Archived: Horncastle Care Centre

Updated 3 July 2020

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.

Inspection team

This inspection took place over two days on 28 and 29 August 2019.

On 28 August 2019 the inspection team consisted of two inspectors, a registered nurse specialist advisor 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.

On 29 August 2019 the inspection team consisted of three inspectors and a registered nurse specialist advisor.

Service and service type

Horncastle Care Centre is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided.

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.

At the time of the inspection, the registered manager had been absent from managing a regulated activity at the service for more than 28 consecutive days.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Before the inspection, we reviewed information we held about the service. We considered the information which had been shared with us by the provider as well as the local authority, other agencies and health and social care professionals.

We looked at any safeguarding alerts which had been made and notifications which had been submitted by the provider. A notification is information about important events the provider is required to tell us about by law. This is necessary so that, where needed, the Care Quality Commission (CQC) can take follow up action.

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We used all of this information to plan our inspection.

During the inspection

During the inspection we spoke with six care staff, four registered nurses, the activities assistant, the chef, the deputy manager, and the provider’s nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We ‘pathway tracked’ six people using the service. This is where we looked at people’s care documentation in depth and obtained their views on how they found the service where possible. This allowed us to capture information about a sample of people receiving care.

We spoke with three people using the service and observed people’s support across all areas of the service.

We spoke with two relatives of people who were visiting the service.

We spoke with a GP and a community NHS dietician who were supporting people at the service.

We reviewed staff training and supervision records, staff recruitment records, medicines records, care plans, risk assessments, and accidents and incident records.

We also reviewed quality audits, policies and procedures, staff rotas and information about activities people were supported with and provided by the service.

After the inspection

We asked the provider to send us information to help validate evidence found.

We asked the provider to send us information in relation to an allegation of abuse of service users living at Horncastle Care Centre. This incident is subject to a criminal investigation and as a result CQC did not examine the specific allega

Updated 3 July 2020

About the service:

Horncastle Care centre is a residential care service that is registered to provide accommodation, nursing and personal care for people with learning disabilities or autistic spectrum disorder, physical disabilities, younger adults. The service also provides support for people with acquired brain injury and neurological disabilities.

Horncastle Care Centre is owned and operated by the provider Sussex Healthcare. Services operated by Sussex Healthcare have been subject to a period of increased monitoring and support by local authority commissioners. Due to concerns raised about the provider, Sussex Healthcare is currently subject to a police investigation. The investigation is on-going, and no conclusions have yet been reached.

Horncastle Care Centre had been built and registered before the Care Quality Commission (CQC) policy for providers of learning disability or autism services ‘Registering the Right Support’ (RRS) had been published. The guidance and values included in the RRS policy advocate choice and promotion of independence and inclusion, so people using learning disability or autism services can live as ordinary a life as any other citizen.

The service was registered for the support of up to 20 people. At the time of the inspection 16 people were using the service, including one person who was receiving short-term respite support. This is larger than current best practice guidance.

The service consisted of two separate bungalows, Maple and Willow Lodge, and was in private grounds between two small villages. Both bungalows had capacity for up to ten people to live in them and were bigger than most domestic style properties. There were identifying signs on the road before the service’s private drive, the service grounds and on the exterior of each bungalow to indicate it was a care home. Staff wore uniforms and name badges to say they were care staff when coming and going with people.

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

The service did not consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; People did not always receive personalised care. People did not always plan, review or develop their individual support needs and wishes. People did not always have support with meaningful activities. People’s communication needs were not always met. Language in people’s care plans was not always respectful of their disabilities or support needs. Staff did not always support people with dignity or to be as independent as they were able to be.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Risks to people were not always adequately assessed, monitored and managed, causing or exposing people to risk of harm. Staff practice and reporting systems to safeguard people from abuse were not always effective. Lessons were not always learnt, and actions taken to investigate safety incidents and act to prevent them re-occurring. Medicines were not always managed safely.

People were not being always being supported to achieve effective support outcomes. Best practice guidance was not always considered when assessing people’s needs, or what people wanted from their support. Staff did not always have the right skills, knowledge or experience to deliver effective care to people. People’s day to day health and well-being needs were not always monitored or met effectively. Staff did not always work well with other agencies. People’s dignity and independence was not always respected or promoted. Staff did not always seek accessible ways to communicate with people.

People’s strengths, levels of independence and quality of life was not always accounted for when planning and reviewing their care. People were not always involved in planning and reviewing their care. People did not always have support to identify and achieve individual goals and wishes. Care plans did not always record when people’s support needs had changed, so staff could access up to date information about these changes.

The service was not always meeting the communication needs of people with a disability or sensory loss. People did not always have support with meaningful activities or to access the community to take part appropriate social activities. People did not always have support to maintain or develop meaningful relationships.

Systems and processes to assess, monitor and improve the quality and safety of the service were not operating effectively. The provider had not ensured that staff at all levels understood their responsibilities and managed staff accountability effectively. Staff had not always shared appropriate information with other agencies for the benefit of people. Leadership at all levels at the service was not always visible and did not always inspire staff to provide a quality service. Staff had not always displayed values consistent with the provider’s vision of delivering high quality, person-centred care.

Some people and relatives we spoke with were very positive about the support they received at the service. One person said, “I never feel unsafe.” There were processes to help ensure staff were safely recruited. There were enough numbers of staff. People were supported to prevent and control hygiene and infection risks. People had support to have a balanced diet and the correct nutrition. The adaptation, design and decoration of the premises met people’s individual needs.

We observed staff supporting people in a caring and patient manner. People had support to access independent services to help them understand, answer questions and speak for them if necessary. Relatives told us if they had ever raised any concerns or complaints, these had been responded to well and they had been happy with the outcome. People’s views and experiences were being gathered to help gain their ideas about how to improve the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

We last inspected this service in February and March 2019. The service was rated Inadequate (Published 9 May 2019). There were multiple breaches of regulations and the service was placed in special measures.

A previous inspection in April 2018 identified multiple breaches of regulations and rated the service Requires Improvement.

Following this inspection, the service remains rated Inadequate, with multiple breaches of regulations and in remains in special measures.

The service has now been rated Inadequate for two consecutive inspections. There have been multiple breaches of regulations identified at three consecutive inspections.

Horncastle Care Centre has been placed in special measures since May 2019. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. Services in special measures will be kept under review and, if needed could be escalated to urgent enforcement action.

Why we inspected

This was a planned comprehensive inspection based on the previous rating.

This inspection looked to see if the provider had acted to make significant improvements to achieve compliance with regulations.

Enforcement

At this inspection, we have identified seven continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations 9, 10, 11, 12, 13, 17 and 18 in relation to: person centred care, dignity and respect, safe care and treatment, consent, safeguarding people from abuse, good governance and staffing.

We have also identified that the provider has not notified the CQC as required to inform them of a registered manager’s absence for more than 28 consecutive days. This is a breach of CQC (Registration) Regulations 2009 regulation 14 (Notice of Absence).

We took enforcement action to issue a Notice of Decision to vary a condition of the provider’s registration and remove this location in July 2019. The provider’s appeal to the Notice of Decision with withdrawn in June 2020 and the enforcement action to remove the registration of this location took effect. Horncastle Care Centre is now de-registered and the provider is no longer able to provide regulated activities at or from this location.

We imposed conditions on the provider's registration. The conditions are therefore imposed at each service operated by the provider. CQC imposed the conditions due to repeated and significant concerns about the quality and safety of care at a number of services operated by the provider.

The conditions mean that the provider must send to the CQC, monthly information about incidents and accidents, unplanned hospital admissions and staffing. We will use this information to help us review and monitor the provider's services and actions to improve, and to inform our inspections.

Follow up

The overall rating for this service is ‘Inadequate’ and the service therefore 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. T