Archived: Hail - Great North Road

Updated 10 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection team consisted of 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. They assisted the inspection by making calls to seek feedback on the service.

Service and service type

HAIL- Great North Road is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement dependent on their registration with us. Hail – Great North Road is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

Inspection activity started on 27 October 2022 and ended on 6 December 2022. We visited the service on 27 October and 16 November. Both visits were unannounced. On 16 November we carried out a visit during the evening to see how people spent their evenings in the home.

What we did before the inspection

Before our inspection, we reviewed the information we held about the home.

We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with the registered manager and 10 support workers, 3 of whom worked as day operations staff who came to the home to support some people to go out during the day. We met the 4 people living in the home. We were able to speak with 2 people. We spent time observing staff interactions with all 4 people to help us understand the experience of people who could not talk with us. We also observed a mealtime. We looked at 3 people’s care records and medicines records for all 4 people; we also looked at various documents relating to the management of the service. This included staff training, provider audits and health records.

We completed a tour of the building and we looked at medicines’ management and food safety. We received feedback from 3 relatives, 1 advocate and 1 professional on behalf of people living in the home to get their views on the service.

We had meetings with the registered manager and regional manager.

We requested further information from the registered manager and provider which we reviewed as part of the inspection and we held a further meeting with them to discuss concerns.

Updated 10 February 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

HAIL- Great North Road is a residential care home providing accommodation and personal care for up to 5 people who have a learning disability. At the time of the inspection, there were 4 people living at the home which is in 1 adapted building.

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

Right Support

People were not supported to have maximum choice and control of their lives. 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.

Staff supported people to take their prescribed medicines, but this was not consistently managed safely and in people’s best interests. People could not always choose how they wanted to spend their time, whether they wanted to be with other people or in their own space. Although most people had support to go out and enjoy their choice of activity during the day, there were less opportunities in the evenings and at weekends. People sometimes went to bed early and spent the evening alone in their room when it was not clear whether this was their choice.

Staff had completed safeguarding training and understood their role in identifying and reporting any concerns of potential abuse or poor practice.

Right Care

There were some positive caring interactions where staff were kind and supportive to people. Some staff were very caring to people living in the home. There was a lack of assurance that staff were trained in understanding learning disability and people’s rights.

One person spent an afternoon and evening in bed with no personal care and staff did not recognise that this was unacceptable care. Staffing did not always meet people’s needs and preferences. Care was sometimes delivered in a routine and task-centred rather than person-centred way.

Right Culture

There was a lack of evidence of a positive person-centred culture which promoted people’s rights and autonomy. The service was not able to demonstrate they were meeting the underpinning principles of right support, right care, right culture. Staff were not aware of the right support, right care, right culture guidance.

Management oversight was ineffective, and although systems were in place to monitor the quality of care provided by the service, we found concerns their systems had not effectively improved. There was a lack of formal engagement with people, staff, professionals and relatives.

Recruitment practices were not consistently safe as some required checks had not been completed before staff worked at the service however the provider advised that no new staff had been employed since the last inspection and they would be operating safe recruitment going forward.

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

At the last inspection we rated this service inadequate (published 27 April 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made but the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We have found evidence that the provider needs to make improvements.

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 HAIL -Great North Road on our website at www.cqc.org.uk

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.

Enforcement and Recommendations

We have identified breaches in relation to providing safe care, medicines management, person-centred care, staffing and the overall management of the service at this inspection. We served a warning notice in relation to safe care and medicines management.

Please see the other action we have told the provider to take at the end of this report.

We have made 2 recommendations. We recommended the provider improve their recruitment practice and in line with best practice and ensure people have opportunity to make end of life care plans.

Follow up

Due to the seriousness of our concerns, we have requested an urgent action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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.