We visited Hodge Hill Grange and carried out an inspection there. During our previous inspections in 2013 and January 2014 we found that the provider was not meeting the requirements of the regulations. We took enforcement action. During this inspection we looked to see if improvement had been made. We found that a lot of improvement had been made but there was a need for further improvement. We looked at information to help us gather evidence about the quality of the provider's care and support to people that lived there. On the day of our inspection, the manager told us that 30 people lived there.
We spoke with the manager, area manager and quality assurance manager. We also spoke with nursing and care staff on duty and other staff members such as the chef and the activities organiser. We spoke with 11 people that lived there and observed other people. We later spoke with 14 relatives. We also looked at records. Our conversations with people helped us to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?
Below is a summary of what we found.
Detailed evidence supporting our summary can be read in our full report.
Is the service safe?
All of the people spoken with told us that they felt safe living at the home. One person told us, 'I feel safe here. Things have improved a lot over the last few months.' All of the relatives spoken with confirmed to us that they felt that their family member was safe there. One relative told us, 'I have no concerns. My family member is safe there.'
There was a system in place to record accidents and incidents. Staff spoken with showed that they were aware of the reporting system. We saw that nine accidents and incidents were recorded for March and fourteen for April 2014. We saw that the provider had taken appropriate action to record these and take the appropriate steps to minimise the risk of reoccurrence.
There was a system in place to handle concerns and complaints. The manager told us that two complaints had been received by the provider from people that lived there or their relatives since our last inspection in January 2014. However, a few relatives told us of concerns and complaints that we saw had not been recorded or resolved.
The manager told us that several new staff had commenced employment at the home since our last inspection. We saw that staff files contained the required pre-employment checks. This meant that the provider ensured that people employed were suitable to work with vulnerable adults.
As part of our inspection we asked the registered manager about how they implemented the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DOLS). They told us that they would make the appropriate referrals for people if needed.
Effective systems were not fully in place to ensure that medicines were managed safely. We saw that people did not always receive their medicines in accordance with the prescriber's advice. A compliance action has been set. This means that the provider will need to send us an action plan telling us how they will make further improvements.
Is the service effective?
We saw that the provider's information guide was displayed in the home and gave people information about the service.
We saw that information was displayed about activities that were planned. We also saw that a newsletter was available to people and their relatives.
All of the people we spoke with told us and we found that meals were appetizing and hot when served. One person told us, 'The food has improved.'
Is the service caring?
Most people we spoke with told us that they thought most of the staff were kind and caring. One relative told us, 'The care has improved overall. Although it could improve a bit more when the home manager is not there, with just the little things like making sure people have their hearing aid or glasses.'
People that lived there and their relatives were asked for feedback about the service. Resident and relative meetings took place so that feedback could be gathered.
Is the service responsive?
We saw that 'resident meetings' and 'relative meetings' took place. We saw examples of how the provider had responded to issues raised. For example people that lived there wanted to go on day trips. We saw that action was underway to take on a few relative volunteer mini-bus drivers so that day trips could be offered to people. This meant that the service was responsive. However, we also observed that one request made by people was not being met during our inspection. One person told us, 'It depends which staff are on duty.' This meant that there was an inconsistent staff approach in responding to people's requests.
Most relatives spoken with told us they had no concerns or complaints. Most relatives told us that they felt the service had improved. One relative told us, 'I now feel that I could recommend the home. Things have improved overall.' However, a few relatives told us that concerns or complaints made by them to staff had not been responded to.
Is the service well led?
On 6 February 2014 we served a fixed penalty notice to the provider, HC One, for failing to have a registered manager in place at Hodge Hill Grange. A fine of '4,000 was paid. In May 2014 an application was submitted by the manager to become registered with us.
All of the staff told us that they felt supported in the job role by the manager. One staff member told us, 'The manager is approachable. There is better communication now and things have improved.' This meant that staff were well-led.
We saw documented evidence that showed that the provider worked with other
health care professionals and made referrals for advice and guidance when needed.
The service had a quality assurance system. Records looked at showed that audits took place. We also saw that audits had action plans and that actions were implemented.