Haldane House Nursing Home

Updated 5 January 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Three inspectors carried out this inspection. An Expert by Experience supported us to speak to relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Haldane House Nursing Home is a ‘care home’ with nursing care. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was no registered manager in post. A new manager had been in post for three months and had submitted an application to register. We are currently assessing this application.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

Prior to the inspection we looked at all the information we had collected since the last inspection about the service including previous inspection reports and notifications the manager had sent us. A notification is information about important events which the service is required to tell us about by law. We reviewed the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke to the manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We observed interactions between staff and people living at the service. We gathered feedback from 11 staff members. We spoke to one professional and two relatives. We reviewed a range of records relating to the management of the service, for example records of medicine management, premises and equipment, risk assessments, accidents and incidents, quality assurance system, and maintenance records. We looked at 11 people's care and support plans, associated records and medicine records. We looked at three staff files in relation to recruitment. A variety of records relating to the management of the service.

After the inspection

We continued to seek clarification from the manager to validate evidence found. We looked at further records and evidence including quality assurance records, training data, meeting minutes, and policies and procedures. We contacted 15 relatives and spoke to 11 relatives about their experience of the care provided to their family members. We contacted six professionals who work with the service and received three responses.

Updated 5 January 2023

About the service

Haldane House Nursing Home is a care home with nursing registered to provide personal and nursing care for up to 25 people. At the time of inspection there were 17 people living in the home.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not ensure compliance with the fundamental standards and identifying when the fundamental standards were not met.

The provider did not ensure that clear and consistent records were kept for people who use the service and the service management. The management of medicines and premises was not safe. Effective recruitment processes were not in place to ensure, as far as possible, people were protected from staff being employed who were not suitable. Risks to people's health and wellbeing were not consistently assessed and staff did not always follow guidance to support people in the right way. Staff deployment was not always managed effectively as we observed people did not always receive timely or effective support. People were at risk of social isolation because the provider did not organise and upskill staff to provide further support with stimulation.

The provider did not inform us about notifiable incidents in a timely manner. When incidents or accidents happened, it was not always clear the provider had fully investigated them, or that any lessons were learnt, and themes or trends identified. Care plans and related documents had information about people, but these did not always contain information specific to people's needs and how to manage any conditions they had. We were not assured people’s hydration and nutrition needs were monitored and met in a consistent way. The provider had not ensured staff were provided with appropriate training, knowledge and skills so they could do their jobs safely and effectively. People's and relatives' feedback were not consistently sought and used to make improvements to the service. We observed a mixture of interactions between people and staff which did not always show effective practice.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service were in place but did not support this practice.

There had been management changes since the last inspection, which affected the service management and the culture at the service. The new home manager was in the process of getting to know the service to ensure they could review, assess and monitor the quality of care in a consistent way.

Families felt they were involved in planning people's care and were informed of any changes in health or wellbeing. Relatives were mostly positive about the staff and the service. People were safe living at the service and relatives felt their family members were kept safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. The management team was working with the local authority to investigate safeguarding cases and provided support to address any issues. People were able to access healthcare professionals such as their GP. The service worked with other health and social care professionals to provide care for people.

The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean. There was an emergency plan in place to respond to unexpected events and equipment was kept clean. Relatives said they could approach the manager and staff with any concerns. The management team appreciated staff contributions and efforts to ensure people received the care and support.

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 requires improvement (published on 22 June 2021).

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 the provider remained in breach of regulations and the rating has changed to inadequate

Why we inspected

The inspection has been carried out based on the previous rating of requires improvement.

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. We carried out an unannounced comprehensive inspection of this service on 20 May 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements. During this inspection we have inspected the key question of Effective as we identified concerns to be reported in this key question. 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 requires improvement to inadequate. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to quality assurance; risk management; notification of incidents; record keeping; effective and person-centred care planning; management of medicines and premises; staff training, competence and deployment, and recruitment. Please see the action we have told the provider to take at the end of this report.

We took civil enforcement to ensure people's safety and ensure improvement occurred at the service. We served a warning notice to the provider following the inspection for the breach of regulation 12 (Safe care and treatment), managment of medicine. A warning notice gives a date the service must be compliant by and we inspect again to check that compliance against the content is achieved within the timescale.

Please see all the actions 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.