Archived: Horncastle Care Centre

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

Horncastle Care Centre is a residential care service that provides nursing and personal care for 10 people and younger adults with learning disabilities or autistic spectrum disorder, physical disabilities, acquired brain injury and neurological disabilities at the time of the inspection. There were three people who also regularly received respite care at the service each week. The service can support up to 20 people.

The service is larger than current best practice guidance and consisted of two separate bungalows, Maple Lodge and Willow Lodge. The service was in private grounds in the countryside. Both bungalows 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.

Horncastle Care Centre is owned and operated by the provider Sussex Healthcare. Services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation in relation to incidents that occurred between 2016 and 2018. The investigation is on-going, and no conclusions have yet been reached.

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

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 and is larger than current best practice guidance.

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 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.

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 with epilepsy, constipation and behaviours that may challenge were not always adequately assessed, monitored and managed, causing or exposing people to risk of harm. People had not received medicines as intended when required and medicines had not always been stored safely.

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 prevent them re-occurring.

Service management and the provider’s wider quality assurance and governance systems had not always ensured actions were taken to address any issues and risks in a timely manner. The provider had failed to act upon known areas of concern, non-compliance and risk to improve the quality of care for people at Horncastle Care Centre.

The provider had not ensured that staff at all levels understood their responsibilities and managed staff accountability effectively. Statutory notifications had not always been submitted when required. he provider had not always shared information openly and honestly with partnership agencies.

Staff did not always have the right skills, knowledge or experience to deliver effective care to people. People’s day to constipation and epilepsy needs were not always met and staff were not always monitoring people’s health and well-being needs effectively.

People had support to have their nutritional needs met and had enough to eat and drink. There were safe recruitment practices. The premises had been designed to accommodate people’s needs.

People told us that staff acted with compassion and responded to their emotional well-being in a meaningful way. We observed positive examples of staff interacting with people in a caring manner. One person told us they liked living at 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 and update

We last inspected this service on 28 and 29 August 2019. The service was rated Inadequate (Published 3 December 2019). The service remains rated Inadequate. The service has been rated Inadequate for the last three consecutive inspections.

This service has been in Special Measures since May 2019. At this inspection not enough improvement had been made and the provider remains in special measures.

Why we inspected

This was a planned inspection based on the previous rating. After the visits on 12 and 13 February 2020 we received further specific concerns about risks to people with epilepsy support needs. The visit on 21 February 2020 was prompted by those concerns.

Enforcement

At this inspection, we have identified six continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regulations 9, 11, 12, 13, 17 and 18 in relation to: person centred care, safe care and treatment, consent, safeguarding people from abuse, good governance and staffing. We have also identified that the provider has not notified CQC in relation to other incidents as required. This is a breach of CQC (Registration) Regulations 2009 regulation 18.

In December 2018 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 several 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.

We took enforcement action to issue a Notice of Decision to vary a condition of the provider’s registration and remove this location. The provider’s appeal to the Notice of Decision was 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.

• Horncastle Care Centre is a residential care home that provides nursing care and support for up to 20 people. Some people had neurological conditions, physical disabilities, a learning disability and other complex health and communication needs. There are two ‘units’ named Willow and Maple Lodge each with their own dining area. At the time of our inspection there were 19 people living at the service. Four people were receiving short term care.

• Horncastle Care Centre is owned and operated by the provider Sussex Healthcare. Whilst Horncastle Care Centre is not part of the investigation, services operated by the provider had been subject to a period of increased monitoring and support by local authority commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. The investigation is on-going and no conclusions have yet been reached.

• At the previous inspection in April 2018 we found five breaches of regulation in relation to safe care and treatment, protecting service users from abuse, staff training, adaption of the home and governance. At this inspection we found these breaches continued. We also found new breaches of regulations relating to person centred care, dignity and consent.

• The service had not been developed and designed in line with the values that underpin the 'Registering the Right Support' and other best practice guidance. These values include choice, promotion of independence and inclusion. These values were not always seen consistently in practice at the service. For example, some people were not treated with dignity and other people were not being supported to attend meaningful activities and access the community often enough. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

• All of the areas of concern we found during this inspection had already been highlighted to the provider following inspections of some of their other services. Learning had not been effectively shared to ensure that people living at Horncastle Care Centre received consistently safe, effective and well-led care.

People’s experience of using this service:

• A number of aspects of the service remained unsafe. This included risks associated with constipation, epilepsy, skin integrity and behaviour management.

• Some people were at risk as some risk assessments were not in place. Risk assessments that were in place were not always effective in reducing the possibility of harm. Staff had not always taken steps to keep people safe as there were failings in meeting some people's health needs such as bowel, epilepsy and skin integrity management.

• People were not consistently protected from abuse as concerns had not been identified by the provider.

• Learning from incidents had not been consistently implemented. Most of the areas of concern we found during this inspection, such as risks associated with health needs not being reduced and poor-quality auditing, had already been highlighted to the provider following inspections of some of their other services.

• The provider failed to ensure agency care staff had the necessary training they required to carry out their role, such as training about epilepsy and people's specific diagnoses.

• Adaptions had not been made to ensure people could move independently around the home.

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

• People were not consistently treated with dignity and the language some staff used was not person centred.

• People did not always receive personalised care. Some people were not provided with a range of person-centred activities.

• The previous inspections rated the well led domain as ‘Requires Improvement’. At this inspection the rating has reduced to Inadequate, therefore, leadership at the service was not effective.

• Quality audits had not been effective in highlighting and putting right all the shortfalls we found at the last and this inspection.

• There were enough staff deployed to meet people's needs safely and the provider operated safe recruitment systems for permanent staff employed.

• We observed some people receiving caring and kind support by staff who knew them well.

• People told us that they liked their staff.

• People had enough to eat and knew how to make a complaint.

More information is in the detailed findings below.

Rating at last inspection:

At our last inspection in April 2018, the service was rated "requires improvement" overall with a requires improvement rating in the safe, effective and well led sections, and a good rating in caring and responsive domains. Our last report was re-published on 5 February 2019 (after additions were made to include information about provider-level enforcement action by the Commission). This is the first time this service has been rated Inadequate.

Why we inspected:

We received information of concern alleging abuse and mistreatment of service users living at Horncastle Care Centre. We informed the local authority safeguarding team and the police were made aware. No conclusions have been reached by their investigations at this point.

Enforcement:

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 enforcement action took effect in June 2020. 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'. This means that it has been placed into 'Special Measures' by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Services operated by the provider had been subject to a period of increased monitoring and support by commissioners. As a result of concerns raised, the provider is currently subject to a police investigation. We used the information of concern raised by partner agencies to plan what areas we would inspect and to judge the safety and quality of the service at the time of the inspection. Between May 2017 and April 2018, we have inspected a number of Sussex Health Care locations in relation to concerns about variation in quality and safety across their services and will report on what we find.

Horncastle Care Centre is a care home that provides nursing and residential care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

Horncastle Care Centre is registered to provide nursing and accommodation for up to 20 people who may have a learning disability, neurological conditions, physical disabilities and other complex health needs. At the time of our inspection there were 19 people living at the home. Accommodation is provided across two units called Willow Lodge and Maple Lodge. Each unit has a separate living room, dining room and kitchenette. Rooms were of single occupancy and had en-suite facilities. The home offers the use of specialist baths, a spa pool and physiotherapist.

A registered manager was in post. 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.

Some features of Horncastle Care Centre had been developed in line with the values that underpin the Registering the Right Support and other best practice guidance. This includes involving people and their families and taking into account their preferences, providing access to the local community amenities and ensuring people had access to routine medical screenings. However Horncastle Care Centre is a large clinical setting, split into two units. It is in a geographically isolated area rather than a small-scale home environment with easy access to local amenities and services. The design and layout of the premises meant that people could not always move independently around the service without support from staff.

The service did not always demonstrate the correct action had been taken after an incident had occurred including whether it had been shared with the local authority safeguarding team for their review. We found inconsistencies within how risks were being managed on behalf of people.

There were missed opportunities to provide staff with essential training to assist them in carrying out their role and responsibilities. Systems were not always effective in measuring and monitoring the quality of the service provided. There were ineffective systems in place to drive continuous improvement.

People's consent to care and treatment was gained in line with the requirements of the Mental Capacity Act 2005 and people were treated with dignity and respect. Care records were accessible for the people being written about and they reflected people received personalised care that met their needs. We observed people enjoyed the activities they were offered. Staff received supervisions and appraisals and they found the registered manager’s approach supportive.

People were provided choices on a daily basis regarding what food they ate and clothes they wore and complaints were managed effectively. The provider sought feedback from people and their relatives regarding the care received.

The registered manager had sought information about the new Key Lines of Enquiry (KLOE) which the Commission introduced from 1 November 2017. They were keen to improve the quality and safety of care provided to people living at the home.

At this inspection we found the service was in breach of five of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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.

Horncastle Care Centre had 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.

People living at Horncastle Care Centre had a range of complex needs. There were robust arrangements in place to ensure that risks to people were identified, assessed and managed to protect people from avoidable harm whilst supporting their freedom. Staff had a clear understanding about their responsibilities with regard to safeguarding people. The provider had safe systems in place for recruitment of staff to ensure that they were suitable to work with people. There were enough staff on duty to support people and they told us that they felt safe living at the Care Centre. People’s medicines were managed safely by trained staff.

Staff were well supported and received the training they needed to be effective in their roles. One staff member said, “We are well supported with training and courses.” Staff understood their responsibilities to comply with the Mental capacity Act 2005 and there were systems in place to ensure that people’s rights were protected. People told us that they had confidence in the staff, one person said, “They are really, really good at what they do. I can’t fault the staff at all.” People had support to access the health care services that they needed. A relative told us, “Staff are excellent, they always have a qualified nurse on duty. Any pain is dealt with quickly and they get the doctor in. It’s better than at home, they notice more.” People had enough to eat and drink and they told us they enjoyed the food. People who needed help with eating and drinking were supported by staff who were patient and attentive.

People spoke highly of the caring nature of the staff, one person said “The staff are excellent. ” Staff knew people well and understood how to communicate effectively with people to support them to express their wishes about their care. People were enabled to be in control of their support, one person said, “They always accommodate me.” Staff had developed caring relationships with people and spoke of them in a positive and respectful way. Staff were mindful of protecting people’s privacy and confidentiality.

People had comprehensive care plans that guided staff in how to provide care in a person centred way. Things that were important to people, their preferences and wishes were included in plans to ensure they received support in the way that they wanted to. Staff supported people to follow their interests and to have access to facilities in the local community. When at home, people were occupied with activities that they found stimulating and that were meaningful to them.

People and their relatives knew how to raise complaints or concerns and felt comfortable to do so. Complaints were addressed in a timely way by the registered manager. Feedback about the quality of the service was gathered in a range of ways and contributed to the development of the service. The registered manager had systems and processes in place to monitor service provision, to look for trends or patterns that needed to be addressed and to ensure that recording was accurate and robust.

There was clear leadership and staff understood the responsibilities of their roles. The person - centred values of the service were embedded within staff practice at every level. People, their relatives and staff all spoke highly of the management of the service. A visitor told us “I think it’s a very happy home because of the manager.”