Polebank Hall Residential Care Home

We found the following examples of good practice.

There were procedures in place to allow people to move into the home safely. Staff and visitors were required to undertake COVID-19 testing and wear personal protective equipment (PPE) in line with current Government guidance. Staff had received training in infection control and prevention and correct use of PPE.

Whilst restrictions on visiting had been in place based on Government guidance, staff and the registered manager had ensured people were kept in touch with their friends and relatives. There were lots of activities for people to take part in to help support people’s well-being. They had links with a local school and as the children could not visit, they had set up a pen pal group and were now exchanging letters and artwork with the children.

The home was extremely clean. Comprehensive cleaning schedules were in place and carried out daily and weekly.

The registered manager had been in regular contact with the local authority and public health teams. The service had detailed risk assessments and policies and procedures in place to manage the risks of COVID-19. The registered manager and provider had a range of auditing and monitoring in place to ensure infection control procedures were being followed properly.

Polebank Hall Residential Care home is registered to provide accommodation and care for up to 29 people. The home provides a service to older people living with varying degrees of dementia or memory loss. The home is situated in the Gee Cross area of Hyde, Manchester and is set in 16 acres of parkland.

At the time of the inspection the home was at full occupancy.

Polebank Hall Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 of Polebank Hall Residential Care Home in May 2016, the home was rated as Requires Improvement overall and for the key questions Safe and Well-led. A breach of regulation 12 with regards to safe care and treatment was identified. This was because we found concerns in relation to medication and infection control practices. This inspection looked at the progress made since our last visit, to ensure the requirements of the regulations were now being met.

There was a registered manager in post. 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 used the service and their relatives told us they felt the service was safe, as did visiting healthcare professionals that we spoke with. There were appropriate risk assessments in place with guidance on how to minimise risk. Staff recruitment was robust with appropriate checks undertaken before staff started working at the home.

Everybody we spoke with told us there were sufficient numbers of staff working at the home. There was a dependency tool used and this determined how many staff were required to care for people safely.

We found staff received sufficient training, supervision, appraisal and induction to support them in their role. The staff we spoke with told us they were happy with the training they received and felt supported to undertake their work.

Whilst several people living at the home had Deprivation of Liberty Safeguards (DoLS) in place, the registered manager told us that several other applications still needed to be made. The registered manager told us shortly after the inspection that these had now been submitted to the local authority for review. We have also made a recommendation about using formal mental capacity assessments, when determining people’s ability to make their own choices and decisions about their care and treatment.

The people we spoke with said the food served at the home was of a good quality and we saw people being supported to eat by staff at meal times. People were weighed on a regular basis and more frequently if they were identified as being at risk of losing weight.

We found the home works closely with other health professionals and made appropriate referrals if there were concerns. Details of any visits from other professionals were recorded within people’s care plans.

We received positive feedback from people we spoke with about the care provided at the home. Visiting relatives and healthcare professionals also said they had no concerns with the care being delivered at the home. People said they felt they were treated with dignity and we observed staff treating people with respect during the inspection.

Each person living at the home had their own care plan in place which provided an overview of their care requirements and any associated risks. People’s life histories were documented which provided details about their life prior to living at the home.

There were a range of different activities available for people to participate in. The home also had a dedicated activities room which we were told was well used. During the inspection, we observed people enjoying singing Christmas songs, as a local choir group had been to the home so that people could join in.

We found complaints were responded to appropriately. A policy and procedure was in place and was displayed near the main entrance for people to refer to.

There were systems in place to monitor the quality of service being provided to ensure good governance, with a range of audits being undertaken by the registered manager.

Staff meetings took place on a regular basis, giving staff the opportunity to discuss their work and raise any concerns about practices within the home. We also observed a handover taking place where the team leader provided an update on people’s care needs.

Staff spoke positively about management at the home and said the manager was supportive and approachable. Staff said the manager had made changes for the better since starting work at the home.

Policies and procedures were in place and were being reviewed regularly.

We last inspected Polebank Hall on 2 February 2015 where we found the home to be in breach of four regulations and the overall inspection rating to be ‘Requires Improvement’. We asked the home to make improvements in the management of medicines, quality assurance systems, staff recruitment and appraisals. At this inspection we found that appropriate action had been taken to address these findings. However, we found that the administration of people’s topical creams was not always recorded accurately.

Polebank Hall is situated in the Hyde area of Tameside. The home provides care, support and accommodation for up to 29 people who require personal care without nursing.

The building is a large, Victorian detached house with an additional single-storey annexe and is set in municipal parkland. The home has 25 single rooms and 2 shared rooms, of which 20 are en-suite. There is a ramp at the front door and disabled access throughout the building. Bedrooms are located over three floors and floors one and two are accessed using a passenger lift or staircase. There are several communal bathrooms, communal toilets, one small ‘quiet’ lounge, one large lounge area, reception area and one large dining room. The larger lounge also has a carers’ station and therefore, care staff are usually visible in this area. There is car parking and secure gardens with a patio area for people to sit outside.

At the time of our inspection 28 people were living at Polebank Hall.

The service did not have a registered manager in place. 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. A new home manager had been in post since November 2015 and had not yet submitted an application to register with the Care Quality Commission (CQC) to become the registered manager for Polebank Hall. The previous registered manager had left in July 2015 and there had been an interim manager in the meantime.

This inspection was carried out in response to a regulation 28 report from the Coroner’s office. This is a report that is written after an inquest into someone’s death and the Coroner believes there is a risk of other deaths occurring in similar circumstances. The home is required to produce an action plan to ensure the prevention of a reoccurrence. We found evidence to support that the improvements outlined in the action plan had been effectively implemented.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

We have made one recommendation for the home manager to conduct more frequent building and environmental audits.

People, their relatives and staff spoke highly of the service; one person’s relative told us, “They’re very good with mum” and “Always made to feel welcome”. Visiting professionals were also complimentary of the service and one person told us that they received appropriate referrals promptly and found the staff, “Very helpful”.

The staff files we looked at showed us that safe and appropriate recruitment and selection practices had been used to ensure that suitable staff were employed to care for vulnerable people.

During this inspection we found that there were sufficient numbers of staff on each shift to provide a safe and effective level of care and support to people who lived at the home.

Staff we spoke with were aware of how to safeguard people and were able to demonstrate their knowledge around safeguarding procedures and how to inform the relevant authorities if they suspected anyone was at risk from harm.

During our inspection, we found some issues with the building environment, such as visible damp on walls/ceilings in three of the occupied annexe bedrooms, two radiators without covers and missing light bulbs. We discussed these issues with the home manager.

The laundry room was found to have shortfalls in its facilities and improvements were needed to safeguard people from the risk of cross infection.

We found that the administration of medication was accurate; however, we found that there were gaps in recording sheets for the administration of topical creams.

Our observations showed us that consent was always sought before care was provided and people were treated with respect and dignity by staff who were knowledgeable and competent in their role.

People received good quality care from respectful and attentive staff. People looked well cared for in their appearance and we observed that staff were very kind and caring during delivery of care and support.

As part of this follow-up inspection, we looked at records for staff and people who used the service. We observed how staff provided care to people, and we looked at records relating to the management of the service. We saw that people looked comfortable and well. We talked to people who lived in the home but their comments did not relate to the outcomes we looked at on this inspection.

We saw that the provider had made improvements to the service. They now had better systems for recruiting staff, which included collecting and reviewing the required information. Records were well-organised. We saw that staff provided care to people according to their individual needs, as detailed by care plans which were regularly reviewed and up-to-date. We saw that the provider had taken steps to improve the records relating to the management of the service, to ensure they were fit for purpose.

Polebank Hall Residential Care Home is a large grade II conservation property. We saw that the provider had made improvements to the property to ensure that people who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. People were protected from the risk of infection because the provider had a system in place to maintain a clean and hygienic environment. Staff were aware of but did not always follow guidance on the appropriate use of gloves in reducing the risk of cross-infection.

Although the provider took adequate steps to regularly assess and monitor the quality of service provision, they did not have an adequate system in place to recruit suitably qualified, skilled and experienced staff. We saw that people's records did not reflect all of their care needs or the care provided.

We found that people living at Polebank Hall residential care home were supported to live as independently as possible and their views were taken into account in the way they like to be cared for. We found that people received good care and treatment but risks to people's safety were not always recognised and responded to. People told us they felt well cared for and staff treated them respectfully. We saw care staff speaking to people in a respectful way.