Archived: Hendford Care Home with Nursing

At this inspection we found the provider had not made the necessary improvements. The assessment, planning and delivery of care did not meet people's individual needs, and service users were not protected against the risks of inappropriate and unsafe care.

We had not planned to look at the management of medicines at this inspection. However, while examining other areas of care delivery we found evidence that people were not protected against the risks associated with the unsafe use and management of medicines. These concerns were significant and indicated that the risks in this area had increased from our previous inspection.

As this was a targeted inspection to follow up on specific areas of concern, we did not consider all of the five key questions that we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Instead, we concentrated on whether the service was safe.

Is the service safe?

We found the service was not safe.

People's risks were not always assessed and care was not always planned and delivered to meet their needs.

People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We identified concerns in relation to the obtaining, handling, administration, recording and safe storage of medicines.

People who had been identified as being at high risk of pressure sores did not receive care in line with their needs and were put at avoidable risk. People were not supported to change position to reduce the risks of developing pressure sores.

Assessments regarding eating and drinking were not always followed which put people at risk of choking and dehydration.

People's welfare needs were not met as they were not supported to take part in activities of their own choosing or in line with their known interests. Steps had not been taken to ensure people received sufficient interaction to meet their social needs. The failure to plan and provide activities in line with people's known interests, preferences and assessed needs meant that people received inadequate mental and physical stimulation and insufficient social interaction.

In this inspection we considered five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, speaking with relatives and from looking at records.

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

Is the service safe?

Inaccurate assessments of need led to a risk that not all people's needs were fully known and those people did not receive the level of care they needed.

Failure to follow some people's care plans put those people at risk of receiving inadequate or inappropriate care.

Some people were not supported to drink sufficient amounts to meet their needs, and so were put at risk of dehydration.

Failure to ensure people were only given food which met their specific needs put them at risk of choking and had serious implications regarding their welfare and safety.

People were not protected fully against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We identified concerns in relation to the obtaining, recording, storage and disposal of medicines.

People using the service were put at risk because the provider had failed to properly assess and reduce the potential risks associated with the staffing level.

Staff were not always able to respond appropriately to ensure the welfare and safety of people at the home at all times.

Is the service effective?

There were not enough staff to meet people's needs at all times. This put people at risk of not receiving appropriate care.

An ongoing issue with obtaining medicines meant some people did not receive essential medicines at the right time and in line with their needs.

Is the service caring?

People were supported by kind and attentive staff. Care was observed to be respectful and responsive to individuals' needs. We saw that care workers showed patience and gave encouragement when supporting people.

People spoke positively about the support they received from staff. One person told us the staff were 'lovely', and another person said they were 'very reasonable.' One relative told us they thought the staff were 'very nice', and another person told us their relative 'appears to be happy, likes the staff.' Staff and people living at the home were seen to know and get on well with each other, and interaction was observed to be polite and positive throughout the inspection.

Is the service responsive?

People who used the service and their representatives were given the opportunity to express their views about the service.

Where shortfalls or concerns were raised, the provider did not respond effectively to ensure all of the issues were addressed.

The provider had a system in place to deal with complaints, but we found evidence that not all complaints were responded to effectively.

Is the service well-led?

We identified some serious concerns in respect of people's basic health and care needs not being met. For example, some people had received inappropriate food which had put them at risk of choking, and some people had not received sufficient fluids to remain safely hydrated. The home's management had not identified or addressed these issues.

We identified some people's care needs were not being met at all times and specific incidents where people's safety and welfare were compromised. The registered manager was unable to provide necessary assurance that the home's monitoring and checks were robust enough to ensure the safety and wellbeing of people at the home at all times.

Staff had appropriate experience of care provision and were knowledgeable about the systems and processes required for a care home's operation. Stronger leadership was required to make sure all staff followed those systems and processes and to ensure people's care and support needs were met.

At the last inspection we found that people did not always receive care in line with their assessed needs. At this inspection we found that new charts had been put in place to enable the registered nurses to easily monitor the care that people received. We looked at a sample of these charts. Each chart gave the details of the care given on a daily basis and demonstrated that people received care to meet the needs identified in their care plans.

During the visit we observed lunch time on all three floors of the home. We saw that people received the support they required to eat their meal at the intended temperature. We noted that in addition to care staff, activity staff and the registered nurse on duty, assisted people with their meal. We saw that people were supported to eat in a calm relaxed manner. This showed that adjustments to staffing had ensured that people received the help they needed to eat their meals.

Since the last inspection the home had implemented observational audits based on the Care Quality Commission's Essential Standards of Quality and Safety. These were in addition to the existing audits that were in place at the last inspection. This meant that as well as auditing incidents and records the home were able to audit practice and ensure that people's needs were met in an appropriate manner.

This inspection was to look at the progress made in achieving compliance. We saw evidence that the managers and staff had made a considerable effort to improve practices and ensure that people were protected from unsafe or inappropriate care.

People appeared comfortable and relaxed with the staff who supported them. The home had updated its safeguarding policy and all concerns were being appropriately reported and investigated.

People said that they were able to make choices about their day to day lives. We saw people being offered choices throughout the day.

In some instances we saw that care plans were not being followed and some information was not accurately recorded.

Some increases to staffing levels had been made since the last inspection. We noted that there were still insufficient staff in some areas of the home at lunch time.

Quality assurance audits were being carried out and we were able to see that action was being taken to address shortfalls identified. These audits did not always include discussions with people at the home or direct observation of care.

Care and treatment was not planned and delivered in a way that ensured people's safety and welfare. One person who uses the service told us "If you are in bed you are less work.'

People who use the service were not safeguarded against the risk of abuse because the provider had not responded appropriately to some allegations of abuse.

Medicines were prescribed and given to people appropriately.

There were not enough qualified, skilled and experienced staff to meet people's needs. People who use the service told us 'At times there were not enough staff.' Staff were also not being supported in relation to their responsibilities.

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others.

People's personal records including medical records did not contain accurate information and some were not fit for purpose.