Archived: Hames Hall Residential Care Home

Hames Hall Residential Care Home is a care home providing personal care for up to 25 older people. At the time of our inspection there were 23 people living at the service.

Hames Hall Residential Care Home accommodated people in one adapted building.

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

Whilst people felt safe living at the service and confident in the knowledge that staff were available should they need them, the provider’s approach put people’s health and safety at risk at times. The provider had not always acted on recommendations made by health and safety experts in a responsive way to keep people safe. We have made a recommendation about this.

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. We made a recommendation about capacity and consent records at the last inspection, which remains ongoing.

People were supported by staff who were familiar with their needs and how to support them. However, details of risks to people were not always robustly recorded. The registered manager made some changes to people’s care records following the inspection. The provider had plans to review and update care records to support improvements across the service.

People and their relatives praised the leadership of the service by the registered manager. There were opportunities for people, relatives and staff to provide feedback on the running of the service to support improvements. The provider’s quality assurance systems were being developed to help improve high quality care for people. We have made a recommendation about this.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 18 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of Safe and well-led only.

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.

The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hames Hall Residential Care Home on our website at www.cqc.org.uk.

Recommendations

At our last inspection we recommended that the provider reviewed how it recorded people’s capacity and ability to give consent. At this inspection we found further work was needed to capacity assessment records. We have made recommendations about health and safety and quality assurance systems.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last inspection on 7 May 2015 the service was rated Good. At this inspection we found the service remained Good.

The service 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 who used the service and relatives consistently praised the staff and their skills. People were supported with care and compassion and there was an ethos of care which was person-centred, valuing people as individuals.

The way care plans were developed had improved being written now in a very person centred style and were regularly reviewed to reflect peoples’ individual care and support requirements. People were given safe care because risks had been identified and managed.

The environment was well maintained and the atmosphere was relaxed and homely.

People’s rights were protected and staff obtained people’s consent before providing care. The service had recorded people’s capacity to consent to care but had not recorded their capacity to make other decisions.

We made a recommendation that the service seeks advice about how the service checks people’s capacity to make decisions and how they can support them to do this.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff were well motivated and proud of the service. They received extensive training and support to meet people's needs effectively. Staff had regular opportunities to reflect on their practice and to request any additional support or training.

Systems were in place for the safe storage, administration and disposal of medicines. Records showed people received their medicines as prescribed and in their preferred manner.

We made a recommendation about developing care plans to manage ‘as and when’ medicines.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

People were supported to eat a well-balanced diet and those who were at risk of malnutrition and/or dehydration had their food and fluid intake monitored. People told us of the high quality and range of the meals provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

The provider had a range of quality monitoring systems and had made improvements in response to people's feedback and audits. There was a commitment to deliver a high standard of personalised care and continued improvement based on the views of people who used the service.

Complaints were taken seriously, thoroughly investigated and lessons learnt from them.

Staff and people who used the service said the registered manager was supportive and approachable. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people's care and support needs and the running of the service.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found-

Is the service safe?

We found that the service had updated the policies and procedures on safeguarding vulnerable adults and had ensured that all staff had received training on protecting people.

We saw that the environment was well maintained and that people lived in a clean, well cared for and safe environment.

We had evidence to show that staff had received training on health and safety and on specific issues like moving and handling. Medication management had improved since 2013 and suitable arrangements were in place to sustain this improvement.

Staff had a good understanding of their responsibilities under the Mental Capacity Act 2005 and no one was deprived of their liberty.

Is the service effective?

We had evidence to show that a new approach to care planning had ensured that people were given the right kind of care and treatment. There was improved communication with health and social work professionals. On the day of our visit we observed staff taking action where people were unwell, distressed or disorientated.

Is the service caring?

We judged this by observation and by listening to staff talk about the people they cared for. We saw respectful interactions and we saw staff treat people in a kind and caring way that maintained their dignity. Written records were appropriate and there were no judgemental statements about any person in the home. People told us:

"The staff are very kind...I can't grumble about the treatment I receive."

"I am treated quite kindly by most of the staff."

Is the service responsive?

We found that the staff had listened to the requests of people in the home and they allowed people to be as independent as possible. We saw that where people had asked for different activities this had been acted upon and new activities started. Friends and relatives were encouraged to visit and, where people lacked capacity, they were able to act on behalf of individuals. Care plans were much more detailed than previously and gave a better picture of the person's wishes and needs.

Is the service well-led?

We judged that the deputy manager was making a good attempt at leading the home at a time when there was no manager in post. The provider and other people in the company were giving her as much support as possible. The home had also lost senior care staff in the weeks before the inspection.

We judged that the lack of a permanent, registered manager was preventing the service from developing staff appropriately. We were concerned that there were too few shift leaders in post to give good day-to-day leadership. The provider had put an interim plan in place to ensure that the home ran smoothly until a manager and new team leaders could be recruited.

We judged that the home was not being as well led as it might be and we made a compliance action about the way the home was staffed.

On this occasion we only looked at one outcome about care and welfare. Two inspectors spoke with people who lived in the home, visitors, the acting manager and the staff. We also looked at the planning and assessment around the delivery of care. We had evidence to show that the home had met the concerns contained in the warning notice and had become compliant in terms of care and welfare.

A visiting relative told us:

"Communication is much better and our relative is now receiving the right levels of care."

A person in the home said to us:

"Now I know what is in my care plan and I have been able to talk to staff about the kind of support I need. I feel that my independence is being encouraged now."

We could see that staff training and supervision was being improved and that all of the people who lived in the home had been reassessed. Care planning had been updated and improved. Further improvements, for example the introduction of a key worker system, were underway.

The people we spoke to told us they felt safe living at the home. One person said, "I feel safe here. I've no issues." However, we found that a recent safeguarding incident had not been reported in a timely manner and some staff were unclear about the principles of safeguarding vulnerable adults.

We found that the provider was now making relevant checks before recruiting new staff and, from observations, there were suitable numbers of staff employed at Hames Hall. However, we found that training for some staff in key areas were either out of date or had not been completed.

We looked at the provider's quality monitoring systems and found that these had not been effective in identifying problems in areas such as medication dispensing and care planning.

'I can't fault the girls'.

'I put my own creams on. I like to do as much for myself as possible'.

'I am happy with the care I get'.

'I have no complaints'.

Overall, we found that medicines were managed in a safe way.

"It is very nice here and I am anxious about being able to stay..."

"We are very well looked after...there is nothing wrong here...I wouldn't complain."

"I have a lovely room and the food is very good."

"The manager has been very good with us as a family".

Some comments gave some more complex responses:

"It is fine but I think it is very expensive and I don't think it is value for money."

"I would like some different activities ...what is on offer doesn't interest me".

"I just do what the staff want...it is fine but I am not sure they really understand me".

We saw evidence to show that people were asked before they consented to treatment but we asked the provider to look at ways to involve people more.

We judged that the delivery of care needed to be more individualised and planned. There were some issues about the storage of medicines that did not comply with the legislation. Compliance actions were made about these issues

Recruitment in the service was non compliant as references had not been obtained.

The manager of the home did most of the management, care planning and supervisory tasks. The home was not compliant in staffing as not enough supervisory staff were employed.

Complaints were managed adequately in the service.