Hulton House Care Residence: Preston brain injury centre placed in special measures following probe into resident's death

The specialist care home in Preston has now been placed in special measures and is danger of closing after being rated inadequate by the Care Quality Commission (CQC). Inspectors carried out an unannounced inspection last November at the Lightfoot Green Lane centre after a separate investigation was launched by the CQC into the circumstances surrounding the death of a resident. The CQC says information it uncovered during the initial stages of the investigation “indicated potential concerns about the management of risk to people living in the home”.

Following the latest report, the care home was branded ‘inadequate’ by inspectors and placed into special measures, meaning unless there is a dramatic improvement, the home could be forced to close. Inspectors raised concerns about unsafe medicine management and a lack of ‘person-centred’ care and activities to keep residents occupied. A lack of staff training was also highlighted by the inspection team.

Is Hulton House rated as safe?

At the last inspection this question was rated as requires improvement. At this inspection the rating changed to inadequate, meaning residents were not safe and were at risk of avoidable harm.

The report read: “At our last inspection the provider had failed to manage medicines safely. Enough improvement had not been made at this inspection and the provider was still in breach. A prescription for insulin was not recorded on the Medicines Administration Record (MAR) and dose directions were only recorded on the insulin pen. This left a risk of the right dose not being administered as the label deteriorated on the pen.

“Administration of topical medicines including creams and patches was not done so in line with best practice. Most people on one unit had their medicines administered covertly. We were not assured procedures for the safe and lawful administration of covert medicines were always in place. We noted one person had been administered a medicine covertly prior to any agreements or assessments being in place.

“We found contradictions in people's records which would lead to confusion as to the correct care and support to provide. This included contradictions in people's dietary needs, their skin integrity and risk of falls. This put people at risk of receiving inappropriate care.”

Equipment had been safely tested and risk assessments for the environment were in place. However, the fire evacuation point had recently been repositioned following a recent risk assessment. Signage was yet to be put in place to show the new evacuation point and other procedures had not been updated to account for the change. Systems were not effectively developed to ensure all potential risks of abuse were reported and investigated.

The provider had failed to ensure staff understood their responsibilities to keep people safe from abuse or improper treatment. Staff had not received appropriate training to ensure allegations of abuse were appropriately recorded and escalated to the appropriate person for investigation.

The report added: “The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We found the service was not working within the principles of the MCA and if needed, appropriate legal authorisations were not in place to deprive a person of their liberty.”

Is the service well led?

The last inspection rated this question as requires improvement which had now changed to inadequate. This meant there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.

Key information about people's needs on admission and changing needs once in the home were not routinely captured in risk assessments and care plans. This meant staff did not always have all the information they needed to support individuals in a person-centred way.

The report read: “Staff told us working at Hulton House Care Residence was a rewarding job but also a very challenging one, made worse by the lack of activities staff to engage with people to develop and sustain their emotional, social and mental wellbeing. The home supports people with very complex needs. Some people have both dual diagnosis and both physical and mental health needs. On each providers registration there are details of different service user needs called 'service user bands'. Hulton House Care Residence does not have mental health as a service user band. We recommend the provider ensures that for each service user type supported there is the associated service user band on their registration with the Care Quality Commission.

What will happen next?

The CQC will be meeting with the provider to discuss how they will make changes to ensure they improve their rating to at least good and would also be working with the local authority to monitor

progress. The service is now under review and if they do not cancel the provider's registration, they would be re-inspecting within six months to check for significant improvements.

If the home has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating it may be closed down.