Archived: Little Hayes Rest Home

There was 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.

People’s safety was compromised as the risks to their health and safety were not always managed appropriately and action was not always taken to reduce the level of risk. This included the risks of people falling, choking or developing pressure injuries. People were not protected from the risk of infection as relevant guidance was not being followed in the laundry and care staff did not consistently make sure that people’s bedding was kept clean.

Staff did not followed legislation designed to protect people’s rights and ensure that decisions are only taken in the best interests of people. However, they did seek consent from people before providing care and understood how to protect people’s freedom.

People received personalised care from staff who understood their needs. However, this was not supported by the care planning system, which was disorganised and inconsistent. The registered manager showed us a new care planning system they were planning to introduce to address this.

With the exception of medicines audits, there were no effective systems in place to assess, monitor and improve the service, such as the management of risks to people, infection control arrangements and care planning.

Medicines were managed safely, although procedures to make sure medicines were always available were not robust. We have made a recommendation about this.

People told us they felt safe at the home. Staff knew how to identify, prevent and report abuse, and the provider responded appropriately to allegations of abuse.

The process used to recruit staff helped make sure that only suitable staff were employed. There were enough staff to meet people’s needs at all times. Staff were knowledgeable, suitably trained and were supported appropriately in their work.

People were offered varied and nutritious meals, enjoyed the food and received appropriate support to eat and drink enough. They had access to healthcare services, such as doctors and nurses, when needed.

People were involved in planning the care and support they received, although they were not always involved in reviews of their care. They were treated with kindness and compassion by staff who knew them well. Their privacy and dignity was protected and staff encouraged them to remain as independent as possible.

Staff encouraged people to make choices about all aspects of their lives and were responsive to people’s needs. People had access to a range of suitable activities. The provider sought and acted on feedback from people and staff.

There was a clear management structure in place. Staff understood their roles, were motivated, and worked well as a team. There was an open and transparent culture; visitors were welcomed and there were strong links to the local community.

We identified breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.

Is the service well-led?

This is a summary of what we found-

Is the service well-led?

We found improvements had been made to the quality assurance systems in place in the home. A satisfaction survey was in use and people told us they had regular conversations with the manager about their level of satisfaction. Staff practice was monitored and actions were recorded and carried out promptly. People knew how to complain and the home's complaints policy was posted on a noticeboard in the foyer. Audits were carried out to ensure the home's environment was maintained and improved, and that records were accurate and informative.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

People were cared for by staff who were fully aware of their needs and who had the skills to provide the support people required. There were enough staff on duty to meet people's needs in a safe and unhurried way. People had the equipment they required and staff provided assistance in an appropriate manner.

Staff had completed training in the safeguarding of vulnerable adults. They could describe different types of abuse and how it could be determined if someone was being abused. All the staff we spoke with were knowledgeable about the home's safeguarding policy and the local procedures for reporting suspected abuse. They told us they felt confident to use these. Risks to people's health and safety had been assessed and management plans were in place to reduce these risks.

Is the service effective?

People we spoke with said their needs were met by care staff. One person said, 'If you want to see a doctor or anything like that they sort it out pretty quickly. I don't think I would change a thing'. We saw people were cared for according to their care plan and staff knew what people's support needs were. A visitor told us, '[My friend] has everything they need. I would quite happily come and live here myself'. Staff were conscious of people's needs and were attentive to them. There were enough staff to ensure people received the support and care they required.

Is the service caring?

Staff were supportive and patient as they provided care to people. They ensured people received the care they needed in an unhurried way. We observed people being cared for in the lounge. Staff took time to talk with people and see if they were comfortable. Refreshments were offered throughout the day and people who needed it received assistance to eat and drink in a calm and respectful manner. People told us the staff were caring. One person said, 'They are very caring; all the staff are kind and helpful'.

Is the service responsive?

People's needs had been assessed before they moved into the home. Care files included details of how to care for each person, including their personal preferences. Daily records of care showed people's preferences were respected. A person who used the service told us, "They will do anything for you. You only have to ask". We spoke with a regular visitor to the home. They told us, 'They call the doctor when [my friend] needs it, and they check on [my friend] through the night'. They added that the person liked to stay in their room to eat their meals and this was respected. When people's health deteriorated or their support needs changed we saw their care plan was updated and extra measures to reduce risks to their health and safety were put in place.

Is the service well-led?

The home did not have robust quality assurance systems in place. Visual checks were carried out on cleanliness and the standard of personal care provision, but these were not recorded. Therefore, it could not be ascertained if concerns had been identified and addressed. Staff supervision was infrequent. An annual satisfaction survey sent to people using the service and their relatives had not been carried out since 2012. Incidents and accidents, though recorded, were not analysed to see if changes could be made in order to prevent further incidents. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

We observed care in the communal areas of the home. Staff addressed people with respect and people appeared to be content and relaxed. People were provided with drinks throughout the day and the meal served at lunchtime was presented in an appetising way. All the people we spoke with said they enjoyed the food provided in the home.

We spoke with two care staff, the assistant manager and the deputy manager. They were fully aware of people's needs and how to support them. We saw people had access to the equipment and support they needed. All parts of the home we viewed were clean and infection prevention and control measures were in place.

Staff records showed Disclosure and Barring Service (DBS) checks had been carried out. However, other necessary checks had not been completed for some staff. A complaints procedure was in place and information on how to complain was available to people using the service.