Archived: Hammerwich Hall Care Home

We returned to inspect Hammerwich Hall on 24 October. This was earlier than we had planned and was brought forward because we had received further information of concern regarding the level of staffing and the effect this was having on the care of the people who used the service.

During this inspection we asked the questions we always ask;

Is the service safe?

The service was not safe because there were insufficient staff to maintain people's safety.

Is the service effective?

The service was not effective because people were not receiving the care which was planned for them in a timely manner.

Is the service caring?

We did not consider evidence for this during our inspection.

Is the service responsive?

We did not consider evidence for this during our inspection.

Is the service well-led?

The service was not well-led because the provider had not recognised the effect staffing levels was having on the care people received.

When we arrived for our inspection we were advised that the previous manager had left the service. A new manager had been appointed and started working at the service one week before our visit.

During our inspection we spoke with six people who used the service and three relatives. We also spoke with 12 members of staff, the regional support and newly appointed home manager.

Below is a summary of what we found. The summary describes what we observed, the information we looked at and what people who used the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was not safe. People we spoke with told us they did not feel safe in the home because so many of the staff did not know them or understand their needs.

People spent long periods of time without supervision from staff.

Is the service effective?

The service was not consistently effective. The provider could not assure people that care could be delivered in line with their assessed needs.

There were no arrangements in place to provide replacement staff for sickness cover.

Is the service caring?

The service was caring. People and their relatives were complimentary about staff. We observed kind and considerate interactions between staff and the people who used the service.

Is the service responsive?

The service was not consistently responsive. Lack of staff meant some people's preferences for care were not being met.

Is the service well led?

The service was not well-led. The provider was not ensuring the level of staff available reflected people's level of dependency and the support they required.

This inspection was completed by an inspector for adult social care. The inspection was unannounced, this meant the manager and staff did not know we were coming. The purpose of the inspection was to review the actions taken since our last inspection in August 2013 and answer the questions we always ask; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found.

Is the service safe?

The provider had increased staffing levels since our last inspection but we found there were still insufficient staff to meet the needs of all the people living in the home. One relative told us, 'My X (relative) hasn't got access to the call bell when she sits in the lounge and sometimes waits for a long time for assistance because there are no staff around'.

We saw that staff reported any adverse incidents which occurred and these were investigated to establish if further management plans or precautions were required.

Staff were aware of the categories of abuse that people might be subjected to and felt confident to report safeguarding concerns.

People's individual risks and specialised equipment needs, such as hoists, bedrails and wheelchairs were assessed and reviewed on a regular basis.

People had access to specialist health care professionals to maintain their physical and mental health.

Is the service effective?

The people who used the service had detailed care plans which provided staff with the information they required to care for people. Some of people's individual preferences on care were recorded, for instance their preferred name but the care plans lacked further detail, for example what time people liked to get up or go to bed in the evening.

There were effective processes in place to regularly review and update the care records to ensure they remained current.

Is the service caring?

The people we spoke with told us they were very happy with their care. One person said, 'We're looked after very well, I can't fault it'. Another person told us, 'Everyone is lovely. We're looked after very well'. The relatives we spoke with said, 'My X (relative) is very well cared for. Another said, 'The care is fine. The staff go beyond their duty'. This meant the people and the relatives we spoke with were positive about their experience of care.

During our inspection we observed staff providing kind and compassionate care however we also saw some staff have poor interactions with people. This meant the care people received was not consistent.

Is the service responsive?

The provider had not responded to the concerns raised at the last inspection about matching the staffing levels to people's dependencies and by relatives regarding the level of staff available to care for people. A relative told us, 'Not having enough staff to get meet people's personal needs quickly, makes more work for the staff in the end'.

There was a complaints system in place and people felt supported to raise concerns.

Some people were able to participate in a range of activities and social events as a group however we did not see what arrangements were in place for people who were unable to leave their rooms.

Is the service well-led?

The provider was regularly monitoring and assessing the quality of service provided through a range of audits so that, if necessary, improvement could be made.

The acting manager responded to concerns raised by people and their relatives. We saw that concerns raised at the relatives meetings concerning the level of staffing had been escalated to the provider. One relative said, 'I can definitely raise concerns with the manager. She'll sort it out even if it's not her job. She's very efficient'.

Staff received individual supervision sessions to discuss their personal development, concerns and feedback on their performance. A member of staff told us, 'The supervision sessions are good'.

Staff had access to training appropriate to the needs of people they cared for.

We saw that people were enjoying both the garden and the lounges although some people were restricted to their rooms due to their health condition. We saw that the activities plan offered a wide range of activities which people said they enjoyed.

People we spoke with told us that their care was good and that they felt they were well looked after. One relative told us: 'The care here is very good'. Another relative told us: 'They look after them very well'. One person who used the service told us: 'Staff are kind and thoughtful'.

We found that the home was clean and tidy throughout. The home had recently purchased a new steam cleaner which the domestic staff had found helped with the cleaning schedule.

We had concerns about the number of available staff to meet people's needs. Four of the six people we spoke to told us that they had to wait for someone to help them to the toilet. this did not promote the person's dignity.

We found that the home had a system of audits which covered most elements of care and upkeep of the building.

We saw that the complaints procedure was easy to find in the reception area. One relative we spoke with told us: 'The manager is very approachable. I raised a concern and the manager came straight away to put it right'.