This inspection took place on 11, 12 and 13 July 2018 and was unannounced.Haydock Nursing and Residential Care Home is registered to provide accommodation for up to 50 people who need nursing and personal care. The home has two separate units, including a unit for people with dementia and is a modern, purpose built home located on a quiet road with views over the local countryside.
Haydock Nursing and Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.
We undertook a comprehensive inspection of Haydock Nursing and Residential Care Home on the 16 September 2015. The overall rating from this inspection was Good, with requires improvement in effective. This was due to two recommendations being made in relation to staff training and staff supervisions.
During this inspection we found no improvements had been made in relation to staff training or staff supervisions. We also found a number of concerns and highlighted five breaches of the regulations in relation to recruitment, risk assessments, medicines management, training and supervision of staff. We also made recommendations in relation to supporting people and the environment on the ‘dementia specialist unit’ and end of life care.
We also highlighted other concerns throughout our inspection which were addressed immediately.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals are concluded.
We found risks had been identified for people such as, weight loss, falls and pressure ulcers. However, there were no risk assessments in place to show how these risks were being managed and to direct staff. People who were at risk of choking did not have risk assessments in place. The registered manager had also not considered the risks present within the environment.
Medicines were not managed safely within the service. We found topical creams were not being stored safely, thickening powder was not being stored or used safely, rooms were medicines were being stored were exceeding the recommended temperatures and handwritten medicine administration records were not signed or had only been signed by one person.
Recruitment systems and processes within the service were not sufficiently robust. For example, we saw people subjected to conditions on their visas were working over the stipulated hours. People who other concerns had been raised about had not been risk assessed prior to commencing employment.
We identified concerns in relation to the premises and its safety. The nurse call system in one part of the building was not working correctly; immediate action was taken and we received confirmation shortly after our inspection it was fully functioning. Some hot water outlets were running higher than the recommended 43 degrees; this was dealt with during our inspection. Water samples were not being sent off as required to check for legionella; action was taken to address this during our inspection and we were told going forward this would be maintained. Substances which would be hazardous if ingested were found accessible in bathrooms and in a cupboard; these items were immediately removed. In a number of bedrooms, we found the bedding was poor, pillows and duvets were lumpy and some sheets were threadbare; the registered manager told us they would ensure these were replaced as they had stocks of new bedding.
All the people who used the service and their relatives told us they felt safe. All the staff members we spoke with told us they had undertaken training in safeguarding and were aware of their responsibilities to raise any concerns.
We found there was adequate staffing levels within the service. Staff did not appear rushed during our inspection.
The registered manager told us the first floor was a ‘dementia specialist unit’, however, training records we looked at showed that dementia training had not been offered to staff since 2013. The training matrix was out of date and did not reflect what training people had or had not done. We gave the deputy manager time to update this and found a number of people were overdue ‘mandatory’ training [training the provider deemed was necessary for the role]. Staff members were also overdue supervisions and appraisals.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005. However, one person’s capacity assessment we looked at did not accurately reflect the persons current capacity.
All the people we spoke with told us the meals within the service were good. We saw people had a choice of two hot meals at lunchtime; if people wanted alternatives these were available. The kitchen had a good stock of food items. The service employed a cook and a kitchen assistant.
All the people we spoke with told us staff were kind and that staff listened to them and respected them. We observed kind and sensitive interactions with people who used the service.
On the first day of our inspection we found information that was confidential and should be stored securely, was stored in accessible areas. Before the end of our inspection on the first day, all confidential, personal information was held securely and in locked areas.
Records we looked at showed staff had not received equality and diversity training. We spoke with the registered manager regarding this who could not tell us why this training was not available to staff. The deputy manager informed us they were commencing with a new training provider very soon and new training would be available.
We saw the service had open visiting times. We observed large numbers of visitors within the service throughout our inspection.
None of the people we spoke with had been involved in the development of their care plans. They were not able to explain if they had the opportunity to discuss with staff how they wanted support from them. Care plans we looked at were not person centred and did not reflect people’s current needs.
We looked at how complaints and concerns were managed within the service. The registered manager told us they had not received any complaints. However, after speaking with relatives we found a number of complaints/issues had been raised with the registered manager. Whilst people were satisfied they had been dealt with, complaints should be documented and reflect actions taken and lessons learned.
All the people we spoke with who used the service told us they were able to make everyday choices, such as what they wanted to eat. We observed staff giving people choices throughout our inspection.
Whilst the registered manager was very knowledgeable about the people who used the service and their needs, our findings showed the registered manager lacked understanding of their pivotal role in overseeing all aspects of the service and guiding staff to ensure people received good quality care.
Audits within the service were not sufficiently robust to identify the issues and concerns we raised throughout our inspection. Notifications that should have been submitted to us in relation to incidents/accidents/safeguarding had not been sent.