Archived: Hilbre Manor EMI Residential Care Home

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.

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 lift access. At the time of our inspection 13 people were living at the home.

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

The policy and systems in place at the service, designed to safeguard people from the risk of abuse were not being followed. The registered manager and provider had not always ensured appropriate safeguarding alerts had been raised and the registered manager had not candidly engaged with social workers who investigated safeguarding concerns.

The monitoring of people’s safety and wellbeing remained ineffective and people's risk assessments and associated care plans did not always reflect the risks present in their care. Plans and checks in place to help ensure people were safe in an emergency, the monitoring of people’s falls and monitoring the safe use of medication were inadequate.

There was often a failure on behalf of the provider and registered manager to acknowledge, learn and make improvements when events went wrong within the service. The systems in place used by the registered manager to have oversight of the safety and quality of the service were inadequate.

The provider and registered manager operated the home as a closed culture, they had resisted information sharing and engagement with stakeholder organisations.

The provider and registered manager had failed to ensure they had informed the CQC of information where they had a legal obligation to do so. The registered manager has also failed to be candid in his communication with the CQC.

There were enough staff present to meet people’s needs in a timely manner; the rota system demonstrated there were consistent staffing levels. Care staff were friendly, and we observed them treating people with kindness.

The home’s environment was clean and well-maintained.

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 1 February 2020) and there was a breach of Regulation 17 (Good Governance). The registered manager completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found there had been a deterioration in the governance of the service; therefore, the home remains in breach of Regulation 17.

This home has been rated requires improvement for the previous six consecutive inspections.

Why we inspected

The inspection was prompted in part by information we received that raised concerns about people receiving safe and effective care. The provider had moved five people into Hilbre Manor from one of their other homes at the end of April at the height of the COVID-19 pandemic, without engaging with partner organisations and against the published advice of Public Health England.

We had become aware of a number of events recently taking place at the home, that had resulted in serious safeguarding concerns being raised. The registered manager and provider have not been candid about these events; they had not reported them to the CQC even though they had a legal obligation to do so.

A decision was made for us to conduct a focused inspection and examine those risks under the key questions of; ‘Is the service safe?’ and ‘Is the service well-led?’ Ratings from previous comprehensive inspections for the other key questions were used in calculating the overall rating at this inspection.

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

The overall rating for the service has therefore changed from requires improvement to inadequate; based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hilbre Manor EMI Residential Care Home 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 pandemic when considering what enforcement action was necessary and proportionate to keep people safe. 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.

In May 2020 we took urgent enforcement action to restrict new admissions to Hilbre Manor EMI Residential Care Home and restrict the moving of people between this home and another home then owned by the provider, unless they had written permission of the CQC. We took this action because we received information of concern that the provider was planning to move five people into Hilbre Manor from one of their other homes during April, at the height of the Coronavirus pandemic. The moving of people by the provider took place with a lack of communication and transparency, without engaging with partner organisations and against the published advice of Public Health England.

At this inspection we have identified breaches in relation to assessing risk and ensuring people are safe, safeguarding people from the risk of abuse and the provider, notifying CQC of events that they have a legal obligation to do so and the provider and registered manager failing to assess, monitor and improve the safety and quality of the service being provided.

Full information about CQC’s regulatory response to the serious concerns found during this inspection will be added to this report after any representations and appeals have been concluded.

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 have raised our concerns about this service with the local authority and will work with them to closely monitor the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 six 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 of their 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.

Hilbre Manor is a residential care home providing personal and accommodation for up to 15 people in one adapted building. At the time of the inspection 12 people were using the service. The home in a residential area of Wirral.

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

The oversight of the systems in place to ensure people were safe needed improving. The monitoring of people’s safety had not always been effective, risk assessments did not always provide appropriate guidance for staff and plans to keep people safe in the event of an emergency were not robust. The pre-employment records in staff files did not always demonstrate that a robust recruitment process had taken place.

The registered manager had not ensured that staff had received appropriate training. For example, a low percentage of staff had completed the providers safeguarding, falls prevention and dementia care training.

We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed. This placed people at risk of harm and was a continued breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The registered manager and the provider had not informed the CQC of certain events that they are legally obligated to do so. This is a breach of the conditions of registration for this service, which will be considered separately to this inspection.

Overall the environment of the home was clean and safe. The services and equipment in the building had been regularly checked and serviced and the registered manager completed regular health and safety audits. People received their medication safely and as prescribed.

Staff spent time sitting and chatting with people and were responsive to people’s everyday requests. Staff provided people with information and supported them to make day to day choices. People told us they 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. However, the records and systems in the service did not clearly demonstrate this practice.

People told us that they were well treated and supported by staff. Each person had an individualised care plan which contained important information about their background, family history, their preferences and other details that were important to them. Staff were knowledgeable about people and used this information to improve people’s experience at the home. People’s relatives told us that their family members had benefited from this approach. One person’s relative said, “[Name] looks so much better since coming here, I can’t believe the difference.”

There were opportunities for people who were able, to go out into the community in the providers mini bus. People told us that they enjoyed doing this. There were other activities available for people based within the home. People told us that they enjoyed the food and the dining experience at the home. The cook was enthusiastic about their role and had an excellent knowledge of people’s food needs and preferences.

People and their family members told us that they felt consulted and communicated with by the registered manager and the staff team. The registered manager had positive relationships with people and their relatives. People’s relatives told us they thought there was a positive culture at the home and people had benefitted from this.

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 28 November 2018) and there was a breach of regulation 17 (good governance). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the provider was still in breach of regulation. This service has been rated requires improvement for the last five consecutive comprehensive inspections.

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

Why we inspected

This was a planned inspection based on the previous rating.

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.

Hilbre Manor EMI has accommodation for people over four floors. It provides accommodation and support for up to 15 older people who live with dementia. The house has a large garden and a passenger lift. It is on a main road in Prenton and has good access to public transport and other community facilities. At the time of inspection, the home had 14 people living there.

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 the time of inspection the service had a manager in post who was going through the registration process with the Care Quality Commission.

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

We last inspected this home in July 2017. During this inspection we found the service was in breach of regulations 12, 18 and 17 of the health and social care Act 2008 (Regulated Activities) Regulations 2014.

Following this inspection the registered provider sent us an action plan which described how they were going to meet these breaches and we checked this during this inspection.

At this inspection, we found that significant improvements had been made, and the registered provider was no longer in breach of regulations 12 and 18. However the registered provider remained in breach of Regulation 17 as there were continued concerns around consistency of paperwork and quality assurance systems and processes.

Despite some improvements being made to the audit and checking systems that were in place, there were still come inconsistencies in the recording of information which had not been highlighted by the current checking regime. We did feed this back during our inspection process and the manager accepted and took our feedback on board.

The registered provider had ensured regular checks were carried out and the premises were safely maintained. We also saw that risk assessments for people were completed and risks were adequately assessed. We did highlight some recording issues which were recertified during our inspection.

The registered provider had enrolled all staff on training which was appropriate to their roles. This information was recorded in the training matrix and we saw evidence this had took place by looking at certificates in staff files. Staff had also engaged in regular supervisions.

We checked records in relation to the Mental Capacity Act 2005 and whether people were being lawfully deprived of their liberty following a capacity assessment. We saw that Deprivation of Liberty (DoLs) were suitably applied for and people’s capacity was assessed. We did see however that some of the information in relation to people’s capacity required further clarification. We made a recommendation regarding this.

There was information recorded in people’s care plans which specified how they required their support to be delivered. There was also detailed information regarding people’s likes, dislikes and backgrounds. We did see however, that the level of this information differed from care plan to care plan, and some more information would have been beneficial.

Everyone was complimentary about the home and the staff. People told us they felt safe and well supported.

Medication was managed well and stored correctly. Medication was only administered by staff who had the correct training to do so.

Staff recruitment was safe. Appropriate checks had been carried out on staff before they started working at the home, and most staff had been working at the home for a long time. We did see some missing records from staff files, however these were made available to us before the end of our inspection.

The home as clean and tidy and there was Personal Protective Equipment available for staff to utilise when they supported people with their personal care needs.

People were complimentary concerning the food. We observed lunchtime and people were offered a choice of main meal and desert. The food looked appetising and we observed people were enjoying the food.

The decor was pleasant and reflected a dementia friendly environment. There was directional signage around the home to help people living with dementia orientate their way around.

Observations and conversations with people who lived at the home, visitors and relatives indicated that staff were kind and caring in their approach. We saw staff interacting with people in a kind and familiar way, and staff enjoyed caring for the people at Hilbre Manor.

Complaints were well documented and addressed in line with the registered providers complaints procedure. People we spoke with told us they knew how to complain.

People were supported to remain at the home if this was their choice during the final days of their life. Staff were trained to offer sensitive and compassionate support to people and their families.

People spoke positively about the manager and the registered provider. Team meetings took place often and the registered provider often attended these meetings. Staff said the manager and registered provider were a good source of support to them and felt they could raise any issues and they would be addressed.

The ratings for the last inspection were displayed in the communal area of the home.

You can see what action we have told the registered provider to take at the back of this report.

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 the time of inspection the service had a manager in post who was going through the registration process with the Care Quality Commission.

During our inspection we found breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report. These breaches related to the safety of the premises, risk assessments, governance of the service and staffing.

During our visit we found that care plans and risk assessments were mostly in place for people living in the home, however some risk assessments were not always in place or had contradictory information in them. The personal evacuation plans for people did not always match the risk assessments contained in their care files. The provider informed us on the second day of inspection that this was being actioned. These files and people’s needs should be regularly checked and updated, not as a consequence of a CQC inspection.

There were some quality assurance systems in place but these did not operate effectively enough to ensure people received a safe, effective, caring, responsive and well led service. Staff did not receive the training and supervision they needed to support people with dementia. This placed people at risk of receiving inappropriate and unsafe care.

The service had systems in place to ensure that people were protected from the risk of harm or abuse. We saw there were policies and procedures in place to guide staff in relation to safeguarding adults. However most staff had not received any up to date training surrounding safeguarding.

We saw that the home did not have records of any reassessment of people’s capacity before deprivation of liberty safeguards were applied for. The acting manager told us of the people at the home who lacked capacity and that the appropriate number of Deprivation of Liberty Safeguard (DoLS) applications had been submitted to the Local Authority in relation to people’s care. We identified one was out of date and this was reapplied for during the inspection.

People told us they felt safe at the home and had no worries or concerns. From our observations it was clear that staff cared for the people they looked after and knew them well. Relatives we spoke with said they would know how to make a complaint. No-one we spoke with had any complaints.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. All medication records were completely legibly and properly signed for. All staff giving out medication had been appropriately trained.

Staff had been recruited safely with appropriate criminal records checks, however some checks required under legislation had not been completed.

The home had recently undergone an infection control audit and we saw that the findings had been actioned and completed. The home was clean, safe and well maintained. We saw that the provider had an infection control policy in place to minimise the spread of infection and a good supply of personal and protective equipment. For example, hand gels, disposable aprons and gloves.

We had previously carried out an unannounced comprehensive inspection of this service on 5, 12, 14 and 15 April 2016. Since that inspection we received concerns regarding lack of care and risk assessments, safe recruitment of new staff members, inadequate bathing facilities, the security of people’s monies and inadequate staffing numbers at the home. As a result we undertook this focused inspection on 21, 22 and 23 September 2016 to look into those concerns. This report only covers our findings in relation to those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hilbre Manor EMI Residential Care Home on our website at www.cqc.org.uk .

We found that there was evidence to show some of the allegations would have been substantiated without any intervention. However, in the short time since the allegations had been made, when we visited the home in September 2016, the new nominated individual and the new manager for the service had made good progress with respect to the areas of concerns. They were positive about the future progress of the service.

Hilbre Manor EMI Residential Care Home has accommodation for people on the lower ground, the ground, first and second floors. It is registered to provide accommodation and support for up to 15 older people who live with dementia. There are 12 rooms, three of which are able to be double. The house has a large garden, a passenger lift and the home was refurbished in 2015. It is on a main road in Prenton and has good access to public transport and other community facilities. At the time of our inspection, there were eight people living in the home and all were accommodated in single rooms.

We saw that staff recruitment had not been carried out in a safe way, as recently recruited staff were found to be working without the required checks.

This is a breach of Regulation 19 of the Health and Social Care Act 2008, which states that fit and proper persons are employed. Recruitment procedures were not operated effectively to ensure that persons employed were suitable to work in health and social care. You can see what action we have taken, at the bottom of the full report.

Care and risk assessment had been completed for a new person living in the home and we saw that the records showed that assessments had been updated for most of the people living in the home. The remainder were in the process of being completed and updated.

The home requires 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. The home did not have a registered manager and had not since September 2015.

However, we noted that the provider had been actively recruiting for a new manager over this period. The previous manager had left the home unexpectedly two weeks before this inspection. A new manager had been appointed and was in post and present at this inspection. At the time of writing this report, an application by the current home manager for registration by CQC has been received by us.

The nominated individual had applied for Deprivation of Liberty Safeguards for people living at the home who had been assessed as lacking the capacity to consent to their care and accommodation. This complied with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA) for people who had been assessed as lacking mental capacity in aspects of their lives. We saw however, that people who were deemed to have capacity 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 had some inappropriate restrictions on their freedom.

This inspection took place on 05, 12, 14 and 15 April 2016 and was unannounced. There were several visits because there was no manager present and the provider was unavailable for much of our inspection. We needed them to respond to requests for information about people being supported by the service or about the way the service was run and managed.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hilbre Manor EMI Residential care Home on our website at www.cqc.org.uk

In addition, we had recently received two pieces of information of concern.

After our visit and in response to The Care Quality Commission raising several areas of concern with them, the provider told us that improvements had taken place and we re-visited the home to check these on 12 May and 29 June 2016. We found that improvements had been made to a number of safety factors that had previously given the Commission cause for concern on the lower ground floor.

The home required 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. The home did not have a registered manager and had no dedicated manager to lead it.

During the inspection we found breaches of Regulations 10, 11, 12, 13, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to dignity and privacy, consent, safe care and treatment, safeguarding and governance.

The home had CCTV installed but we did not see evidence that people, their relatives or staff had been consulted or had given their consent to this.

We also saw that people were not referred to specialist teams when aspects of their needs indicated they would benefit from such a referral.

People’s care records were improved since our inspection in October 2015 and most were person-centred. However reviews did not accurately reflect peoples changing needs.

The home did not have a registered manager as required. We were concerned about the inconsistent management of the home.

You can see what action we told the provider to take at the back of the full version of the report.

Staff were recruited appropriately and knew about abuse and how to report it. Staffing levels were appropriate to the numbers and dependency of people living in the home at the time of our inspection.

Staff were trained to do their job and we found them to be caring and kind.

People enjoyed a range of activities and told us they had no complaints, but knew what to do if they did.

During our inspection the provider brought in a team of managers to begin to check on the home and to complete audits and action plans.