Archived: Homecrest Care Centre

Updated 29 June 2023

The inspection

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act under the domains of safe and well-led, to look at the overall quality of the service, and to provide 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 undertaken by two 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 service.

Service and service type

Homecrest Care Centre is a care home. People in care homes receive accommodation and personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

We announced this inspection from the car park on the day of the inspection. The inspection took place over four days. The first day was spent on site.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. The provider completed an annual 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 spoke with the manager, the regional manager, the deputy manager, two care staff and a domestic member of staff. We also contacted the provider and area manager to obtain information about the service. We reviewed a range of records. This included five people's care records, a sample of medication records, three permanent staff files; information pertaining to the use of agency staff and records relating to the management of the service.

We contacted people using the service and their relatives by telephone to seek feedback about their experiences of the care provided.

After the inspection visit

We continued to seek clarification from the manager and provider to validate evidence. We continued to review evidence in relation to people’s care, health and safety, maintenance records and the management of the service.

We liaised with the Local Authority to share information about the service and our inspection. We made safeguarding referrals for four people living in the home as we had specific concerns about their care, health and wellbeing.

We concluded the inspection on 05 November 2021.

Updated 29 June 2023

About the service

Homecrest Care Centre provides accommodation for up to 29 people who need help with personal care. At the time of the inspection 24 people lived in the home. Most of the people living in the home lived with dementia.

People's experience of using this service

At this inspection, we identified serious concerns with the management of risk, care planning and delivery, the management of medicines, staff recruitment, staffing levels and service management.

People’s needs and risks were not always properly assessed or managed. Guidance on the support people needed to keep them safe and well was not always in place for staff to follow. This placed people at risk of inappropriate or unsafe care. People’s health needs and checks had not always been followed up with other health and social care professionals to ensure their health remained stable.

People were not always protected from the risk of abuse. Some people had experienced unexplained bruising that had not been investigated and reported appropriately to protect them from harm.

Medication management was not always stored or managed safely. Staff lacked sufficient guidance on how to administer as and when required medicines; diabetes management and medication allergies. It was difficult to tell if some medicines were administered in accordance with the manufacturer’s instructions. The competency of some staff to administer medicines had not been assessed to ensure sure they were safe to administer medicines.

There were not enough staff on duty to meet people’s needs at all times. Staff and the people we spoke with confirmed this. Staff were kind and caring but were task orientated. People told us staff did their best but there wasn’t enough of them.

Fire safety arrangements were not adequate; staffing levels at night were a serious concern as they were not sufficient to ensure all people could be evacuated in the event of a fire. The fire evacuation procedure was unclear and there was not enough evacuation equipment in place to help people evacuate.

There was not enough domestic cover to ensure the home was thoroughly clean to good infection control standards. The arrangements in place to mitigate the risk of COVID-19 were also not robust.

Staff recruitment was not safe. The necessary checks on staff suitability had not always been checked fully prior to appointment to ensure they were safe to work with vulnerable people.

The management and leadership of the service was poor. Neither the manager or, the provider had identified the issues we found at the inspection. This was despite a range of audit systems being in place to monitor the quality and safety of the service.

The manager did not demonstrate they understood the service, people’s care needs or their regulatory responsibilities.

Rating at last inspection

The last rating for this service was requires improvement (published 08 February 2020).

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

At this inspection, we found that the quality and safety of the service had significantly declined. Multiple breaches of the regulations were found, resulting in a rating of inadequate.

At this inspection, breaches of regulations 12 (safe care and treatment); 13 (Safeguarding people from the risk of abuse); 17 (Good governance); 18 (Staffing) and regulation 19 (Fit and proper persons) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, were found.

Why we inspected

We conducted a focused inspection in response to information of concern shared with us by the Local Authority and the general public about the service. As a result, we undertook a focused inspection to review the key questions of safe, and well-led only.

We reviewed the information we held about the service. No areas of concern were identified within the other domains of ‘effective’, ‘responsive’ and ‘caring’. We therefore did not inspect these domains. Ratings from previous comprehensive inspections for these key questions were used in calculating the overall rating at this inspection.

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

For more details, please see the full report which is on the CQC 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 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 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.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. We will work with the local authority to monitor progress.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service had been placed 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.