Archived: Hedges House Residential Hotel Limited

Hedges House Residential Hotel Limited is a residential care home providing personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 34 people in one adapted building. The home has two lounge areas, a dining area, a conservatory and a secure garden.

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

People told us they felt safe living at the home. They told us they were satisfied with staffing levels and said staff were always at hand if needed. Systems and processes were established to ensure people were protected from risk of abuse. Staff had a good awareness of people’s needs and risk was suitably managed. Infection control processes were followed, and the home was suitably maintained to promote safety. Medicines were managed safely, in line with good practice.

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.

The service had worked hard to ensure peoples’ needs and choices were assessed in line with standards, guidance and the law. People said they had access to a GP and other health professionals. The service worked proactively to ensure people were supported to live healthier lives. Staff told us they had access to training and felt supported in their roles. People’s nutritional needs were met, and we received positive feedback about the standard of food provided.

People and relatives all agreed staff were kind and caring. Staff worked discreetly to maintain people's privacy and dignity. There was a light-hearted atmosphere throughout the home. Privacy was promoted.

People told us they received person-centred care. They told us they were able to contribute to how they lived and were supported within the home. Organised activities took place. No one had any complaints at the time of the visit but were confident any complaints would be dealt with effectively by management. The registered manager spoke passionately about and was committed to providing high-quality person-centred end of life care.

Everyone we spoke with agreed the home was well-led. The management team was aware of their responsibilities and was committed to providing high-quality, person-centred care. This included having systems for continuous learning and driving up standards. Staff told us the home was a good place to work and morale within the home was high. Staff turnover within the home was low. The registered manager had a system for monitoring quality and safety within the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection on 04 March 2016, we asked the provider to take action to make improvements to people’s recorded consent to care and treatment. We requested they ensured mental capacity assessments were completed before they made decisions on behalf of people unable to consent to aspects of their care. At the focused follow-up inspection on 22 December 2016, the provider completed improvements and had met the requirements of the regulations.

We further recommended the provider continued to make progress with risk assessment and care planning recordkeeping, the cleanliness of the medication trolley, overdue refresher training and limited quality assurance auditing.

During this inspection, we found the registered manager closely monitored staffing requirements against the complex needs of Hedges House and those who lived there. A visiting healthcare professional told us they found plenty of staff were on duty and they never seemed rushed. The management team followed safe recruitment and induction procedures to protect people from unsuitable employees. One staff member told us, “The recruitment was very professional.”

People told us they felt safe and secure whilst living at Hedges House. The registered manager ensured staff had safeguarding training to underpin their awareness. Environmental and personal care risk assessment were in place to protect people from unsafe or inappropriate care. The management team were in the process of developing and strengthening these processes further.

Medicines, including controlled drugs, were stored in a clean and secure environment. We observed staff followed correct procedures when they administered medication and fully completed associated records.

We looked at staff files and the registered manager’s training matrix and found staff received a wide range of training. One person who lived at Hedges House told us, “Oh yes, the staff are well trained.”

Care records held evidence people or their representatives had signed consent to all aspects of their care. Throughout our inspection, we observed people were not limited and staff assisted them to move about the home freely. Staff received training in the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS) to underpin their understanding.

Menu programmes we looked at evidenced people had a good selection and variety of meals. One person said, “I love my fruit and I get plenty of that.” Staff completed fluid, food and weight monitoring charts and screened each person for any nutritional risks.

We observed staff were kind and patient and when we discussed this with people, they confirmed they were supported with a caring approach. One person said, “The staff are excellent and attentive.” Care records we reviewed held evidence people and their representatives were involved in their support planning.

The management team completed a variety of assessments, which formulated each person’s care plan. Records were personalised to people’s individual requirements and were updated regularly. Staff checked and recorded each person’s backgrounds and preferences in relation to their care.

Staff said they felt the registered manager was supportive to them and worked with them as part of the team. People we spoke with felt the management team assisted them to comment about the quality of their care. To underpin this, the management team was strengthening their auditing systems to ensure everyone’s safety and welfare.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 22 December 2016 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Hedges House Residential Hotel Limited’ on our website at www.cqc.org.uk.

Hedges House provides care and support for older people and younger adults. The home is situated near the centre of Lytham. The building provides accommodation over three floors and there is a passenger lift for people’s ease of use. Bedrooms are offered on a single room basis only and there are a range of communal lounges, dining areas and a conservatory.

A registered manager was in place. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection, we found the management team and staff had in-depth training about the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). They demonstrated a good awareness of related principles and we observed they used this in practice. A staff member told us, “I give them the choice about what they want to wear and how they want to do something, like washing and dressing. It’s an important part of helping the residents to make decisions.”

The registered manager had introduced new documents and completed required procedures to demonstrate they worked effectively under the MCA. For example, a new consent form was implemented and we saw these were signed to evidence people had agreed to their care.

Those who lived at the home and their representatives told us they felt safe and comfortable at Hedges House. We found staff treated individuals with respect and consistently offered choice and support to make their own decisions. We did not observe people being deprived of their liberty during our inspection. One person who lived at the home said, “I’ve never seen staff force residents or be rough with them.”

We could not improve the rating for effective from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

Hedges House is a care home situated near the centre of Lytham. It provides residential care for up to 34 people. The building has three floors which are serviced by a passenger lift. All accommodation is offered on a single room basis. There are a range of communal lounges including a conservatory.

At the time of the inspection there were 30 people who used the service.

The last inspection of the service took place 21 May 2014. At that time the service was found to be compliant with all the regulations assessed.

Most people, (all apart from one) we spoke with expressed satisfaction with the service provided at Hedges House and spoke highly of staff and the registered manager. People told us that staff were kind and caring and had a good understanding of their needs.

Care workers we spoke with demonstrated a good understanding of people’s needs and how to support them in a safe manner. We found that one person who had been admitted to the home several days earlier did not have a completed care plan in place. However, one of their relatives expressed satisfaction with the level of discussion that had taken place with the registered manager about their loved one's needs. We made a recommendation about recording such discussions in the future.

People told us they were treated with dignity and that their rights were respected. The registered manager and staff had awareness of the Mental Capacity Act 2005 (MCA) and processes to follow in the event that a person they supported was not able to consent to an aspect of their care or accommodation. However, we found some examples where decision specific mental capacity assessments had not been carried out. This meant that the rights of people unable to consent could be compromised.

The management of people’s medicines was generally satisfactory, but improvements were required in relation to medicines records and medicines audits. We made a recommendation about this.

Staff spoken with expressed satisfaction with the service and felt they were well supported. However, we found that some of the required training programmes were out of date and that formal supervision had also fallen behind. The registered manager had identified this issue and was taking steps to address it. We made a recommendation regarding the future monitoring of these areas.

Staff were aware of their responsibilities to protect people who used the service from abuse and improper treatment and were confident about reporting any concerns in relation to the safety and wellbeing of people who used the service. In general the policies and procedures of the home helped to protect people’s safety, but we made a recommendation about ensuring robust monitoring of any private arrangements entered into by people who used the service.

The registered manager worked closely with staff and monitored standards on an ongoing basis. However, audit systems were not properly formalised. This meant there was a risk of some aspects of the service not being properly monitored for safety and quality. Following the inspection the provider made arrangements to obtain advice from an external organisation about making improvements to audit systems.

People expressed satisfaction with the quality and variety of food provided at the home. We saw that arrangements were in place to help ensure that people’s individual preferences and wishes were met.

Whilst the feedback we received about activities was varied, we saw there was an activities programme in place, which included a variety of regular events. Efforts were made to involve people who used the service and their families in the running of the home, by way of residents meetings and regular open events.

People were enabled to express their views and raise concerns. People told us they felt comfortable in approaching the registered manager and were confident any concerns raised would be dealt with in an appropriate way.

People who used the service were provided with a good standard of accommodation. The home was well maintained, well-furnished and comfortable. There were a variety of pleasant areas for people to spend their time, including a safe outdoor space, a sunny conservatory and a pleasant reception with a well- stocked bar.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to consent to care and treatment. You can see what action we have told the provider to take at the back of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, 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 safe?

Carers had a good understanding of people's needs and how to support people in a safe manner.

Risks to people's safety and wellbeing were identified and appropriate action was taken to promote their safety.

There were effective arrangements in place to protect people against the risks of infection.

Staff were carefully recruited to help ensure they had the necessary skills and were of suitable character.

Is the service caring?

The feedback we received from people who used the service and their relatives was extremely positive. We spoke with five residents and two relatives who were all highly complimentary about the service provided at Hedges House.

Staff provided support in a kind and respectful manner. We observed staff supporting residents patiently and with care.

Is the service effective?

People expressed great satisfaction with the facilities and standard of accommodation provided. One relative commented that the environment was excellent because people had plenty of communal areas to choose from.

Carers were aware of people's needs and how to meet them. We saw evidence that staff identified concerns quickly and took the appropriate action, for example, changes in people's health.

The home worked well with community health care professionals to ensure people's needs were met.

Is the service responsive?

The manager sought the views of people who used the service and their representatives and ensured that their comments and views were considered.

We saw that the manager had responded to changes in residents' needs to ensure that they continued to receive safe and effective care.

This included the review and increase of staffing levels and the provision of an upgraded call bell system.

Is the service well led?

We received very positive feedback about the provider and the manager. People told us that the provider of the home visited daily and spoke with residents and staff. We were also advised that the provider always ensured that the necessary resources were made available for the effective running of the home.

Staff and residents spoke highly of the manager, describing her as approachable and supportive. The manager demonstrated a good understanding of her role and the needs of people using the service.

The manager was also able to demonstrate that she constantly updated her knowledge through new learning and projects within the home.

There were processes in place to monitor quality throughout the service. Any areas for development identified were addressed in a positive manner.

'Everything is perfect here.'

'I don't think you will find a better place than this!'

'I have no complaints at all. I think we are very well looked after.'

'The attention we receive is second to none. I only came for a short stay but decided I wanted to move in.'

At this inspection, we looked at standards relating to the care, welfare and involvement of people living at the home. We also looked at how people were safeguarded from abuse. We assessed standards of staff training and support and also examined how the provider monitored standards. We found evidence that the provider was compliant in all the areas we inspected. However, we identified some measures the provider may find useful, to help ensure that good standards are maintained.

We were able to speak with residents during the day of the inspection about their care and support. People we spoke with told us they could express their views and were involved in discussions about their care. They told us they felt listened to when discussing their care needs. One resident told us, 'The place is tops.' A relative we spoke with said, 'We came to visit and we were impressed with the warmth of the staff and the homely atmosphere.'

We contacted the Lancashire contracts monitoring team. They told us they currently had no concerns with the service being provided by the home.

We spoke with staff working in the home and they demonstrated an awareness of individual care needs of people living there. Also, the importance of treating people with respect and dignity. A relative told us, "Staff are always supportive and helpful to people living here.'

All the staff we spoke with told us this was a good care home to work for and staff felt supported in carrying out their roles. One staff member said, "We have a lot of staff who have been here a while we support each other and get along fine.'