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Archived: Haddon Court Nursing Home Requires improvement


Inspection carried out on 22 September 2016

During a routine inspection

We carried out this inspection on 22 September 2016. The inspection was unannounced. This meant no-one at the service knew that we were planning to visit.

Haddon Court was last inspected by CQC on 15 September 2014 and was compliant with the regulations in force at that time.

Haddon Court is a nursing home registered for up to 80 people situated within Beighton Village, approximately five miles from the city centre of Sheffield. The home is within easy access of the local community, which has a selection of shops and churches. Haddon Court is a large purpose built three-storey care home. It provides nursing and personal care for older people who have a physical disability, nursing needs or are living with dementia. The provider has temporarily closed the top floor of this service to focus on supporting people living with dementia. There were 53 people living at Haddon Court at the time of our inspection.

There was a manager at the service who was registered with CQC. 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 told us they liked living at Haddon Court and they felt safe there. Relatives said they felt their family member was safe at Haddon Court.

All staff understood what it meant to protect people from abuse. They told us they were confident any concerns they raised would be taken seriously by management.

Not all medicines were stored safely. We found gaps in medication administration records which meant people may not have always have been given their medicines at the right time. Medication administration records were not regularly audited to check that medicines were given to people as prescribed.

People’s care records included risk assessments; however some contained gaps in recording information, and others were incorrectly completed. This meant staff didn’t always have all the necessary information required to meet people’s needs as safely as possible.

Care staff we spoke with had received training on understanding the Mental Capacity Act (MCA) and were able to give examples of what this meant in practice.

Care records did not reflect whether a person had capacity to make decisions about their care and treatment. The registered manager had referred everyone living at Haddon Court for a Deprivation of Liberty Safeguards (DoLS) authorisation. This blanket approach was not necessary and meant they may not have fully understood their responsibilities with regard to the MCA.

Staff were provided with appropriate training, regular supervisions and an annual appraisal to ensure they were suitable for their job and supported in their role.

We saw people had access to external health professionals and this was evidenced in people’s care records.

People living at Haddon Court and their relatives told us staff were caring and supportive. We saw and heard positive interactions between people and staff.

People told us they enjoyed the variety of food and drinks available to them. We saw there were different options available at mealtimes, and drinks and snacks were made available throughout the day.

People living at Haddon Court and staff working there, told us the registered manager was approachable and responsive to any concerns they had.

The service had up to date policies and procedures which reflected current legislation and good practice guidance.

There were no records of any meetings with people, their relatives or staff. This meant that although people and staff may have been asked for their views, their responses were not recorded and therefore not necessarily acted on. There was evidence of regular quality audits being undertaken. However, there was no record of any actions to be taken as a result. In addition in

Inspection carried out on 15 September 2014

During an inspection looking at part of the service

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Haddon Court is a residential care home which was providing care and support to 59 people at the time of our inspection. A number of people living at the home had dementia. As part of the inspection we spoke with two people who lived at the home, three members of staff and the home manager. We also looked at a selection of records.

This was a follow up inspection to check that improvements had been made in the management of medicines since our previous inspection on 23 June 2014. At the previous inspection we found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

The manager of Haddon Court submitted an action plan following our inspection which detailed the actions they intended to take in order to achieve compliance.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

At this inspection two people who used the service gave positive feedback about the care and support they received. They told us staff gave them their medication as prescribed and when they preferred.

People told us, �they [staff] are good to me. I have no complaints� and �I have to take my tablets at a specific time of day. The staff usually bring them on time. If they�re running late they�ve told me to press my buzzer and they�ll come straight away. I don�t like to do this but they said they don�t mind.�

We checked the Medication Administration Records (MAR) sheets for people living in the home. We found MAR sheets had been signed by the member of staff administering the medicines in all cases.

A staff member told us the manager and senior staff carried out frequent medication audits so that any errors were identified promptly. We saw evidence of this.

Staff training records evidenced staff received medication training to ensure they were competent in their role to safely manage medicines.

Inspection carried out on 23 June 2014

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at this time.

At the time of this inspection Haddon Court was providing care and support to 49 people, some of whom had a diagnosis of dementia. We spoke with 12 people living at the home, and three visiting relatives to obtain their views of the support provided. We also spoke with the home manager, the company director and seven members of staff.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they felt safe. Comments from people included, "I like it here. It�s a pleasure to be here,� �Staff are very nice. There are no arguments� and �Nobody upsets me."

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their lives.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. One application had been submitted which confirmed to us that relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded.

We found people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We have asked the provider to send us a report setting out the action they will take to meet this standard. We will check to make sure that this action is taken.

Is the service effective?

One relative told us the home had made contact with them in the early hours suggesting they might like to come as their family member was unwell. They said, �Our [family member] has been looked after very well. They were admitted to the home with their spouse and until this period they had been given adjoining rooms. Their spouse has Alzheimer�s so is not entirely aware of situation but arrangements are being made to bring the couple together today.�

During our visit, we found people were provided with the support they needed. However we observed people often had to wait as staff were very busy. We found staff knew people well and were aware of their individual preferences. We found staff treated people in a kind manner.

Care files we checked confirmed that initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. Specialist mobility and equipment needs had been identified in care plans where required. People and their relatives said they had been involved in writing them and they reflected their current needs. Visitors confirmed they were able to see people in private and that visiting times were flexible.

Staff were provided with training to ensure they had the skills to meet people�s needs. Managers� were accessible to staff for advice and support. Staff were provided with formal individual supervision and appraisals at an appropriate frequency to ensure they were adequately supported and their performance was appraised.

Is the service caring?

People who used the service and their relatives said staff treated people respectfully. Relatives told us, �Staff do a good job. I wouldn�t do their job for anything� and �Everyone is respectful and our [family member] has been treated with dignity.�

Other comments made to us by people who used the service were, �They [staff] tell me what to do,� �They�re always picking on you. They [staff] tell you what to do all the time and I don�t like it,� �I get up at 6.15 and nobody comes near me. If I go and ask for a cup of tea, they say �in half an hour� and then they don�t get me one.� One person said that when her relative had visited recently, staff had been laughing about their last name and its pronunciation.

During our observation we saw friendly interactions between staff and people who used the service and there was kindness in staff�s tone of voice when speaking with people. Staff addressed people by their preferred names and people seemed comfortable in the presence of staff. Interactions between staff and people who used the service were relaxed and unrushed.

We found staff skills in recognising and respecting the diversity and human rights of people who use the service varied significantly. Some staff were able to tell us how important it was for people, other staff were less understanding of the concepts of privacy, dignity and independence.

Is the service responsive?

Staff and a relative told us the care and support provided was flexible to the person�s needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed. For example, one person was requiring palliative care and this was being provided.

On the day of the inspection the activity worker was asked to work as a carer because a member of staff was sent home ill. When we looked at the record of activities provided we found there had been a significant number of days over the last month where the activity worker had worked as a carer to cover staff shortage. This meant very little activity had been provided for people.

People knew how to make a complaint if they were unhappy. Five people who used the service said, �Everything here has improved in the last six months.� One person also said, �Management is more easy going.�

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.

All people spoken with said they weren�t aware of any �residents meetings�. One person said, �That would be a good idea.� Another person who used the service told us the manager came to see them twice a week and this gave them the opportunity to raise any concerns they may have.

On the notice board we saw a �relatives meeting� was planned for the end of the week. Staff told us relative meetings took place every �few months� and we saw the minutes recorded at the last meeting in March 2014.

Staff had regular meetings with the manager and were kept updated about any information they needed to know about the service. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information.

The service carried out a yearly �Quality Assurance Survey�. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends, staff and healthcare professionals. This showed people had the opportunity to put their views across.

The service had a quality assurance system. Monthly and weekly audits were completed regarding such things as medication, care plans, the environment, staffing and infection control. We found there was not always an action plan with a timescale of the action required to ensure improvement. This meant there was a risk that intervention and improvements may not be made within a reasonable timescale.

Inspection carried out on 8 April 2013

During a routine inspection

People that we were able to communicate with told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included, "the staff are excellent, in fact they're brilliant," "I am happy here," and "the food is good."

During the inspection we spent time sitting with people in the communal areas of the home. We found that care and support was offered appropriately to people. People that we were unable to fully communicate with looked content and we observed positive interactions with staff and people living at the home.

Each person living at the home had a care plan. We found that the information in these was detailed and complete.

We spoke with three relatives/friends who were visiting the home and they confirmed that they were satisfied with the care provided.

During the SOFI we observed people having lunch. Overall we found the mealtime was a positive experience for people.

Our conversations with people, relatives and staff, together with observations on the day of our inspection evidenced that there were sufficient staff available to meet people's needs.

The provider had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided.

We found that records required to be kept to protect the safety and well being of people living in the home were held securely.

Inspection carried out on 10 July 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector, joined by a professional professional and an �expert by experience� (a person who has experience of using services and who can provide that perspective).

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During the SOFI and whilst walking around the floors of the home we saw lots of examples where people moved about the home independently. For example, some people used their rooms as they wanted and some spent time in the communal areas.

We saw that staff had a caring approach to people and people were treated with dignity and respect. Staff were polite towards people and behaved in an appropriate manner towards them.

People told us the manager or staff did ask if they were happy with the care provided and any changes they made involving their care, before they were introduced. They told us it was their choice how they spent their time.

People we spoke with said they didn�t like the meals provided. Some comments included, �it�s edible but I don�t always like it too much� and �I�m never hungry and have plenty to drink. I put up with the food. Sometimes it�s ok, but most times it is ...�. They told us they got a choice of menu, but it wasn�t very good. They told us food was available between meals if they wanted it, but it was usually biscuits. We asked if anyone asked them what they liked to eat and they either said no or they didn�t know.

The lunch time period was a poor meal time experience for some people. For example, one person who remained in their wheelchair for their meal, had their hoist sling velcroed around them, which kept going into their meal and some people were not offered alternatives, when they didn't eat their meal. There was no choice of sweet and people were not offered an alternative, if they didn�t want the dessert on offer. People were not asked if they�d had enough to eat nor offered more. The trolley on which dirty crockery, cutlery and waste was placed, was sited next to a dining table where people were sitting, which wasn�t very pleasant for those individuals.

People felt they could talk to the manager if they had any concerns or were worried about anything.

People we spoke with said it depended on the time of day as to whether there were sufficient staff to help them and sometimes staff were off sick so staff had to rush things and had no time to talk with them.

People we spoke with felt staff had the skills to look after them properly. They told us staff were always away training.

Inspection carried out on 8 August 2011

During an inspection looking at part of the service

A number of people who live at Haddon Court have conditions that mean they have difficulty talking with people and therefore have varied methods of communication. Some people were able to express their views, others were not able to verbally communicate with us. Due to people�s communication needs, during the site visit we sat with people in communal areas and observed them closely. This meant we were able to ascertain whether their needs were met.

Throughout the observation we saw all staff treat people kindly and with courtesy.

During our observation period there appeared to be sufficient numbers of staff to meet the needs of people who use the service.

We saw occasions where staff interactions with people could have been handled more appropriately.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. People�s comments included:

�I like it here�.

�The staff look after me well�.

�I'm OK no problems�.

Inspection carried out on 11 May 2011

During a routine inspection

A number of people who lived at Haddon Court had conditions that meant they had difficulty talking with people and therefore had varied methods of communication. Some people were able to express their views clearly, others were not able to verbally communicate with us. Due to people�s communication needs, during the site visit we sat with people in communal areas and observed them closely. This meant we were able to ascertain whether their needs were met.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. People said:

�It�s alright here�.

�I think the staff are good�.

�It runs smoothly most of the time�.

Relatives said that they were satisfied with the support provided to their loved ones and were always made to feel welcome at the home when they visited. Relatives said:

�The nurses and staff are kind and helpful�.

�We�re happy with the care our father receives�

�Staff seem attentive�

One health professional told us that they visited the home on a regular basis (each week) and were happy with what they had seen and heard. They said staff were aware of people�s current and changing health conditions and staff called in other health professionals when it was appropriate.

Reports under our old system of regulation (including those from before CQC was created)