Haylands Residential Home for Gentlemen

Haylands Residential Home for Gentlemen is a residential care home providing accommodation with personal care to up to 24 people. The service provides support to people over the age of 65 including people living with dementia. At the time of our inspection there were 21 people using the service.

Haylands Residential Home for Gentlemen accommodates people across three floors in one adapted building.

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

Medication was not always safely managed or recorded correctly. We found examples where medication administration records (MARS) had been completed incorrectly and one person had not received their medication. Care plans were not always updated in line with changing risk for people. Accidents and incidents were not always formally recorded and therefore not reviewed to identify trends. Staff wore personal protective equipment (PPE) appropriately.

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.

People gave positive feedback about the staff and the service was described as a happy place. Staff felt supported by the registered manager and able to raise concerns. People were supported to access the community and were involved in decisions relating to the service, such as choosing the food menu. The staff training matrix showed multiple gaps in staff training. The registered manager told us they were having difficulty with the training provider and pulling information from the system.

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 good (published 2 September 2017).

Why we inspected

We received concerns in relation to the care being provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Following the inspection the registered manager completed additional audits of the medication at the service.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the administration of medicines at this inspection. We have recommended the provider reviews their systems around care planning updates.

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.

Haylands Residential Home for Gentlemen is a care home providing accommodation and personal care for up to 24 people some of whom are living with dementia. It is a spacious, three storey building located in Urmston and situated near local amenities such as shops, a library and public transport links. There is a chair lift in place and communal facilities for cooking, dining, personal care, relaxing and leisure. The home has two lounges and one dining room. At the time of this inspection there were 22 people living in the home with care provided on the ground and first floor.

Our last inspection took place on 25 and 26 July 2016 when we gave an overall rating of the service as 'Requires Improvement'. We found two breaches of the legal requirements in relation to safe care and treatment and good governance. At this inspection we found that the service was now meeting these regulations.

At the time of the inspection there was a registered manager at Haylands Residential Home for Gentlemen. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 noted improvements in medicines management from the last inspection in July 2016 and some examples of good practice. Medicines were ordered, stored, administered and disposed of safely.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs.

At the last inspection we made recommendation for the provider to access the best practice guidance to promote the health and wellbeing of people who are living with dementia. At this inspection we found the provider had made a number of positive changes within the environment of the home to make it more dementia friendly.

Staff had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), and they demonstrated a good understanding of the act and its application. Where people did not have the capacity to make decisions about their care, meetings were held with people, their relatives, and health and social care professionals to help ensure that any decisions were made in the best interests of people using the service.

The registered provider had policies and systems in place to manage risks and safeguard people from abuse. Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the managers if they had a concern.

People had a choice of nutritious food and their weight was monitored, with

appropriate referrals made to other healthcare professionals when concerns were identified. However, we received varied opinions on the quality of food on offer.

Care plans were complete and regularly reviewed. We saw any changes to care plans were reflected in handover documents to help ensure all staff were aware. Information on preferences, social history and interests were recorded.

The involvement of people and their relatives in care planning had improved since our last inspection and a regular quality assurance meeting was now held with people and their relatives. Care workers knew people well as individuals and we saw warm and friendly interactions between people and care workers.

We found accident records at the home were comprehensive and evidence showed people were monitored effectively following an accident.

Some senior care staff at the home had received advanced training in end of life care and some people had their future wishes recorded in their care plans. The registered manager confirmed this was a working progress and wanted to ensure care planning discussed people’s future wishes going forward.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the registered manager.

Care workers had supervision with senior staff. The registered manager had reviewed the supervision and appraisal system to ensure care workers received an annual appraisal and regular supervisions. Staff received the training they needed to meet people's needs.

A clear system of safety and quality auditing was now in place at Haylands Residential Home for Gentlemen. A range of audits and checks were undertaken by the manager to monitor the quality and safety of the service.

The atmosphere and culture at the home was much improved. The managers each knew their own roles and responsibilities. Staff expressed confidence in the management team and in each other. There were regular staff meetings where staff could contribute their views.

The service was previously inspected 4 February 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Haylands Residential Home for Gentlemen is a care home providing accommodation and personal care for up to 24 people living with dementia. It is a spacious, three storey building located in Urmston and situated near local amenities such as shops, a library and public transport links. There is a chair lift in place and communal facilities for cooking, dining, personal care, relaxing and leisure. The home has two lounges and one dining room.

At the time of the inspection there was a registered manager at Haylands Residential Home for Gentlemen. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

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.

During this inspection visit we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment and ineffective quality assurance and auditing systems. You can see what action we told the registered provider to take at the back of the full version of the report.

The manager was present during our inspection and engaged positively in the inspection process.

The manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. During the inspection we found Haylands Residential Home for Gentlemen to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service we spoke with was generally complimentary about the standard of care provided. People living at Haylands Residential Home for Gentlemen told us the manager was approachable and supportive.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate systems were not in place for the recording, safe keeping and disposal of medicines.

The service lacked governance systems to assess the quality of the service. For example, effective systems to monitor medicines were not in place and auditing systems were not robust.

Some staff and people told us that activities could be limited at times. A part time activities co-ordinator was responsible for activities, however no activities were organised when they were not at work. This meant at times people lacked social stimulation.

We found that the home was properly maintained and ensured people's safety was not compromised. However, we felt the stair lift at the home required a safety guard in place to minimise any potential trip hazards.

Staff were supported through induction, regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. There were however, gaps in some topics in particular food hygiene and health and safety training.

Consent to care and treatment was sought in line with legislation and guidance. Capacity assessments had been completed appropriately for people and were in their care records. Staff we spoke with understood the principles of the Mental Capacity Act 2005 which meant staff understood the importance of ensuring people's rights were protected.

People felt safe living at the home and their relatives were confident they were well cared for. If they had any concerns, they felt able to raise them with the staff and management team.

Risks to people's health and wellbeing were assessed and managed. There were sufficient suitably recruited staff to keep people safe and promote their wellbeing. Staff received training so they had the skills and knowledge to provide the support people needed.

Staffing levels were structured to meet the needs of the people who used the service. There were sufficient numbers of staff on duty to meet people's needs. However, we found the lunch time observation of our inspection was chaotic and lacked a sense of organisation to ensure this was an enjoyable meal time experience for people.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and their relatives told us they would raise any concerns with the manager.

Staff were aware of the whistle blowing policy and they told us they would use it if required. Staff told us they were able to speak with the manager if they had a concern.

We have made recommendations to ensure people who are living with dementia are supported in an environment which is appropriate to their needs.

We also recommend that the provider ensures there are policies and procedures in place for the ‘Mental Capacity Act 2005’ and ‘Deprivation of liberty safeguards’, to ensure staff are familiar with the most up to date policies and procedures to follow.

We spoke to four people using the service. They were able to talk to us about their experiences at the home, although not in detail. They were positive about the home and the staff; comments included 'The nurses are very good', 'They work hard' and 'The staff are nice'.

We spoke with three members of staff and we observed and heard staff interacting with people and assisting them. They were knowledgeable and understood the needs of the people using the service.

The atmosphere was relaxed and homely; we observed staff interacting with people and engaging in conversations. The staff clearly understood their needs and had good relationships with all of them.

The home had well-kept garden areas with a small memorial area, seating and parking. There was an accessible ramped entrance and a stair lift. Accommodation was provided on two floors and we saw that rooms were clean and personalised with people's belongings. There were two lounge areas and a separate dining area with a bar.

A variety of information was displayed in the foyer, such as complaints information, health and safety and fire information, a dignity in care policy and a philosophy of care which included a commitment to dignity. A Dignity in Care award had been made by the local authority.

We also saw photographs of activities, poems, 100th birthday telegrams and paintings by people living at Haylands displayed around the home.

Robust assessments of need had been undertaken for people living in the home and care plans contained detailed information about the care and support each person was receiving. Care plans also provided evidence that people were receiving their care and support in a manner that suited their preferences.

Hayland's had a suitable policy and procedures for keeping people using the service safe from abuse. Staff knew what they must do to keep people safe from harm. One of the four people we spoke with said, "The staff know what they are doing and I am confident that they care about my safety."

Staff working in the home had received the appropriate training to safely meet the needs of the people they cared for. Staff had been consulted on a regular basis and were encouraged to participate in decisions about the day to day management of the home.

We saw evidence that Haylands had implemented a robust system to monitor and review the quality of the service being provided. People using the service, their representatives and staff working in the home had participated in this process and their views and suggestions had been used to make continual improvements to the way the service was provided.