Archived: Hurst Hall

Hurst Hall is a residential care home providing accommodation and personal care. The service can support up to 50 people. At the time of the inspection there were 47 people using the service.

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

We found the evidence supported the overall rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

Detailed risk assessments were in place, risks were well managed and detailed records were kept of care and support provided. Records were up to date and fully completed. Peoples nutritional needs were met. The service worked closely with healthcare professionals to ensure people’s health needs were met.

Medicines were managed safely. Safe systems of recruitment were in place. Staff had received training in safeguarding people from abuse. Staff and people who used the service knew how to raise any concerns and were confident any concerns they raised would be dealt with appropriately.

There were sufficient staff to meet people’s needs and staff received the training and support they needed to carry out their roles. 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.

Significant improvements had been made in the pre-admission process and documents. These included information about people's wishes, choices and the support they needed. Care records were person centred, reviewed regularly and updated when people’s needs changed. People were positive about the staff and living at the home. The home was well maintained, and furnishings were in good condition.

Staff and the registered manager knew people well. We saw staff were kind and caring and interactions were warm and friendly.

There were now good systems of daily, weekly and monthly quality assurance checks and audits.

Rating at last inspection

The last rating for this service was requires improvement (published September 2016) and there were two breaches of regulation. 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.

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

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.

Hurst Hall is a “care home”. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hurst Hall accommodates 50 people. The home is a purpose built single storey building. There are 50 single occupancy bedrooms, 33 of which have an en-suite toilet. There were two separate communal lounge/dining areas, a conservatory and a paved garden/courtyard area. The home has a small car park. At the time of our visit there were 41 people living at Hurst Hall.

We last inspected Hurst Hall on 16 and 17 August 2016 when we rated the home as requires improvement overall and for each of the five key questions other than caring, which was rated good. At the last inspection we identified multiple breaches of four of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These were in relation to the safe management of medicines, safety of the premises, seeking consent, person centred care and good governance. We issued a warning notice for good governance which identified a timeframe that the service needed to be compliant with the regulation by. We also asked the provider to complete an action plan to show what they would do and by when to improve.

At this inspection we found satisfactory action had been completed to ensure the safe management of medicines, safety of the premises, seeking consent and person centred care. However, we identified a continued breach of regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014, relating to a lack of maintaining accurate, complete and contemporaneous records. You can see what action we told the provider to take at the back of the full version of this inspection report.

There was a registered manager in place, although, at the time of this inspection the person was on extended leave. 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.

The service was being managed by an experienced manager brought in to manage the service during the registered manager’s absence. Throughout the report we have used the term ‘acting manager’ for the current manager in charge of the service.

We found issues in relation to care and treatment records, such as positional change records not being consistently maintained. We also found concerns relating to pre-admission assessment documentation not being fully completed with all required details. Lack of clear recording and appropriate completion of documentation could put the person receiving support at risk of inappropriate care and treatment being provided.

Medicines were found to be safely managed. We saw that records of medicines administration were accurately completed and all medicines were stored safely.

Staffing levels were sufficient at the time of the inspection to meet the needs of people who were cared for and supported by the service.

We found there was a safe and robust system of staff recruitment in place. All pre-employment checks were completed before an offer of employment was made.

We observed positive interactions between staff and people living at the home. Our observations of care, and discussions with staff indicated that they knew people and their support needs well. We saw staff communicated effectively with people and took positive steps to ensure people’s privacy and dignity was upheld when delivering care.

We observed staff communicating clearly and effectively with people and also observed staff acknowledging non-verbal communication used by some people, such as a nod or shake of the head.

Staff had a good understanding of how to identify and report potential safeguarding concerns. Staff told us they would feel comfortable raising any concerns with the acting manager or deputy manager if required.

Staff we spoke with told us they had completed various mandatory training that enabled them to support people effectively. Staff said they felt they received sufficient training to enable them to undertake their roles competently.

Records were available to confirm that staff were receiving supervision from their line manager and staff confirmed they attended regular staff/team meetings.

Two wellbeing coordinators were employed to provide various activities to keep people occupied.

We saw food and drinks were offered to people regularly and care plans documented people’s preferences and any dietary requirements. Staff we spoke with were aware of these requirements.

Where required, we saw evidence of regular involvement of other health professionals such as district nurses, doctors and dieticians in people’s care and support.

People’s weights were monitored and, where required, food and fluid intake, although some of the documentation relating to recording food and fluid intake had not been fully maintained. Records indicated that when required, appropriate measures had been taken such to help ensure the person’s health was maintained by making a referral to the doctor, district nursing service or dietician.

We found evidence the provider and acting manager were in the process of making improvements to the service. For example, the acting manager was reviewing all care plans and associated documentation to ensure people’s needs were clearly identified and being met in accordance with regulatory requirements. This was on-going at the time of our inspection.

Hurst Hall is a residential care home registered to provide care and accommodation for up to 50 people. The home is situated in Ashton Under-Lyne, Greater Manchester. The home is a purpose built single storey building. There are 50 single occupancy bedrooms, 33 of which have an en-suite toilet. There were two separate communal lounge/dining areas, a conservatory and a paved garden/ courtyard area. The home has a small car park. At the time of our visit there were 49 people living at Hurst Hall.

We last inspected Hurst Hall on 12 and 13 October 2015 when we rated the home as requires improvement overall and for each of the five key questions other than caring, which was rated as good. At the last inspection we identified multiple breaches of the regulations, which related to the safe management of medicines, assessing and mitigating risk, infection control, cleanliness, assessing preferences and monitoring the safety of the service.

We found improvements had been made in some areas; however we also identified some on-going breaches of the regulations. At this inspection we identified multiple breaches of four of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. These were in relation to the safe management of medicines, safety of the premises, seeking consent, person centred care and monitoring and improving the quality and safety of the service. You can see what action we told the provider to take at the back of the full version of this inspection report. We are currently considering our options in relation to enforcement in relation to some of the breaches identified. We will update the section at the end of this report once any action has concluded.

There was a registered manager in post at the time of our inspection. 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. The registered manager was also the registered manager at another location run by the provider and they had registered to manage Hurst Hall whilst a new permanent manager was being recruited. A new permanent manager was in post at the time of our inspection and was in the process of registering with CQC.

We found evidence the provider and acting manager were in the process of making improvements to the service. For instance, we saw a new format of care plans had been introduced, there was an on-going refurbishment of the environment, and the acting manager was taking steps to make the environment more ‘dementia friendly’. However, these changes had not been completed at the time of our inspection.

We found issues in relation to the safety of the environment. Locks on doors to areas containing electrical equipment did not function properly and would allow people to access these areas. The provider took action to fix the locks, but had not identified this concern before we had raised it. We also found there were on-going issues in relation to the heating system at the home. This meant the heating could not be fully turned off on the day of the inspection, which was a warm day. The room of one person who was cared for in bed was very warm and the provider did not have adequate systems in place to monitor the temperature of the environment despite the known issues with the heating system. There was no evidence of actual harm to this person and the provider took action to reduce the room temperature. However, the provider had failed to identify and act on this risk until this was highlighted by the inspection team.

Staff were able to demonstrate a reasonable understanding in relation the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), and staff were aware which people they supported had an authorised DoLS in place. However, we found the provider could not demonstrate they had considered issues around capacity when administering medicines covertly (without the person’s knowledge). We were concerned the service may have been administering medicines covertly to a person who had the right and capacity to refuse medicines. We raised a safeguarding alert in relation to this concern.

We found medicines were stored safely. However, records of medicines administration were not always accurate, and one person had not been observed taking their medicine, which meant they had been left unsupervised with their medicine on the table.

We observed positive interactions between staff and people living at the home. Our observations of care, and discussion with staff showed that they knew people and their support needs well. We saw staff communicated effectively with people and took positive steps to ensure people’s privacy and dignity was upheld when delivering care.

The provider was transferring care plans to a new format. Because of this, we found care plans to be variable in quality and content. We found some older care plans did not show evidence of regular review and some contained inconsistent or contradictory information.

Staff had a good understanding of how to identify and report potential safeguarding concerns. Records kept by the provider showed appropriate actions had been taken in response to any concerns raised. Staff told us they would feel comfortable raising any concerns they might have with the manger or the provider’s head office if required.

Staff received regular supervision from a manager and attended team meetings. This would help the provider ensure staff were competent and received the support they required. Staff told us they felt they received sufficient training in order to undertake their role effectively. We saw training had been provided in areas including safeguarding, infection control and health and safety.

We received mixed responses from people living at Hurst Hall as to whether they felt there were sufficient activities provided to keep them occupied. The home employed a part-time activity co-ordinator, although they were not present at the time of our inspection. Records of activities showed some activities including an aerobics session had taken place recently. However, there was no evidence that opportunities for activities had been provided to people who were cared for in bed.

We saw food and drinks were offered to people regularly throughout our inspection. People’s care plans documented their preferences and any dietary requirements in relation to food and drink. The staff we spoke with were aware of these requirements and how to prepare food accordingly.

There was evidence of regular involvement of other health professionals such as district nurses, GPs and dieticians in people’s care. Where a need had been identified, the service was monitoring people’s weights and food and fluid intake. We saw one person had not had their weight monitored as frequently as their risk assessment indicated was required, which staff told us was due to this person now being cared for in bed. However, we were satisfied other appropriate measures had been taken such to help ensure this person’s health was maintained such as a referral to the GP.

Staff we spoke with were aware of actions to take in the result that someone became unwell or sustained an injury. Staff had a reasonable awareness of how to reduce the risk of people falling, and there were comprehensive systems in place for monitoring any trends in accidents such as falls.

Regular audits of the quality and safety of the service were undertaken by the manager and provider. However, we found not all actions identified from audits had been effectively implemented. The provider had also not made the necessary improvements to ensure the requirements of all regulations found to be in breach at the last inspection had been addressed.

Relatives of people who used the service were also satisfied. One relative said 'Staff have been excellent here, they are very friendly.' And another relative said 'I have been made to feel welcome.'

We found that the people who used the service are treated with dignity and respect and are able to make choices about their lives. One relative commented 'Preferences and choices were taken into consideration.'

The care that people received was planned and reviewed and changed according to need.

The home was clean and well maintained.

Staff received the appropriate training to do their job successfully and felt well supported by senior staff. One member of staff 'we get a lot of training, such as fire , manual handling and dignity.'

The home has systems in place to make it a safe environment for people to live in.

We saw that people in the home were supported by a fully trained staff team who had a good knowledge of individual care needs. We saw that staff used care plan records as a working tool to support them in providing care and support to people in a way that matched their individual needs and preferences.

We found that care plans were regularly updated to reflect any changes in care need requirements and that where possible people and their relatives were informed and involved in the process.

The service had good systems in place to manage the medication in the home and to ensure that people received their medication in a safe way.

There was a robust complaints system in place that encouraged and supported people to express their views and opinions.