assessed, but they were not in place for everyone that needed support in making decisions. The registered manager sent us a report in June 2016 to address the areas of concern we identified.

The area that required improvement at our last visit was under the key question; is the service effective. This report covers the areas that required improvement and all key lines of enquiry (KLOE) under this question. The KLOEs are a set of questions we use that directly relate to the five key questions we ask of all services. You can read the report from our last comprehensive inspection visit, by selecting the ‘all reports’ link for The Hermitage Charity Care Trust on our website at www.cqc.org.uk

The Hermitage Charity Care Trust provides accommodation and personal care for up to 30 older people, ladies only. They are not registered to provide nursing care. At the time of this inspection visit there were 29 people living at the home.

The service had a registered manager in post. 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.

We saw that improvements had been made to ensure people’s rights were protected, as mental capacity assessments were in place for people that needed support to make decisions. Applications were being made under the Mental Capacity Act Deprivation of Liberty Safeguards for people whose liberty may be restricted.

Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. Staff knew about people’s care and support needs and received training to support their knowledge and learning. People received food and drink that met their nutritional needs and preferences and were referred to healthcare professionals to maintain their health and wellbeing.

The Hermitage Charity Care Trust provides accommodation and personal care support for up to 30 older women. There were 30 people who used the service at the time of our visit.

The service 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.

At our previous visit on the 14 November 2014 the service was meeting the regulations that we checked but we did ask the provider to make some improvements. Although best interest decisions were in place for people that were unable to make specific decisions for themselves, mental capacity assessments had not been completed to demonstrate that these people lacked the capacity to make decisions. At this visit we saw that some improvements had been made, some people had received a capacity assessment, but they were not in place for everyone that needed support in making decisions. The registered manager had not made any applications under the Mental Capacity Act Deprivation of Liberty Safeguards for people whose liberty may have been restricted.

People told us and we saw there were sufficient staff available to support them. Staff had knowledge about people’s care and support needs to enable care to be provided in a safe way. Staff told us that they were supported by the management team and provided with the relevant training to ensure people’s needs could be met.

Staff understood what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. Policies were in place and followed so that medicines were managed safely and people were given their medicine as and when needed. Thorough recruitment checks were done prior to employment to ensure the staff were suitable to support people.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Plans were in place to respond to emergencies to ensure people were supported in accordance with their needs. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported to socialise and take part in activities to promote their wellbeing. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us the staff made them feel welcome and were approachable and friendly.

Staff listened to people’s views and people knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

Is the service safe?

Since our last visit improvements have been made to ensure medicines were managed in a safe way.

Recruitment records demonstrated that thorough recruitment checks were undertaken before staff commenced employment, this ensured that the provider and registered manager had assured themselves that the staff employed, were considered safe to work with the people using the service.

Not all identified areas of need had a risk assessment and care plan in place to ensure people's safety and welfare. This meant that staff did not have guidance to follow to ensure people were provided with safe care.

Capacity assessments were not in place for people that lacked capacity to make decisions. This meant there was no written evidence to demonstrate that when people lacked capacity they were supported in the least restrictive way.

Is the service effective?

Information in care plans showed people made decisions about their daily lives and how they wished to be cared for. People spoken to confirmed that they were able to follow their preferred routines. One person said; 'I go to bed when I'm ready, there's no set times.'

In general people's care packages met their needs and preferences. People using the service told us that staff followed their agreed care plan.

Is the service caring?

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

People using the service told us they were happy with the support they received from staff. One person said; 'I'm very happy here, the staff are very nice, if I need any assistance I just ring the buzzer and they come and help me.' Another person told us; 'The staff are lovely, very good.'

Is the service responsive?

Staff spoken with had a good understanding regarding the level of support each person required to maintain their safety and well-being.

People we spoke with told us that if they had any concerns or worries they would tell a member of staff or a family member.

From our observations we saw that people using the service appeared relaxed and comfortable with the staff on duty and were able to openly express their opinions and preferences.

Is the service well-led?

Staff spoken with told us that the registered manager was approachable and did a good job. One member of staff said; 'The manager is lovely, she is so approachable.'

Staff were given an opportunity to express their views through staff surveys and team meetings.

Meetings for people using the service were provided on a monthly basis and people spoken with confirmed this. We looked at the minutes and saw that each meeting reviewed the previous matters and provided feedback to people. This demonstrated that people were given the opportunity to raise and discuss any issues.

Surveys were sent out annually to people's relatives to get their views on the quality of service provided. An evaluation of the survey and actions to be taken was displayed within the home. The questionnaires viewed contained positive feedback about the quality of service received.

We saw the staff were respectful to people when providing this support. People were relaxed in the company of staff. One person told us, 'The staff are very good here. They do their very best for us.'

People told us they could make choices about their food and drink. We saw that people were supported to eat and drink a healthy and balanced diet that met their individual needs.

We saw that people received support taking their medicines. The systems in place for the storage of Controlled Drugs and recording of these and other medicines were ineffective. This meant that the provider could not account for all of the medicines which were held on the premises, and some Controlled Drugs were stored inappropriately.

We saw that the provider had a system in place to regularly assess and monitor the service which focussed on service improvement.

People told us they were satisfied with the care and support they received and were happy with the staff team that supported them. People using the service told us that they felt safe. We observed the way staff interacted with people and we saw positive relationships.

We found the care and support were delivered in a warm and caring manner. Records were up to date, although some records, such as moving and handling assessments needed reviewing.

We looked at the training offered to the staff team and found that suitable training opportunities were provided.

The provider had systems in place to check on the quality of the care people received. We saw complaints were acted upon to improve outcomes for the people who used the service.