Haydock Nursing and Residential Care Home

We found the following examples of good practice.

Infection prevention and control (IPC) policies and procedures were followed and kept under review. The home was clean and odour free. We discussed replacing open bins with pedal operated bins to ensure safer disposal of waste and ensuring cleaning schedules reflected the frequency of cleaning high touch areas. The registered manager agreed to address these points. There were designated domestic staff and cleaning schedules were followed. The registered manager ensured regular checks of the environment and cleanliness were carried out and any shortfalls were acted on.

The registered manager was accessing testing for people using the service and staff. Clear records showed safe processes were followed in response to any positive COVID tests, in line with government guidance. There were enough staff to provide continuity of support should there be a staff shortage. The registered manager spoke positively about the care and commitment shown by staff.

There were enough stocks of personal protective equipment (PPE). We observed staff and management using PPE correctly and there were procedures in place to support staff with its use. Staff had received training in the use of PPE and infection control. Signage was in place to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

The registered manager was facilitating safe visiting in line with government guidance. Visitor assessments were carried out to consider temperature checks, current health needs, lateral flow test results and COVID-19 symptoms; PPE and sanitisers were readily available. The registered manager was following safe guidance in relation to admissions to the home.

About the service

Haydock Nursing and Residential Care Home is a residential care home providing personal and nursing care to 50 older people, including people living with a dementia and mental ill health. At the time of the inspection, there were 45 people living in the home.

The home is purpose built two storey building. There was a separate specialised unit for people living with dementia.

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

Safeguarding adults’ procedures were in place and staff understood how to protect people from abuse. Relatives had no concerns and were fully confident their family members were safe, and people told us they felt safe and were happy with the service they received. Recruitment processes had improved and ensured new staff were suitable. There were enough numbers of staff to meet people's needs and to ensure their safety. The management of people’s medicines had improved, and people received their medicines when they needed from staff who had been trained and had their competency checked. Risk assessments included positive risk taking to optimise people's independence and receive support with minimum risk to themselves or others. The home was clean and free from hazards.

People's needs were thoroughly assessed in line with good practice guidance which ensured positive outcomes. Throughout the inspection, there was evidence of how management and staff supported people to have a good quality of life. People's health needs were identified and closely monitored. People enjoyed the meals and where appropriate, were supported and encouraged with eating and drinking. Specialists were involved when people were nutritionally at risk. Induction, ongoing training and support for staff was thorough and kept their skills up to date which had a positive impact on people’s health and well-being. 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.

Management and staff had developed friendly, caring and respectful relationships with people and their families. People were treated as individuals which helped protect their dignity; their equality and diversity was respected by a caring staff team. Staff understood the importance of giving people their time and knew the importance of encouraging people to maintain their independence. People consistently described staff as kind, friendly and caring.

Management and staff worked hard to understand and respond to people's needs and preferences. People's care was tailored to their needs, routines and preferences and staff knew people well. People were actively involved in the local community and had access to a broad range of meaningful activities which improved their quality of life, developed their self-confidence and their self-esteem. Activities were adapted to each person's needs to support social inclusion and promote choice whilst considering their preferences. People did not have any complaints about the service but were confident to raise any issues and were confident they would be listened to.

The service was well led by a committed and skilled management team who led by example. They used effective checks and audits of care to provide high-quality, person-centred care. There was an ongoing plan of development for the service and communication was good. Without exception, people spoke highly about the service provided and told us they would not hesitate to recommend the home. Staff felt valued and enjoyed working at the home. People's views and opinions of the service were sought and acted on.

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 requires improvement (published 01 March 2019).

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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service: The provider and registered manager had made significant improvements since our last inspection of 11 July 2018. These improvements require time to become embedded within normal routines and sustained to ensure continued development of the service.

During this inspection, we found two continuing breaches of the regulations in relation to safe recruitment and safe management of medicines. We have also made a recommendation in relation to the management of complaints.

People who used the service and their relatives told us they felt safe. Staff knew their responsibilities in relation to report any concerns of safeguarding and relevant policies and procedures were in place to guide them. Risks to people’s health and wellbeing had been assessed and were reviewed on a regular basis to keep people safe. Good infection control practices were observed throughout our inspection.

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 supported this practice. Relevant deprivation of liberty applications had been submitted to the assessing authority.

People told us they were supported by staff who were knowledgeable. We saw training for staff had improved since our last inspection. People told us they enjoyed the food and were supported to access a varied diet. Staff supported people to eat their meals when necessary.

We observed staff were kind and caring when interacting with people who used the service. People who used the service gave us positive feedback about the staff. Systems were in place to ensure people were able to communicate effectively. People were treated with respect and without discrimination.

Care plans had been reviewed and updated since our last inspection. The care plans we looked at contained good information about people’s individual needs and how to support them. People had access to activities both within the service and in the community.

We received positive feedback about the registered manager and the operation and oversight of the service. Audits and monitoring had improved although the new systems needed time to become embedded within normal routines. Team meetings were taking place that provided staff with updates about the home and its operation.

More information is in the full report.

Rating at last inspection: At the last inspection this service was rated requires improvement [published 25 January 2019]. Whilst the overall rating of this service has not changed at this inspection, the ratings in some domains has improved.

Why we inspected: We undertook this inspection based on the previous ratings of the service.

Enforcement: You can see what action we have told the provider to take at the end of the full report.

Follow up: We will plan a follow up inspection as per our inspection programme. We will continue to monitor the service and if we receive any concerning information we may bring the inspection forward.

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.

Was the service safe?

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, safeguarding, whistleblowing and investigations. The registered manager audited any incidents and used the information to improve the service. Two people who used the service told us, "I have no concerns and you can talk to the manager or other staff if you do have" and "I have no concerns or worries. I cannot think of anything they do wrong".

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one.

We conducted a tour of the home and found it was clean, warm and free of any offensive odours. There were dedicated domestic staff to clean the home. A person had shared their experience with us and said the home sometimes smelled of urine. Two people who used the service told us, "The home is clean and tidy" and "The home is always clean and tidy. I have never known it to smell". Three relatives said, "It is always clean and tidy. No nasty smells which is important", "The home is very clean and tidy and no offensive odours" and "The dementia unit is clean and tidy. There are no offensive odours that I have noticed".

Was the service effective?

People's health and care needs were assessed with them if possible, and they were involved in writing their plans of care. We looked at three plans of care and found them to be individual to people's needs and kept up to date. Two people who used the service said, "The care I get is good and I do a lot of things on my own" and "The staff treat me very privately. They are real professionals and know how to care for me. They update me about my care. We have a laugh". Three relatives told us, "They look after her very well. We are very satisfied with her care. They are very careful to give her privacy", "I am happy with her care and have no complaints about care or her treatment" and "The care is very good".

Specialist dietary, mobility, skin care and community support needs had been identified in care plans where required. Specialist equipment was provided such as pressure relieving devices or mobility aids. People had access to healthcare professionals and specialists for treatment and advice.

The manager and other key staff audited the effectiveness of the systems they used. This included medication, the environment, infection control and plans of care. The information was used to improve the service.

Staff were trained in key topics such as health and safety, infection control, fire awareness, food hygiene, medication administration, first aid, mental capacity, deprivation of liberties and moving and handling. There were other training opportunities in dementia care. Staff were encouraged to take a nationally recognised qualification in health and social care. Two staff members told us, "We get a lot of training. I have done all the mandatory training and have just updated my safeguarding and infection control training again. We get regular supervision. You can discuss what you want or bring up your training needs" and "We are very well supported and get lots of training. I like the extra training like catheter care or how to peg feed".

The meals served at the home met people's expectations. Two people who used the service told us, "There are only one or two meals I do not like but they give me something else. They give you plenty. I see lots of people cannot eat it all" and "The food is very good". Three relatives said, "The food is very nice. I used to stay here when they gave her a meal and if I wanted they gave me a meal", "When I have been here the food has been good" and "The food is very good".

Was the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. There was a friendly atmosphere within the home and we observed that staff interacted and chatted to people

who used the service. Three relatives told us, "The staff are very good and know what they are doing", "The staff are very friendly. I have got to know a few of them. They are pleasant and polite to my aunt. They know how to look after her. They arrange everything she needs such as chiropody" and "The staff are very nice. I come here five times a week. They staff know what they are doing". Two people who used the service said, " Staff are wonderful to me" and "I am happy here. It has really surprised me how well I settled in".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People who used the service were encouraged to provide as much information about their past lives and what they liked or did not. This information gave staff the knowledge to treat people as individuals.

People lived in a comfortable environment and were able to personalise their rooms to make them feel more at home. People who used the service told us, "I like my room and as you can see I have made it my own" and "I have a nice room with a lovely view".

Was the service responsive?

People completed a range of activities in and outside the service regularly. Each person had their known hobbies and interests recorded. Activities were suitable for the people accommodated at the home. Two people who used the service told us, "I go shopping on my own twice a week and with family on other days. I go to church when I want. I go swimming twice a week. I like to use my computer and play my keyboard" and "They take me out but when I am inside I like to read. I also knit and crochet".

The registered manager held regular meetings with people who used the service and staff. Each day staff attended a 'handover' meeting to ensure they were up to date with people's needs. Staff were able to voice their opinions at meetings and supervision sessions.

Was the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. There was a system for providing information to other providers in an emergency.

Records we looked at were up to date and policies and procedures had been reviewed by the manager. The records were stored securely and readily available for inspection.

The service had good quality assurance systems. The registered manager undertook regular audits of the service. Records seen by us showed that identified shortfalls were addressed promptly and as a result the quality of the service was continually improving.

Plans of care contained sufficient up to date details for staff to give effective care. The home was warm, clean, free from offensive odours and suitably decorated in a homely style. People who used the service told us they were satisfied with their bedrooms.

There was a system for repairing any faults and keeping gas and electrical equipment in good working order. This helped protect the health and welfare of staff and people who used the service.

The records we looked at were stored safely and up to date. There were sufficient records to meet the needs of people who used the service and show that staff were well trained and safely recruited.

Several people told us that care was good. Plans of care contained sufficient detail for staff to follow good practice. The plans had been developed with people who used the service or their family members to take account of their wishes.

People who used the service said, "I am very happy here. It is an excellent home. Staff leave us to our privacy. They come quickly if you want them but they leave us to ourselves when we feel like it, which is how we wish to live" and "I am very well looked after. My mobility has improved and I go out to the shops, to church and swimming". People were satisfied with the care at this nursing home.

People told us they felt safe. There were robust systems to protect people from possible harm.

People who used the service said, "It is a home from home. I have all I need in my room. I have my computer and play music on my organ. I have the freedom to come and go" and "The family helped choose the home for us. They visit us regularly and the staff are good to our visitors. I am very satisfied with the bedroom and they let me eat here, which I prefer". People were satisfied with the facilities and equipment provided by Haydock Nursing and Residential Home.