Archived: Hadley Place Residential Home

Hadley Place Residential Home is a care home providing accommodation and personal care for up to 29 older people, some of whom may live with a mental health condition or dementia. At the time of our inspection 23 people lived at the service.

People’s experience of using this service

Risks to people's health, safety and welfare were not always identified and managed. Lessons were not learned when things went wrong. Medicines were not managed safely.

There were gaps in the skills and knowledge of staff in relation to fire evacuation procedures and supporting people with complex needs and behaviours that may challenge.

People did not always receive person-centred care and care records did not fully reflect their needs. There was a lack of meaningful activities for people.

People were not consistently supported to have maximum choice and control of their lives and staff did not support them in the least restrictive ways possible and in their best interests; the policies and systems in the service did not support this practice.

Areas of the environment were poorly maintained. Some improvement works had been completed recently and other work underway, following guidance from the community infection prevention and control nurse. Appropriate standards of hygiene had not been maintained in all areas.

Staff were recruited safely. Feedback from staff was mixed about having sufficient numbers of staff on all shifts to meet people’s needs. We have made a recommendation about reviewing people’s dependency needs effectively and the staffing levels.

People and relatives said they liked the staff and described them as kind and caring. However, there were times when some people’s dignity was compromised.

People’s nutritional needs were met. Although staff worked closely with a range of health and social care professionals, there had been delays in making referrals for assessments when some people’s needs changed.

The service was not well-led and there continued to be a lack of effective governance and oversight by the provider and manager. The provider’s quality assurance systems were not effective in identifying and addressing issues. The provider had not always notified CQC when people had deprivation of liberty safeguards authorised by the placing authority. The service has a history of not sustaining improvements.

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 14 September 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations and significant concerns remained.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about infection control, the premises and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. However, we identified other concerns during our inspection and therefore a decision was made for us to inspect all five key questions.

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 coronavirus and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person-centred care, safe care, consent, dignity and respect, the environment, staff training, governance and notifications.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Hadley Place Residential Home is a care home providing personal care for up to 29 older people who may be living with mental health needs or dementia. The service was supporting 20 people at the time of our inspection.

People’s experience of using this service

People were at risk of harm as risks to their health, safety and wellbeing were not effectively identified and managed. There remained widespread and significant concerns about the quality and safety of the service, which had not been addressed since our last inspection.

The service was unclean and not properly maintained. Risks associated with the environment had not been addressed in a timely way to help keep people safe. Robust systems were not in place to ensure the service was regularly and thoroughly cleaned or to effectively reduce the risks of people catching and spreading COVID-19.

People raised concerns about staffing levels, the provider’s dependency tool did not provide assurances that staffing levels were effectively monitored. Appropriate fire drills had not been completed to check and make sure night-time staffing levels were safe and people could be safely evacuated if there was a fire at night.

Accidents and incidents were not effectively reported, recorded and responded to. This put people at increased risk of harm.

People received their medicines as prescribed, but further improvements were needed to ensure medicines were consistently managed and administered safely.

Robust systems were not in place to check and make sure all staff were suitably trained and competent.

People’s needs were not robustly assessed and regularly reviewed. Care plans and risk assessments did not always reflect people’s needs, risks or provide up-to-date information to guide staff on how to safely support them.

People were not consistently supported to have maximum choice and control of their lives and staff did not support them in the least restrictive ways possible and in their best interests; the policies and systems in the service did not support this practice.

People did not receive person-centred support to engage in regular meaningful activities to reduce the risk of social isolation. Any wishes or views people had for their care and support approaching the end of life wishes were not always explored and recorded.

The service was not well-led. There were continued widespread concerns about the quality and safety of the service. The provider had failed to take sufficient and timely action to address safety issues and to make improvements, which would help keep people safe and improve their quality of life. There was a lack of effective oversight and governance.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was inadequate (published 8 June 2021) and there were multiple breaches of regulation.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated inadequate. This service has been rated requires improvement or inadequate overall for the last five consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at our last inspection.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We identified breaches in relation to person-centred care, dignity and respect, consent to care, safe care and treatment, the environment, staffing, and the provider’s governance arrangements. Please see the action we took at the end of this report.

Hadley Place Residential Home is a care home providing accommodation and personal care for up to 29 older people, some of whom may live with a mental health condition or dementia. At the time of our inspection 25 people lived at the service.

People’s experience of using this service

Records were not up to date and checks in place to monitor the quality of care being provided had not identified or addressed the concerns found. Improvements had not been made since the last inspection in relation to governance and oversight.

Risks to people were not always identified and managed. Processes in place to ensure the health and safety of the building were not being clearly recorded to provide assurance to the manager that the building and equipment were safe. Medicines processes did not always follow best practice.

One area of the recruitment process required improvement to ensure safe and robust recruitment of new staff.

Accidents and incidents were not effectively monitored to consider lessons learnt and reduce the risk to people. There were a number of incidents that should have been notified to Care Quality Commission (CQC) and the local safeguarding authority but this had not been done.

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 18 November 2019) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of this regulation and more breaches were found.

Why we inspected

We undertook this focused inspection to check the provider 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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same as the last inspection, requires improvement. This includes the findings at this inspection.

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

Enforcement

We have identified breaches in relation to record keeping, safeguarding, the management of risks and monitoring of improvements and the notification of serious incidents and safeguarding matters to CQC.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hadley Place accommodates people across four floors in one adapted building.

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

Quality assurance systems failed to identify shortfalls, for example, accidents and incidents were dealt with appropriately, but there was no analysis of these to identify patterns or trends to prevent similar instances in the future. The manager responded promptly, and this was an area they were going to address.

Supervision of staff was not consistent, during the inspection the manager told us they were introducing a new system to ensure all staff received regular supervision from their line manager.

We have made a recommendation about staff supervision and support.

People at the service were safe and told us they felt safe. The provider followed safe recruitment procedures and staff received training for their roles. The home was clean and risk assessments were carried out. Staffing levels were enough to meet people's needs and provide safe care. Medicines were managed safely, people received their medicines in a timely manner as prescribed. People received a healthy, well balanced and nutritious diet. The chef cooked fresh food daily which people enjoyed.

People and their relatives spoke very positively about the caring nature of staff. We received positive feedback on how supportive staff were. People told us they were always treated well by staff and were consulted about their care. Staff supported people with their personal care needs in a sensitive manner. People told us how staff supported them in protecting their privacy.

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 had pre-assessments before arriving at the home and had their care regularly reviewed. People could personalise their rooms in any way they wished. People brought pictures and furniture in to the home to make it feel familiar.

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 01 October 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to monitoring and addressing quality shortfalls at this inspection. 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hadley Place provides personal care and support for a maximum of 29 older people some of whom may be living with dementia or have mental health care needs.

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.

There was no registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The person employed as manager had not started the registration process at the time of the inspection.

During this inspection, we had concerns with how medicines were managed, how the provider worked within mental capacity legislation and quality monitoring. You can see what action we have told the provider to take at the back of the report.

Some people had not received their medicines as prescribed which could impact on their health and well-being. This mainly referred to eye drops, but other medication administration records had gaps with no reason identified for the omission. Records showed that people were refusing medication over long periods of time but care plans and risk assessments did not always contain information relating to the action taken by the service. Medication prescribed to be given 'as and when required' (PRN) did not always have clear guidance to enable staff to administer it consistently. The register of controlled drugs was inaccurate as records indicated stock remained in the service when it had been returned to the pharmacy.

Accidents and incidents were not always managed effectively. People did not always have up to date risk assessments in place which identified the action required to minimise the risks to their health and well-being.

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

There was inconsistency with the application of mental capacity legislation. This had led to one person potentially being deprived of their liberty unlawfully, as staff had not recognised they met the criteria for a Deprivation of Liberty Safeguard. Assessments of people’s capacity and records of best interest decisions when restrictions were in place were not consistently in place. One person was given their medicine covertly in food but there was no assessment in place identifying this was in their best interest. However, we found staff had a good understanding of the need to gain consent from people before carrying out care tasks.

The internal quality monitoring systems were not effective. The current system did not cover all aspects of care delivery. When shortfalls were identified, for example when medication was refused over long periods of time. Action was not taken in a timely way and the quality assurance systems used had not identified the shortfalls found on this inspection.

Staff had not received formal supervision or appraisal since the registered manager left. However, staff told us the new manager was very supportive and approachable and was implementing new systems to improve the service. We have made a recommendation about this.

There were enough numbers of staff deployed to meet people's needs and to keep them safe. The provider had effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe.

People were cared for with kindness and compassion. We saw they were treated with dignity and respect and supported to maintain their independence. We observed positive interactions between people and staff throughout the inspection. People looked engaged, relaxed, and happy and were supported by staff that knew them well.

People's dietary needs were met and they received appropriate support to eat and drink. People were supported to access other healthcare services when needed. Staff made information available to other healthcare providers to help ensure continuity of care.

Care plans contained sufficient information to guide staff on how to support people, however some areas of the care plans could be more person-centred. Staff knew people well and responded quickly when their needs changed.

People were offered the opportunity to take part in a range of activities in the home and in the community to reduce social isolation and promote their independence.

The provider dealt with complaints and concerns appropriately.

• 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 who used the service and the staff who supported them, and from looking at records.

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

• Is the service caring?

Staff were aware of people's preferences and diverse needs; A member of staff told us, “I carry some PPE (personal protective equipment) with me but its also in people’s room so we can help them straight away without having to run off to find gloves or aprons.”

• Is the service responsive?

At our last inspection on 29 April 2014 we issued a compliance action for this outcome area. We were concerned that people were not protected against the risks associated with not having an effective system in place to reduce the risk and spread of infection. During this inspection on 13 August 2014 we found improvements had been made and that people were cared for in a clean, hygienic environment.

• Is the service safe?

People were protected from the risk of infection because appropriate guidance had been followed.

• Is the service effective?

There were effective systems in place to reduce the risk and spread of infection.

• Is the service well led?

Appropriate actions had been taken to address our concerns. A senior member of staff told us, “Since the last inspection we had changed certain things and its better now.”

What people who used the service and those that matter to them said about the care and support they received.

One person who used the service told us, “It’s always very clean (in the home), they do a very good job keeping it looking its best” and went on to say, “My room is always immaculate.” Another person said, “My bed is always clean and fresh and they do all my washing for me.”

• 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 who used the service and the staff supporting them, and from looking at records.

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

• Is the service caring?

Staff demonstrated a good understanding of the needs of the people who used the service and could describe how to maintain people’s dignity and how to ensure people’s choices were respected.

A visiting district nurse that we spoke with told us, “This is one of the best homes I go to.”

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service, their relatives, friends and other professionals involved with the service, completed an annual satisfaction survey. Where suggestions or concerns had been raised, the provider had listened and made changes to the service.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

• Is the service responsive?

Staff knew the people they cared for and understood their preferences, likes and dislikes and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated when required.

• Is the service safe?

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

The people who used the service told us they were happy and that they felt safe. We saw that people were treated with respect and dignity by staff.

The home was clean and free from odours. However, improvements were need in relation to infection prevention and control.

• Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

There was an advocacy service available if people needed to use it. This meant that when required people could access additional support.

• Is the service well led?

The service had quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were supported by their manager and enjoyed their jobs.

What people who used the service and those that matter to them said about the care and support they received.

People who used the service made comments including, “You can do whatever you like in here, if I want to go to Beverley races or to Hornsea, I just ask and they sort it out”, “You hear about other homes on the news but it’s not like that here, we don’t get told where to sit or what to eat or when to get up, it really is wonderful”, “You couldn’t ask to be in a nicer place, it’s clean, the food is good and the staff treat us really well”, “It’s the little things in life that are important and they understand that here, we have parties when it’s your birthday, with cakes and sandwiches and everything”, “It’s always clean; the staff do ever such a good job”

A visiting relative told us, “They get up to all sorts; they take Dad out and there are activities going on in the home all the time” and “Mum was struggling with Dad at home and things were deteriorating for both of them, now Dad gets the care he needs things are so much better. We are really grateful to the home and all the staff for what they have done for us.”

People we spoke with told us, “Staff involve me in decisions about my care and anything I ask for I can get within reason” and “I really like it here I think it’s great and the staff are brilliant.”

Suitable hand wash facilities and protective equipment was available in most areas. Staff confirmed they had completed training in infection prevention and control, and this was in the process of being refreshed for staff.

The overall building maintenance was kept to a high standard and the grounds outside were sufficiently well kept to offer outdoor activity for example gardening, to existing people who used the service and their relatives.

We found the recruitment records to be in good order and saw they contained the appropriate documentation for example; induction checklist, interview checklist, two relevant references and CRB checks.

We looked at compliments received from relatives or people who used the service. Comments included; “After visiting my relative in the home following his move, I was confident he would be well looked after with you.”