Horkesley Manor

Updated 30 September 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 Health and Social Care Act 2008.

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 was carried out 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 care service.

Service and service type

Great Horkesely Manor is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Great Horkesely Manor is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

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. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We observed the care provided to help us understand the experience of people who could not talk with us. We spoke with nine people who used the service, and four relatives about their experience of the care provided. We spoke with eight members of staff including the registered manager, deputy manager, three team leaders, two care staff and one temporary agency carer. We also spoke with the area manager responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records including four people's care and medicines records. We looked at three staff files in relation to recruitment and a variety of records relating to the management of the service.

Updated 30 September 2022

About the service

Great Horkesley Manor is a residential care home providing personal care. The service accommodates up to a maximum of 73 people across two units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia. At the time of our inspection there were 44 people using the service.

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

Changes within the management team had led to a lack of leadership, management and oversight of the service. This, combined with high use of temporary agency staff had impacted on the quality of the service provided. The service does not always provide enough staff who have the right mix of skills, competence or experience to support people to stay safe, and meet their needs. Staff were not aware of the providers aims and objectives which sets out the values they should adhere to in their work. Staff morale was low. Staff were not working as a team which was impacting on the effectiveness of care delivery.

Risks to the health, safety and welfare of people using the service and staff had not always been identified and managed. NHS England raised a level 3 heat health watch alert in July, which required health and social care workers to pay attention to high-risk groups of people such as the elderly and vulnerable. On the first day of the inspection temperatures rose to 32 degrees and we found the central heating was on which could have had serious consequences to people’s health.

The premises were not clean or properly maintained. The providers approach to assessing and managing environmental and equipment related risks were inconsistent. This included trip hazards, fire doors being wedged open and poor ventilation in the kitchen and laundry.

Systems for managing infection prevention and control (IP&C) needed to improve. Staff were not always following current national guidance and standards in relation to infection control. Although staff had received training, they did not fully understand their responsibilities in relation to hygiene and did not consistently apply good infection control practices.

The provider did not have a system in place to assess the quality of training delivered to staff to ensure they had understood the content, test their skills, knowledge and competence to support people properly and safely.

Systems were in place to ensure people’s medicines were managed consistently and safely.

Peoples rooms were in the process of being redecorated and personalised with paint colours and bedding of choice. Appropriate equipment had been provided to meet people’s mobility and transfer needs and reduce the risks of pressure wounds occurring. These were in good working order and routinely checked.

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. Where people had been deemed to lack capacity to make significant decisions about their health, welfare and finances, relevant people including their Lasting Power of Attorney and health professionals had been involved.

People told us they were supported to see healthcare professionals when they needed them. Processes were in place to manage risks around people’s dietary needs, including risks relating to choking and weight loss. Where people had been identified as at risk, they had been referred to appropriate professionals. However, improvements were needed to ensure accurate records were kept to ensure people were receiving enough fluid to remain well and hydrated.

Although the area manager and the registered manager have worked well with other professionals to make immediate improvements, the governance systems to assess the quality and safety of the service had not always been effective in identifying where improvements were needed. These failed to identify and mitigate the risks to people and staff found during the inspection.

Complaints were not used as an opportunity to learn and drive improvement.

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 good (published 16 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about a lack of staff, high numbers of unwitnessed falls, unexplained bruising, poor leadership and management of the service. A decision was made for us to inspect and examine those risks.

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. We have found evidence the provider needs to make improvements.

Please see the safe, effective and well-led sections of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

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

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

Immediately after the inspection the registered manager told us they had employed extra agency staff to carry out a deep clean around the home, yellow bins had been purchased for clinical waste, closed toilet brushes and toilet roll dispensers had been ordered and additional training was being arranged for staff around use of PPE. They had also contacted the providers head office to request immediate action to improve ventilation in the laundry and install ramps over the thresholds to improve access to the home and gardens.

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

Enforcement and Recommendations

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 and will take further action if needed.

We have identified breaches in relation to safe care and treatment and the leadership and management of the service. Governance systems failed to identify risks to people and staff, poor infection control practices, insufficient staff deployed to meet people’s needs in a timely way and a poor culture amongst the staff team.

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 continue to monitor information we receive about the service, which will help inform when we next inspect. We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.