Hengoed Park

Hengoed Park is a residential care home providing accommodation and personal care to a maximum of 44 people. These residential care home beds are in the main home and 8 bungalows on site. At the time of our inspection there were 44 people using the service.

Hengoed park is also registered with us to provide a domiciliary care service, accommodation for persons who require treatment for substance misuse and treatment of disease, disorder or injury. No one was receiving these services at the time of our inspection.

The service provides support to younger adults and older people who may have mental health support needs, dementia, who misuse drugs and alcohol, are detained under the Mental Health Act or have a physical disability.

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

People's medicines were not managed safely at all times. People were not always protected from environmental risks, although the provider had refurbishment plans in place and work had already started throughout the home to make improvements.

We have made a recommendation about the recruitment of staff because the provider had not ensured the correct information had been recorded. This was addressed at our inspection.

Risks to people were assessed and planned for so staff could support people to stay safe. However, improvement was needed to ensure staff recorded accurate information when they had repositioned people to reduce the risk of skin damage.

Records did not demonstrate people’s voice was sought and what their expectations were for their care and goals. Governance systems were not always effective at identifying concerns within the service, such as people’s records, staff training records, staff recruitment and medicines.

There was minimal provider scrutiny or oversight of the governance arrangements within the service. The registered manager was also the nominated individual. The provider had failed to ensure all notifiable incidents were reported to us as required.

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 generally supported this practice.

People were supported by enough staff. Most people told us they felt safe living at the home and with the staff who supported them. We received mixed feedback from people who used the service, staff and external professionals about their experiences of the service.

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 good (published 2 February 2019).

Why we inspected

We received concerns in relation to people’s care and that the provider was not operating within the scope of their registration. As a result, 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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘All inspection reports and timeline’ link for Hengoed Park on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to medicines management, governance, and failure to notify us about reportable incidents at this inspection. We also made recommendations regarding the recruitment of staff and the need to work with the local authority to clarify the service, contracts and funding people receive.

Please see the action we have told the provider to take at the end of this report.

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.

Hengoed Park is a residential home for up to 31 people with mental health needs, predominately supporting people who have had alcohol and substance misuse problems. The home is situated in its own grounds near the village of Gobowen. The main house provides accommodation for up to 22 people and a further 9 people live more independently in bungalows within the grounds. At the time of the inspection the service was full.

Hengoed Park 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Hengoed Park had a registered manager who has worked at the home for three years. 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.

We looked at how the service managed its recruitment of new staff and saw that this was done well. Staff received a detailed induction, had regular access to training and support from the registered manager, the deputy manager and the team leaders. Training was provided to staff to enable them to support people’s very specific needs.

We spoke with seven people who lived in the home who all gave positive feedback about the home and the staff who worked in it. They told us that the staff supported them to live their lives as independently as possible.

We found that staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout our inspection visit. We saw they had positive relationships with the people in their care and knew them well.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were kept safely with appropriate arrangements for storage in place.

Care plans were person centred and driven by the people who lived in the home. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required. The home employed a care plan coordinator who received support from the registered manager to ensure that all the care records were maintained and that people were actively involved in planning their care if they wished to. Other people in the home were less interested in the management of their care.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

The registered manager and deputy manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. They also regularly spoke with the people who lived in the home and used questionnaires to gain feedback about the care offered. The management team told us that they had an excellent working relationship with the provider who was always available when required.

Further information is in the detailed findings below.

Hengoed Park is registered to provide accommodation with personal care for up to a maximum of 31 people. Hengoed Park provides specialist support for people who misuse drugs and alcohol. There were 31 people living at the home on the day of our inspection. 22 people were living in the main building and the remaining nine people lived in self-contained bungalows within the grounds.

There was a registered manager in post who was present during 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.

People felt safe as staff monitored their wellbeing and were always available to support them when needed. There were enough staff to support people’s health and social needs. Checks had been completed to ensure potential staff were suitable to work with people before they started to work at the home.

People were protected from harm and abuse by staff who were able to recognise the signs of abuse and knew how to report concerns. Staff were aware of the risks to people and how to minimise them without restricting their independence.

Staff encouraged people to be involved in decisions by providing information in a way they could understand. Staff sought people’s consent before supporting them and respected their right to decline support. Where people were unable to make certain decisions for themselves these were made in their best interest by relatives and professionals who knew them well.

People were supported by staff who had the skills and knowledge to meet their individual needs. Staff received training relevant to their roles and felt well supported by the registered manager.

People enjoyed the food they received and were encouraged to follow healthy diets. Snacks and drinks were made readily available to people. People’s medicines were managed safely and they were supported to see health care professionals as needed.

People and relatives felt staff treated people with kindness and respect. People were given choices and felt listened to. Staff promoted people’s dignity and supported people to develop their independent living skills. People were supported to keep in contact with friends and relatives who were important to them.

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

People knew how to raise concerns or make a complaint and were confident that they would be addressed by the registered manager. People were encouraged to give their opinions on the development of the service through meetings held at the home and through surveys.

People found staff and the registered manager easy to talk with and were complimentary about the quality of the service. There was a positive working culture at the home where staff were motivated by the registered manager’s enthusiastic approach. There was a clear vision for the service which was shared by staff. Staff felt that the registered manager provided effective leadership and looked for continual improvement.

The focus of the inspection was to answer one key questions; is the service well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. As part of this inspection we spoke with five people who used the service, five staff and the management team.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service well led?

Most people spoken with told us they were happy with the care they received. One person told us, 'I'm very happy here, I don't know why anybody wouldn't be. I wouldn't want to be anywhere else.'

An effective system was in place to regularly assess and monitor the quality of service that people received. Questionnaires had been introduced to seek the views of visiting professionals and relatives about the service people received. Residents' meetings had been introduced.

A replacement manager had been recruited and was in the application process of registering to become the registered manager of the home. An independent consultant continued to support the staff team to drive forward improvements in the quality of the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Appropriate arrangements were in place to manage medicines. This meant that people were protected against the risks associated with medicines.

Staff told us that there were gaps in staff training in important areas such as health and safety and fire. This meant that people were potentially at risk of receiving care from staff who were not up-to-date in managing risks.

People told us that staff gained their consent to care and treatments. One person told us, 'Staff ask permission, everything works here it's incredible'.

Is the service effective?

People told us that they felt the service met their needs. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs.

People were protected from the risks of inadequate nutrition and dehydration. People were provided with a choice of suitable and nutritious food and drink, which was freshly prepared in the service. Special diets were catered for including diabetic, vegetarian and soft diets.

Is the service caring?

Staff interactions were supportive and respectful. We observed a relaxed, yet respectful atmosphere in the service. All five people spoken with told us they were happy living at the service and felt safe. We were told, 'This is a lovely place, there are never any problems here'.

Is the service responsive?

People told us that they had not been asked their views about the service they received. At the time of our inspection, there were no residents' meetings taking place. There was however, a suggestion box available in the reception area of the home for people to leave their comments. Staff told us that the provider had not sought the views of people using the service or their representatives formally, for example through the use of satisfaction questionnaires.

People told us they had not had a reason to complain about the service they received. They told us that knew what to do if they had a complaint and felt confident that their concerns would be listened to. We were told, 'I just have to ask and I get what I need'.

Is the service well led?

The service was without a registered manager at the time of the inspection. The former manager had left the previous month. Steps had been taken by the provider to recruit a replacement manager, who was due to commence employment in July 2014. In the interim period, the provider had commissioned the services of an independent consultant to work with staff to drive forward improvements in the quality of the service. Staff commented very positively on the contributions of the consultant who had been working closely with staff to identify priorities. Staff commented that they felt communication within the home had improved greatly with the support of the consultant.

At the time of our visit there was not a robust system in place for regularly assessing and monitoring the quality of the service. This meant that any shortfalls in the quality of the service were not identified quickly and rectified.

We spoke with four people who lived in the main house and two people who lived in the supported living homes. They were mostly generally pleased with the service they received. One person told us it was, 'A privilege and pleasure to be here.' However, another person said, 'There is such a variety of people here, they tend to treat you down to the lowest common denominator.'

Most people were able to make decisions for themselves. We found that where staff had assessed people as lacking the capacity to make their own decisions, they had not recorded how decisions were made on the person's behalf or who had made the decisions.

We found that care plans were not centred on people as individuals. They were poorly organised and important information was spread over several different files for each person.

We found conflicting information on people's care plans about their capacity to make decisions about their medication. We found inaccuracies in the recording of some medication.

We were satisfied that the provider carried out all the necessary checks on new staff before they were allowed to start work.

The home had a suitable system in place for dealing with complaints about the service it provided.