The Hurst Residential Home

Updated 16 November 2022

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 Care Act 2014.

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 three inspectors.

Service and service type

The Hurst Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The registered provider is also the registered manager.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed the information we held about the service and the service provider. We looked at notifications and any safeguarding alerts we had received for this service. We sought feedback from the local authority and professionals who work with the service. Notifications are information about important events the service is required to send us by law.

The provider was asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We looked around the service and met with the people who lived there. We used the Short Observational Framework for Inspection (SOFI) during the morning of the first day of our inspection. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with eight people to understand their views and experiences of the service and we observed how staff supported people. We spoke with the registered manager, and six staff members. This included care staff and the cook.

We reviewed the care records of four people and a range of other documents. For example, medicine records, four staff recruitment files; staff training records and records relating to the management of the service. We also looked at staff rotas, and records relating to health and safety.

We continued to seek clarification from the provider to validate evidence found. We spoke with three health care professionals and completed these discussions on 14 October 2022.

Updated 16 November 2022

About the service

The Hurst Residential Home is registered to provide accommodation and support for up to 29 people who live with mental health difficulties including depression, anxiety, alcohol dependency and personality disorders. Peoples ages ranged from 40 to 80 years old. Some people also lived with health problems, such as diabetes, brain injury and mobility problems. The service also provides people with short term care (temporary). There were 22 people living at the home during our inspection. The provider for The Hurst Residential Home is also the registered manager.

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

The provider’s quality assurance systems failed to identify that care and treatment was not provided in a safe way. Audits had not been used to identify and manage risks to people. The registered manager knew the people who lived in the home very well, but had not ensured that staff had access to the information needed to keep people safe. The management structure was not robust and did not include a deputy manager or senior staff that could support the registered manager in the running of the service.

An infection prevention control audit was carried out by CQC during the inspection. It was found the provider was not meeting government guidelines for COVID-19. There was a lack of clarity on procedures to be followed. There had been no COVID-19 person specific risk assessments completed for people or staff, specifically for those who were vulnerable due to their complex health needs.

People were not always protected from harm as staff were not always provided with effective guidance to know how to keep people safe from harm. Not everyone’s specific health needs were identified and planned for to promote their safety and well-being. There were people who had recently arrived at the home who had not been assessed and therefore had no care plans or risk assessments. When people had accidents or were involved in an incident, there was no review or follow up documented for staff to follow to prevent the same thing happening again. There were outstanding actions on a recent fire assessment from February 2022, for example, non-functioning door guards.

There were some care plans and risk assessments that were comprehensive, and reflected changes to their health and well-being. Medicines were managed safely, and people said they got the medicines they needed. Staffing levels were consistent and were seen be enough to meet people’s needs at the time of inspection. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Feedback from people who lived at the Hurst was mostly positive. People told us that, “Staff were really good,” and “The home is a home with good home cooking.”

Staff were open and transparent during the inspection. Staff were kind to people and were committed to delivering good care and support. One staff member said, “This is my first job in care, I am learning so much and really enjoying it here.” Another staff member said, “The Manager is really supportive and the people are such characters. It’s not always straight forward and every day is different.”

There was good partnership working with health care professionals. This was confirmed by their comments. Feedback was sought from people in the form of small house meetings and daily one to one meetings.

The registered manager knew people well and had systems in place to keep staff up to date about people’s needs, this mitigated some of the risks that would otherwise have placed people at more serious risk of harm as documentation was not in place or up to date.

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

Rating at last inspection:

The last rating for this service was Requires Improvement (published 13 January 2022).

Why we inspected:

We undertook this focussed inspection to check on specific concerns we had about peoples’ safety and well-being and the management of risk in the service.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has remained Requires Improvement. This is the third time the service has been rated Requires Improvement since the Inadequate rating in 2019.

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

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 have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

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

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.