Archived: Hallgate

This inspection took place on the 18 and 19 January 2017 and was unannounced. The inspection team consisted of one inspector.

The last inspection we carried out at this service was in December 2015 at which the provider was found to be in breach of three of the regulations that we inspected which included safeguarding people from abuse and improper treatment, staffing and good governance. The provider submitted action plans linked to each of these breached regulations, stating how and by when they would meet the requirements of these regulations. At this inspection we found improvements had been made in all three of the aforementioned areas.

A registered manager was in post at the time of our inspection who had been registered with the Commission to manage the carrying on of the regulated activity since August 2016. 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 who could told us they felt safe living at the home. Their relatives confirmed they had no concerns about the way their family member was treated by staff. The provider had a safeguarding policy and procedure in place that gave staff information about how to appropriately safeguard people in their care from harm or abuse. Historic safeguarding or potential safeguarding matters had been dealt with promptly and correctly.

Risks that people were exposed to in their daily lives had been assessed and were regularly reviewed. Environmental risks within the building were also well managed to protect people's safety. Emergency planning had been considered and measures were in place to support people appropriately in the event of unforeseen incidents taking place. Accidents and incidents were documented, analysed and measures put in place to prevent repeat events.

Recruitment procedures were robust, as was the management of medicines within the service.

People's needs were met and staff were very knowledgeable about how to support people in line with their needs. People's general healthcare needs were monitored and they were supported to maintain their health and wellbeing. Where people were ill, medical attention was sought promptly. Staff and people enjoyed good relationships and there was a calm and happy atmosphere within the home.

People's dignity, privacy and independence was protected and promoted. Staff involved people in their care and they chose how they lived their lives. People were heavily involved in a range of different activities within the community and staff supported and encouraged this.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act (MCA) was appropriately applied and the provider had submitted applications to the local authority to deprive people of their liberty lawfully, to prevent them from coming to any harm where they lacked capacity. The service understood their legal responsibility under this act and they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken and related records were available for us to view.

Staff support and training had improved since our last visit and staff had received training in key areas which had previously not been completed. Supervisions and appraisals took place. The induction programme had been developed to include the Care Certificate.

Care records were well maintained and regularly reviewed to ensure they remained up to date. Monitoring tools were used to ensure continuity of care. Handovers between shifts took place and a diary system was used to pass messages between changing staff teams.

The registered manager was organised and focused. We received positive feedback about her approach and the improvements that had been introduced since our last inspection. The provider's oversight of the service had improved and quality assurance systems were effectively applied. The provider's compliance team monitored the service well and this meant that any shortfalls which were identified were promptly addressed. Staff and the registered manager were accountable for their actions.

The inspection took place on 4 and 8 December 2015 and was unannounced.

There was a manager in post but they had not registered with the Care Quality Commission (CQC). The manager told us this was because the previous manager, who left the service early in 2015, had not formally deregistered themselves with CQC and they were waiting for this to happen first. A registered manager is a person who has registered with the CQC 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 appeared comfortable in the presence of staff and we saw they enjoyed good positive relationships. Safeguarding procedures were in place to protect people from abuse and there were channels via which staff could raise concerns.

People’s needs and the risks that they were exposed to in their daily lives had been assessed, and these were regularly reviewed to help ensure that people remained safe. Regular health and safety checks were carried out on the building and aspects of care delivery, to ensure that people, staff and visitors remained safe. Emergency and business continuity plans were in place to give staff guidance about what they should do in the event of any unforeseen circumstances.

Medicines were managed safely with appropriate systems in place in respect of the administration, storage, ordering, disposal and handling of medicines. Recruitment processes were thorough and included checks to ensure that staff employed were of good character and suitable for the role to which they would be employed.

We identified concerns in respect of staff training which had fallen behind, or had not been delivered in key areas such as safeguarding. In addition, staff had not been provided with training specific to the needs of people that they supported.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their ‘best interests’ and it also ensures that unlawful restrictions are not placed on people in care homes and hospitals. The manager told us that no applications had been made to the local authority safeguarding team to assess whether people living at the home needed deprivation of liberty safeguards to be put in place. The ‘best interest’ decision process was followed in practice, but these decisions were not always fully documented within people’s care records. The manager gave their assurances that records held in relation to this would be improved. This meant the provider was not adhering to their responsibilities under the MCA 2005.

People’s general healthcare needs were met and where there had been any concerns about their care, or a change in their needs, external healthcare support had been sought. People’s care plans and risk assessments had been regularly reviewed and where necessary, amended accordingly. People’s nutritional and hydration needs were met.

Our observations confirmed people experienced care and support that protected their privacy, dignity and staff promoted people's independence. Staff displayed caring and compassionate attitudes towards people and they enjoyed good relationships. Individualised care records were available for staff to follow and they were very aware of people’s diverse needs and how to deliver effective, personalised care. People enjoyed regular activities within their daily lives and they were supported to enter the community safely.

Systems were in place to monitor the service provided and care delivered, although we found that these were not always effective in identifying shortfalls, such as those related to the application of the MCA 2005 and staff training. In addition, the management of the service had not been appropriately addressed in line with the requirements of Regulation 5 of the Care Quality Commission (Registration) Regulations 2009, in that the provider had not ensured that a suitable ‘registered person’ had formally registered themselves with CQC as the registered manager of this service. This matter is being followed up separately with the provider, outside of the inspection process.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to staffing, safeguarding service users from abuse or improper treatment and good governance. You can find the action we told the provider to take at the back of the full version of this report.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

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

Is the service caring?

We saw that people were supported by kind and attentive staff who displayed patience and gave encouragement when supporting people. Our observations confirmed that staff promoted independence whilst ensuring that they offered assistance to people when required. People told us that they were happy with the care and support they received from the service. One person said, "I am happy with things here" and "The staff are lovely".

People told us they pursued many activities and this was evident on the day of our visit. This showed that the provider promoted people's community involvement and well-being.

Is the service responsive?

People's care needs were assessed before they moved into the home. Records showed that keyworkers had regular meetings with the people they cared for to discuss what was important to them and any goals and aspirations they may have. Keyworkers reviewed people's care records three-monthly, or as people's needs changed, to ensure they remained accurate and any issues were promptly addressed

Staff told us, and records showed that where people required input into their care from external healthcare professionals, such as speech and language therapists, this was obtained. One person's care records showed that the Behavioural and Intervention Team (BAIT) had been working recently with an individual where the provider had identified changes in their behaviour. We looked at how the service met people's nutritional needs as part of this inspection and saw that a person with weight related issues had been referred to a dietician, who was subsequently involved in their care.

People and staff told us that on a weekly basis a communal decision was made about the menu choices for the forthcoming week. This showed the provided was inclusive and responded to people's preferences.

There was an effective complaints system in place and when we reviewed complaints that had been received in the service, we could see that these had been handled thoroughly.

Is the service safe?

People were cared for in a safe, clean and hygienic environment. There were enough staff on duty to meet the needs of the people who lived at the home and a member of the management team was available on call for support and in the event of an emergency. Health and safety checks were carried out in the home on a weekly basis and the building was appropriately maintained to ensure it remained safe.

People's care needs had been assessed and their care records showed that risk assessments were in place to reduce the chances of them coming to any harm, whilst living their lives as independently and fully as possible. For example, we saw that where people were at risk of falling whilst mobilising independently, this was clearly highlighted in their care plans and risk assessments. The provider had drafted a personal emergency evacuation plan (PEEP) for each person who lived at the home, to ensure that staff had instruction on how to evacuate them from the building, should this be necessary, for example, in the event of a fire or a flood.

We reviewed the arrangements in place for the management of medicines including how medicines were stored, administered and disposed of when no longer required. We found that these arrangements were both appropriate and safe. Staff were trained in the safe handling and administration of medication.

We saw that the provider carried out appropriate recruitment and selection checks before staff began work at the service. These included for example, a review of their previous work experience, and identity and DBS checks. This ensured that prospective staff were suitably skilled and qualified to deliver safe and effective care.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies to care homes. The manager confirmed that while no applications have needed to be submitted staff had been trained to understand when a relevant application should be made. We saw in one case that a DOLs risk assessment had been undertaken by staff to assess whether or not a DOLs application to the local authority should be made.

Is the service effective?

People told us they were happy with the staff who cared for them and they met their needs. One person said, "I like the staff" and "It's good here". It was clear from speaking with staff and our observations that staff had a good understanding of the people they cared for and their needs.

Certificates were available that showed staff had received appropriate and up to date training to meet people's needs effectively.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

An effective quality assurance system was in place which was successful in identifying shortfalls. Records showed that these shortfalls were promptly addressed. We saw the provider learned from accidents and incidents and in each case these were reviewed. The provider had introduced measures to prevent repeat events, wherever possible.

Staff told us they were clear about their roles and responsibilities. The provider had a range of policies and procedures in place which gave direction and instruction to staff. We saw staff meetings were held on a regularly basis and minutes showed that management and staff discussed people's needs and the service provided overall. This helped to ensure that people received a good quality service at all times.

People told us their consent was obtained before care was delivered and staff acted in accordance with their wishes. Where people did not have the capacity to consent we found the provider acted in accordance with legal requirements.

We found that people's care needs were assessed and their care and treatment was planned. Where necessary, external healthcare professionals had been consulted about people's care needs.

We saw that there were effective systems in place to manage infection control appropriately.

We found there were sufficient numbers of staff in post, who were suitably skilled, qualified and experienced to deliver care and support safely.

The provider had a robust complaints procedure in place and people confirmed they felt confident enough to raise complaints and concerns with staff and that these would be dealt with.