Archived: Haisthorpe House

Updated 21 December 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 and 22 June 2015 and was unannounced. On the 17 June the inspection team comprised five people. These were two adult social care inspectors, an inspection manager, one pharmacist inspector employed by the Care Quality Commission (CQC) and the fifth person was a specialist professional advisor. This was an expert with a mental health background and was an Approved Mental Health Professional (AMHP). On the 22 June the visit was completed by an inspector and an inspection manager.

Prior to the inspection we reviewed the information we held about the service, such as information about incidents that happened at the service, which the registered provider has to inform us about and information shared with us by other agencies. We received information from professionals who regularly visited people who lived at Haisthorpe House and from the City of York commissioning team who had been carrying out their own monitoring visits to the service in recent months.

We also looked at other records about the service kept by CQC, including documents that the registered provider was required to send to us each month to demonstrate how the service delivery was being monitored and improved.

We did not request a Provider Information Return (PIR) as this was an inspection to check whether failings, found at the last inspections in February 2015 and July 2014, had been addressed.

At the inspection we talked to nine people using the service and eight care staff and a domestic who was subcontracted to work at the home.

We looked at the care records for seven people and observed the way staff interacted with people. We also looked at a number of other records including medication assessment records, fire safety records, and other audits of how the service was operating. We looked at the overall environment and how well it was being maintained, including looking in many of the bedrooms. We looked at five staff recruitment files and training records.

Updated 21 December 2015

The overall rating for this provider is ‘Inadequate’. We have cancelled the providers registration.

This inspection took place on 17 and 22 June 2015 and was unannounced.

At our last inspection of Haisthorpe House in February 2015 we found that people were not always treated in a respectful manner and were not always receiving safe, consistent care and support. We also identified that the provider had not complied with the law with regard to the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. We found people were not protected against the risks of being harmed by other people and nor were people protected from the risks of unsafe management of medicines. Furthermore we determined the home was dirty and uncared for and maintenance work needed to be done to the building in order to protect the health and safety of the people living, working and visiting Haisthorpe House. We found there were not always enough staff working, and those staff were inadequately trained and supported. Recruitment processes needed to improve to ensure that only suitably vetted people were employed to work at the service. Records were poorly completed and people were not supported to make complaints. We saw the registered provider did not have arrangements in place to monitor how the service was operating. This meant that no-one had identified that the service delivery was not good enough and therefore needed to improve.

Because we had significant concerns about people’s welfare and safety we took enforcement action against the provider.

At a previous inspection in July 2014 we had issued three warning notices and nine compliance actions to the registered provider and told them that they must make improvements. We also required the registered provider to submit regular updates to us to demonstrate the improvements being made. Furthermore the registered provider had agreed to not admit any more people to the home, until the improvements had been made.

This inspection was to check whether progress had been made as recorded in the registered provider’s action plan. The provider had told us within their action plan that they would have an overall date of compliance of March 2015. There were also a number of key areas which the provider told us they would address prior to this date. As we identified a range of areas where improvements were required at our last inspection, we carried out another comprehensive inspection at this visit, looking at all aspects of the service delivery.

Haisthorpe House has been registered by Haisthorpe House Care Limited to provide personal care and accommodation for up to 30 people with a mental health illness and/or a learning disability. The home is a large detached mature house, located on Holgate Road within about 20 minutes walking distance from the centre of York. There are local amenities close by and the service is on a public bus route. There is very limited parking on site and nearby on-street parking is also quite limited.

On the day of our visit there were 22 people living at Haisthorpe House. There was no registered manager of Haisthorpe House. 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. Although a manager had been employed at the service for approximately five weeks they had not yet applied to be registered.

We found overall that there was insufficient evidence to demonstrate that the required improvements had been made.

We found the risk of harm to people was not well managed. People were not protected from incidents of abusive behaviour and these incidents were not reported to the right professionals. This meant no-one had the opportunity to look into these events and decide how best to minimise the risk of a similar incident happening again.

We found the risk of harm to people overall was not well managed. When staff recognised people were at risk, then this risk was not kept under review, to check whether the service was doing all it could to keep people safe. This meant people may be being exposed to a risk that could be avoidable.

We found that the environment was not well maintained. We found bedrooms without window restrictors and other windows which did not open, meaning there was insufficient ventilation and. Safety checks, completed by staff on the environment did not result in the required works being completed. This posed a risk to people living and working at the home. The fire safety risk management measures at the service were poor. Many of the people living at Haisthorpe House smoked and not all had safe smoking habits. This increased the risk of a fire breaking out. Checks to minimise these risks were not always being completed. We also found rooms which were in a poor state of décor and repair.

Generally people told us that staffing numbers were sufficient, although the home was relying on agency staff to ensure sufficient numbers of staff on duty. Appropriate checks were completed before new staff started work. These checks were needed to ensure that there was nothing in an applicant’s background that would make them unsuitable to work with vulnerable people.

Medicines were not always managed safely for people and records had not been completed correctly. People did not receive their medicines at the times they needed them and in a safe way. Medicines were not obtained, administered and recorded properly.

Despite a domestic now being in post we found some areas of the home were dirty and needed more frequent cleaning.

The staff team had a better understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) than in our last visit. They also had a better understanding of their responsibilities of supporting people who were being cared for in the community under an order of the Mental Health Act 1983 Code of Practice (MHA). However, they still needed to evidence that they were consulting people regarding all aspects of their care and they needed to make sure that people were given sufficient opportunity in making decisions and choices.

Whilst people told us they enjoyed the meals served to them at Haisthorpe House the service did not have a robust way of monitoring people’s nutritional and fluid intake. This meant they could not evidence that some people were receiving sufficient food and drink to maintain their health and well-being.

People’s changing healthcare needs were not always known and understood. This meant people could be at risk of harm because the service failed to respond promptly and appropriately to a new care need.

We observed staff who were kind and caring in their approach to people. People told us they liked the staff who cared for them. However, some people looked unkempt during our visit and we found that some people were not being appropriately supported in terms of their personal care needs.

We found that people’s preferences and choices and their likes and dislikes were not always explored with them. This meant the service could not deliver individualised care and support that was in line with what people wanted and needed.

People’s care records were of varying quality, however some did not contain the required information and others were not being appropriately followed. Not all staff had been given the opportunity to read care plans which meant they may not know how to care for someone appropriately.

People now had a copy of the complaints procedure and people told us they would feel confident in speaking to staff if they had a complaint or concern.

The service was poorly led, with a lack of management support in the home. Day to day communication about people’s needs was ineffective, which meant people’s changing needs may be missed or not known.

We noted care records did not provide good quality information about people’s needs, or their preferences and choices. They were not updated when people’s needs changed. The checks on how the service was being run were also ineffective as recent checks had indicated that service delivery was satisfactory.

There was a lack of consultation with people living at Haisthorpe House about their care and how the service was operating. This showed a lack of respect towards the people living there and failed to value their contribution to how the service was being run.

We found the registered provider was in breach of nine regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). These were in relation to safeguarding service users from abuse and improper treatment, safe care and treatment, premises and equipment, staffing, need for consent, meeting nutritional needs, person centred care, dignity and respect and good governance.

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