Archived: Hartlands Rest Home

Hartlands Rest Home is a residential home providing accommodation and personal care for up to 21 people aged 60 and over. At the time of the inspection 14 people were living there, some of whom were living with dementia.

People’s experience of the service and what we found:

People were exposed to risks from the environment including fire, following our inspection we made referrals to the fire service who have taken action. Management of medicines was not safe. People were not always safeguarded from the risk of abuse. Lessons were not learned after adverse incidents. Infection prevention and control measures were not robust, and people were placed at risk of Legionella and food poisoning.

The provider did not have a clear system to ensure there were enough staff to support people safely. Staff did not receive appropriate training to ensure they could deliver safe and effective care. Staff were not always recruited safely.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not have good oversight of the quality and safety of care, their governance systems were ineffective. People and relative described the registered manager as supportive. The registered manager felt unsupported by the provider and was planning on leaving their post following our inspection. There were no clear systems in place to proactively seek feedback from people, relatives and staff about the running of the service and how quality could be improved.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement 9 June 2023.

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 staffing, training and safety of people. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

During the inspection we found there was a concern with people being given maximum choice and control of their lives, so we widened the scope of the inspection to include effective.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Hartlands Rest Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the need for consent, safe care and treatment, safeguarding service users from abuse, governance of the service, staffing and training.

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 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hartlands Rest Home is a residential home providing accommodation and personal care for up to 21 people aged 60 and over. At the time of the inspection 14 people were living there, some of whom were living with dementia.

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

People were at risk of communicable illnesses as the provider failed to ensure effective infection prevention and control practices were followed.

Repairs and improvements to the physical environment had not been made putting people at the continued risk of harm.

The provider had not introduced effective environmental quality monitoring systems. The provider had failed to introduce an improvement plan which was shared with or known by staff in the home.

The registered manager had introduced checks to ensure people received their medicines as prescribed.

The provider had made changes to the fire safety escape routes meaning people could now safely move to a safe area or exit the building in the event of an emergency. Items hazardous to health were now securely stored.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (published 09 March 2023). At our last inspection the provider was in breach of regulations regarding the safety to people and the management. At this inspection the provider is still in breach of these regulations although some improvements have been noted.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

At this inspection we found some improvements had been made. However, the provider was still in breach of regulations.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hartlands Rest Home is a residential home providing accommodation and personal care to 18 people aged 65 and over at the time of the inspection, some of whom were living with dementia. The service can support up to 21 people.

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

People were not always safe as the physical environment did not always support the safe provision of care and accommodation. The provider did not have effective infection prevention and control procedures in place and people did not always receive their medicines as prescribed. Missed medicines or recording errors were not identified, investigated or corrected effectively. The provider did not have effective quality checks in place to ensure people received safe care.

People were supported by enough staff who were available to assist them in a timely way. People were protected from the risks of ill-treatment and abuse as staff had been trained to recognise potential signs of abuse and understood what to do if they suspected harm or abuse. The provider had assessed the risks associated with people’s personal care and support. Staff members were knowledgeable about these risks and knew what to do to minimise the potential for harm.

People were supported to have maximum choice and control of their lives and the provider supported them in the least restrictive way possible and in their best interests; the application of the policies and systems supported good practice.

The provider and management team had good links with the local communities within which people lived.

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 good (published 24 September 2019). The rating has changed to requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about the safe moving and handling techniques used by staff and people’s increased risk of falls. 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 changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

Enforcement and Recommendations

We have identified breaches in relation to keeping people safe and how the Hartlands Rest Home is managed at this inspection.

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.

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

Follow up

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

Hartland's Rest Home is a residential care home providing personal and nursing care for up to 21 older people including people living with dementia. The home accommodates people in one two-storey adapted building. At the time of our inspection 20 people were living at the home.

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

People had their needs assessed prior to living at the home. They had person centred care plans that reflected their needs, preferences and routines. Care plans were reviewed regularly with people and their chosen relatives. Staff knew people well and had developed positive relationships with them. People told us that staff were kind and caring. People's privacy and dignity was respected and their independence promoted.

Safe recruitment procedures were in place and staff had all undertaken induction, along with training relevant to their role with refresher updates. There were enough staff to meet people's needs. Staff received support from the management team. The staff and management team worked closely with health and social care professionals and also developed community links.

Medication was managed safely by trained and competent staff. Medication administration records (MARs) were fully completed and regularly reviewed. Medicines policies and procedures were available for staff along with best practice guidance. Emergency procedures and contingency plans were in place. Staff had received infection control training and followed good practice guidelines to minimise the risk of infection being spread.

People participated in activities of their choice within the home and in the local and wider community.

Risks to people had been clearly identified and guidance was in place to ensure that staff could minimise these risks. People were protected from the risk of harm and abuse. Staff felt confident to raise any concerns about abuse and had completed training.

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.

Rating at last inspection

The last rating for this service was good (Published 13 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow-up

We will continue to monitor all intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.CQC.org.uk

Hartlands Rest Home is registered to provide accommodation with personal care for up to a maximum of 21 people. There were 17 people living at the home on the day of our inspection. Some people were living with dementia.

There was a manager in post who was present during our inspection. The manager was in the process of applying to become registered manager for the service. 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 felt safe and secure living at the home and with the support provided by staff. People were supported by staff who were knowledgeable about the different signs of abuse and knew how to report concerns.

Risks associated with people’s needs had been assessed and plans put in place to minimise them. Staff knew how to deal with accidents or incidents and these were overseen by the registered manager who took appropriate action to reduce the risk of reoccurrence.

There was enough staff to meet people’s needs in a safe and timely manner. The provider completed checks to ensure that new staff were suitable to work with people before they started work in the home.

People received support to take their medicines safely and accurate records were maintained. People were supported to see health care professionals as required. Staff followed guidance provided by health professionals to promote people’s health and wellbeing.

People and their relatives told us they were happy with the choice and quality of food available to them. Regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration.

People and their relatives were confident that staff had the skills and knowledge to meet their individual needs. Staff felt well supported and received training that was relevant to their role and to further their development.

Staff sought people’s consent before supporting them. Staff provided information to people in a way they could understand to enable them to be involved in decisions about their care and treatment. Where people were unable to make certain decisions for themselves these were made in their best interest to protect their rights.

Staff treated people with kindness and consideration. People were offered choice and felt listened to. Staff promoted people’s dignity and independence. Staff spoke with and about people with respect.

People received support that was tailored to their individual needs and preferences. Staff knew people well and were able to recognise and respond appropriately to changes in their needs.

People were able to spend their time as they wished and had access to activities suited to their interest and ability. People were supported to keep in contact with people who were important to them

People and their relatives felt able to talk to staff or management if they had any concerns or complaints and were confident that these would be dealt with promptly.

There was a warm and friendly atmosphere at the home. People and staff found the manager approachable and easy to talk to. Staff were positive about their caring role and felt valued.

There was an open and inclusive culture at the home where people and staff were encouraged, and felt comfortable, to express their views. The manager carried out a range of checks to monitor the quality and safety of the service and used their findings to make necessary improvements.

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