Archived: Hilbre Manor EMI Residential Care Home

Updated 1 May 2021

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

This inspection was completed by two inspectors.

Service and service type

Hilbre Manor EMI Residential Care 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.

The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and health and social care professionals who work with the service. We used all of this information to plan our inspection.

The provider was not 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.

During the inspection

We spoke with three people who used the service and one person’s relative about their experience of the care provided. We spoke with five members of staff including the provider, care manager, and care staff.

We reviewed a range of records. This included eight people’s care records and a sample of medication records. We looked at two staff members records in relation to safe recruitment. A variety of records relating to the management of the service were reviewed.

After the inspection

We sought urgent assurances and an action plan from the provider to immediately address some of the concerns raised during this inspection. We reviewed some additional information from the provider relating to staff training, safe recruitment, medication records and testing for COVID-19. We also spoke over the telephone with one person’s family member.

Updated 1 May 2021

About the service

Hilbre Manor is a residential care home providing accommodation and personal care for up to 15 people in one adapted building over four floors with passenger lift access to each floor. At the time of our inspection 12 people were living at the home.

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

The provider had not ensured that testing for COVID-19 was taking place at the home in line with government guidance. Some testing was not taking place and the records for other testing showed that its use was sporadic and incomplete. This meant that reasonable measures to help protect people from COVID-19 were not being used effectively.

Following our visit, we urgently raised our concerns and required an urgent action plan along with assurance from the provider that COVID-19 testing in line with government guidance and their own risk assessment, would take place. We are continuing to monitor the testing for COVID-19 at the service.

We have made a recommendation about infection prevention and control practices. Staff did not always wear face masks in line with government guidance.

The requirements for the safe recruitment of staff who carry out regulated activities in social care are laid out in law. The provider had failed to ensure that robust systems were in place that ensured these legal standards were consistently followed.

The provider had not ensured that robust procedures and systems were in place for the safe and effective administration of medication. The provider could not evidence that all staff who were administering medication had received appropriate training and had their competencies assessed to ensure that they were safe to do so. The providers own medication audits for three months had highlighted that not enough staff members had received the relevant medication training and had their competencies assessed in administering medication.

We have made a recommendation about staffing levels and the deployment of staff to fulfil necessary supporting roles.

At our previous inspection people’s risk assessments and associated care plans did not always reflect the risks when caring for a person. At this inspection, risk assessments in place to monitor people’s safety and wellbeing had been recently reviewed, updated and now reflected the risks present when caring for a person.

Since our last inspection staff had received safeguarding training and the systems in place to record safeguarding concerns had shown recent improvements. These improvements need to be sustained and built upon to ensure that cultural change at the service is embedded.

At this inspection there had been some recent improvements in specific areas of the service. However, these were not embedded and there remained significant shortfalls in the quality of the service being provided. At six of the previous seven inspections dating back to 2015; Hilbre Manor has been in breach of Regulation 17, good governance. The provider over time, with different management structures in place has not been able to provide effective leadership, management and governance at the home for any sustained period of time.

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 inadequate (published 16 January 2021) and there were multiple breaches of regulation. Following our last inspection, we took enforcement action to remove the registration of the registered manager.

You can read the report from our last inspection, by selecting the 'all reports' link for ‘Hilbre Manor' on our website at www.cqc.org.uk.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains in special measures.

Why we inspected

This was a planned inspection based on the previous rating.

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

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 monitor the service.

At this inspection we have identified breaches in relation to safe care and treatment, staff recruitment and governance. Please see the action we have told the provider to take at the end of this report.

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 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.