Hulcott Nursing Home

Updated 7 December 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 one inspector 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. The Expert by Experience spoke with relatives or people’s representatives, to seek their views of the service.

Service and service type

Hulcott Nursing Home 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. Hulcott Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

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

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received and held about 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 sought feedback from the local authority and professionals who work with the service. We contacted 39 staff by email, to invite them to provide feedback. Two replies were received.

We spoke with three people who used the service. We had discussions with the registered manager and a range of housekeeping and care staff. We had discussions with 19 relatives by telephone. We looked at a sample of records. These included four people’s care plans and associated documents such as risk assessments and daily notes, four staff recruitment files, checks carried out for four agency workers, the staff training matrix and staffing rotas. We checked a sample of quality assurance audits and records related to maintenance and upkeep of the premises. We viewed a range of health and safety records including accident and incident reports and a sample of policies and procedures.

After the inspection

We requested and received additional evidence from the registered manager.

Updated 7 December 2022

About the service

Hulcott Nursing Home is a home providing personal and nursing care to up to 49 people. The service provides support to older people and people with dementia. At the time of our inspection there were 24 people using the service, in one adapted building.

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

We found concerns about infection prevention and control practice, which could put people at risk of harm. This included inconsistencies in mask-wearing and contamination risks associated with management of laundry.

People were potentially placed at risk of harm as the home could not demonstrate there were effective fire drills to rehearse what to do in the event of a fire or other emergency. Additionally, we found two fire exit routes were obstructed, which could have impeded safe evacuation.

It was not clear whether people received the support they needed to keep well-hydrated. Records showed varying amounts of fluids offered to people from day to day and sometimes only small amounts had been drunk. We observed some people had multiple, sometimes untouched, drinks left on their bedside tables, which were later cleared away. We could not be confident there was effective monitoring to ensure people were being given the right support to keep hydrated.

The registered manager and the provider carried out regular audits and checks of the quality of people’s care. However, we found these audits did not identify the issues were found during our inspection.

The provider carried out a range of checks when recruiting staff. We have made a recommendation about providing better evidence of satisfactory references.

Temporary workers were used to cover the staffing rota when needed. We have made a recommendation about making checks of the training temporary workers have completed.

People spoke positively about the home and the care provided. Comments included “Overall we are very happy with the home. (Family member) is happy and settled and you can tell when staff walk in and he smiles that he is forming relationships,” “Overall it is very good. (Family member) has improved while she has been here and is a happy, contented lady. The nursing home has a real family feel to it” and “I think they are awesome, the staff are diligent and so kind…it is all good except the rooms are a little dated.”

Relatives felt their family members received safe care. The registered manager referred any safeguarding concerns to the local authority or other agencies, as necessary. People’s medicines were managed safely.

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.

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 requires improvement (report published February 2021). The service remains rated requires improvement.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted, in part, due to concerns received about the provider’s approach to visiting, responding to concerns and risk of a closed culture. A decision was made for us to inspect and examine the concerns across a range of Caring Homes Healthcare Group Limited services. We found no evidence during this inspection that people were at risk of harm from this concern.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of the full report.

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

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 fire safety, infection prevention and control and governance of the service.

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.