Halvergate House

Halvergate House is a nursing home providing personal and nursing care for up to 50. The service provides support to older people and younger adults some who might be living with dementia, physical disabilities, learning disabilities or autistic spectrum disorder. At the time of our inspection there were 36 people using the service.

Halvergate House is an adapted building ,split across two floors with access via a lift or a staircase. The service benefits from courtyard and gardens for people to use. Ground floor rooms benefit from patio doors out into the garden and all rooms have ensuite toilets.

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

The quality assurance monitoring systems in place were not effective in maintaining and improving the quality of care provided to people.

People’s documents were not personalised and not all information had been recorded effectively.

The care environment was visibly clean, although some areas of the home were tired and require modernisation, the service have a development plan in place for improvement of the environment.

Staff received mandatory training; however, they lacked training to meet people’s specific needs.

People said they felt safe at the service. One person told us, “Oh yes perfectly safe. Everybody is nice and friendly.”

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 provider and operations manager had implemented an action plan prior to our inspection to make improvements to the service. We saw this action plan was beginning to take effect but would take time to be fully embedded at the service.

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 21 December 2021).

Why we inspected

We received concerns in relation to the safe care and treatment of people living in the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

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

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

Enforcement

We have identified breaches in relation to safe care and treatment, good governance and staffing 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Halvergate House is a nursing home providing personal and nursing care to 33 people aged 65 and over at the time of the inspection. The service can support up to 50 people.

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

People we spoke to told us they were happy at this service and appeared relaxed in this setting.

Person-centre care plans were in place that had been regularly reviewed. Care plans were accurate and robust; enabling staff to safely support people in a manner in which the person had chosen.

Medicine management was safe. All medicines were stored securely, and documentation was completed following all administrations. People were given their medicines safely and in line with best practice.

Good infection prevention and control measures were in place. The service was clean and well maintained. The provider told us they planned further improvements to enhance the service for the benefit of those supported.

The registered manager maintained a good oversight of the service by working alongside their team and reviewing and monitoring documentation that had been completed by staff.

Feedback from families was positive. Families we spoke to told us us that their loved ones were safe at this service and well supported by the staff team in place.

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 16 December 2017).

Why we inspected

We received concerns in relation to management of medicines and infection control practice. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from the concerns that had been raised which led to the decision to inspect. Please see the Safe and Well-led sections of this full report.

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

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.

We undertook this unannounced comprehensive inspection on 17 and 18 October 2017 to look at all aspects of the service and to check that the provider had made improvements and that the service now met legal requirements. At this inspection, we found improvements had been made in the required areas and the provider was no longer in breach of the regulations.

You can read the report for previous inspections, by selecting the 'All reports' link for ‘Halvergate House’ on our website at www.cqc.org.uk

Halvergate House is registered to provide accommodation for up to 50 people who require nursing and personal care, some of whom may be living with dementia. At the time of our inspection, 38 people were living at the service.

There was a registered manager in post. 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.

Staff knew how to keep people safe from abuse. Staff were confident that if they had any concerns they would be addressed quickly by the registered manager. Risks to people had been assessed and regularly reviewed. Actions had been taken to mitigate these where necessary. Checks had been made on the environment to ensure the service was safe. Equipment to support people with their mobility, such as hoists had been checked to ensure people were safe.

There were enough staff to ensure people were safe and had their needs met in a timely way. Medicines were stored safely, people received their medicines when they needed them.

Staff received training to make sure they had the skills and knowledge to carry out their roles. Specialist training such as diabetes and supporting people living with dementia had been completed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Staff understood their responsibilities under MCA, people’s capacity had been assessed and when required best interests meetings had been held and recorded. Staff encouraged people to make decisions about their day-to-day care and remain as independent as possible.

People told us that they enjoyed the food. People had a choice of meals and were supported to maintain a healthy diet in line with their choices, preferences and any healthcare needs. People’s health was assessed and monitored. Staff took prompt action when they noticed any changes or decline in health. Staff worked closely with health professionals and followed guidance given to them to ensure people received safe and effective care.

People’s dignity and privacy was maintained by staff. People told us staff were kind and caring. Staff spent time with people and were genuinely interested in them and what they wanted to say. Staff explained how they maintained people’s dignity and how they encouraged choice.

There was a programme of activities available for people to enjoy. Care plans were detailed and had been reviewed regularly and up dated to reflect people’s changing needs.

Information about how to complain was on display in the service. People and relatives knew how to complain and were confident that any concerns they had would be listened to and acted on.

Audits were in place to monitor the quality of the service people received. When improvements or developments were identified, action was taken to address and implement these. The registered manager reviewed the recorded accident and incidents. These were analysed to identify any patterns or trends and plans were put in place to reduce the risk of them happening again in the future.

Staff told us that they felt supported by the registered manager and that the service was a good place to work. Staff understood their roles and responsibilities and treated people with dignity and respect.

Staff supported people to maintain friendships and relationships. People’s friends and family could visit when they wanted and there were no restriction to this. People and their relatives received regular surveys to enable them to voice their opinions of the service and these were acted on. Staff and relatives meetings were held regularly.

Services that provide health and social care to people are required to inform the Care Quality Commission CQC) of important events that happen in the service. CQC check that appropriate action had been taken. The registered manager had submitted notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

Halvergate House provides nursing care for up to 50 older people, some of whom may be living with dementia. At the time of our inspection there were 37 people living within the home, 34 of which were on a permanent basis. Accommodation is over two floors and the second floor is served with a lift. All bedrooms have en-suite facilities and there are a number of communal areas as well as gardens.

At the time of the inspection, Halvergate House had a manager who had been in post for 12 months but had not yet registered with the Care Quality Commission (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. Shortly after our visit, we received a manager application for this service.

We last inspected this service on 3 and 11 November 2015 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of three regulations relating to consent, dignity and respect and good governance. Following the inspection in November 2015, the service failed to send us a plan to tell us about the actions they were going to take to meet the above regulations.

At this inspection in August 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to dignity and respect, meeting nutritional and hydration needs and good governance.

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

Effective systems were not in place to monitor the quality of the service and drive improvement. Where issues had been identified by the provider, there were no clear plans in place to rectify those concerns. Not all the issues highlighted in this report had been identified by the service.

Some people experienced a poor service at mealtimes. People were left waiting for their meal and did not receive the assistance they needed at a time they required. Equipment was not always available in a timely manner to assist people to remain independent in eating their meal. People were not offered a choice or explanation of what was being served at the time it was received.

People were not always treated with dignity and respect and their privacy was not consistently maintained. Staff were observed to speak across people they were assisting and talk openly about confidential matters in communal areas. People’s consent wasn’t always gained before assisting them and inappropriate language was used by some staff in relation to the people they supported.

People did not always receive the care and support they required at a time they needed it. Some people told us there were not enough staff to meet their needs. Staff, and some relatives, agreed and told us this impacted on the level of service people received. The provider confirmed that this has been identified and was currently being addressed.

The service had processes in place to help ensure that only those staff suitable to work in health and social care were employed. These included references from previous employers and completing criminal police checks. The staff we spoke with, and the records we viewed, confirmed these were in place prior to staff starting in post.

Processes were in place to help protect people from the risk of abuse. Staff had an understanding of what constituted abuse and how, and where, they could report any concerns they may have.

The risks to individuals had been identified, assessed and managed. These were individual to each person and covered areas such as health conditions, risk of malnutrition and dehydration and pressure areas. Although not all risks associated with the building had recently been recorded, checks were in place to ensure the premises were in good working order and regular maintenance was undertaken as appropriate.

All accidents and incidents were recorded and appropriate immediate action taken to ensure the person’s health and wellbeing. However, the analysis of accidents and incidents did not fully identify all trends and therefore mitigate all future risk of reoccurrence.

Medicines administration and management followed good practice and people received their medicines as the prescriber intended.

People told us that they had confidence in the skills and ability of most staff who supported them. Staff told us they had received training and most told us they felt supported although staff had not received regular supervisions or appraisals.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. The service had assessed people’s capacity to make decisions and submitted appropriate applications to legally deprive people of the liberty where required. However, these assessments were not decision or time specific as required by the MCA. Staff had a basic knowledge of this legislation and how it impacted on their role and those they supported.

Where needed, people received the specific diets they required to maintain their health, safety and wellbeing. The service made prompt and appropriate referrals to health professionals and the people who used the service were involved in this. Activities took place within the home although some people told us they felt lonely or unstimulated at times.

People’s care plans were person-centred but not always accurate and up to date. However, staff had a good understanding of people’s needs, likes, dislikes and preferences. Some had been reviewed on a regular basis but this was variable. People had been involved in the decisions around the care and support they received and wished for.

The people who used the service told us that most of the staff were kind, caring and patient. We saw that they worked well as a team and staff told us they helped and supported each other. Staffing levels impacted on the morale of staff and they told us that, when staff numbers were as required, morale was generally good.

The manager was visible and approachable and available to speak with people should they need to. People told us they found the manager to be caring and receptive and that they would feel comfortable discussing any concerns or complaints they may have with them.

Not all legal requirements were met by the service at the time of the inspection visit and we found that they were not displaying their last inspection rating as required by law. This was rectified within the premises before our visit was finished and the rating was displayed on the provider’s website shortly after the inspection.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our discussions with seven people who used the service, two family members, fifteen staff members and one person who was providing hairdressing services. In addition we looked at five people's care and support plans. If you would like to see the evidence that supports the summary, please read the full report.

Is the service safe?

People living at Halvergate House had varying types of physical disabilities or were living with varying stages of dementia. This meant that sometimes they would decline to consent to certain aspects of their care and treatment. For example some people would refuse to eat, take medications or accept personal care. Where this happened staff took extra care to support and engage people in understanding why these things were important to their health and wellbeing. We found appropriate risk assessments were in place. For example we found risk assessments for people at risk of falling. We also found risk assessments for people who wished to go home for short breaks. This meant that the provider ensured that, as far as possible, people were safe in the home and that staff were safe in their working environment. Where risks to people had been identified measures had been taken to minimise or remove them.

People we spoke with told us, or indicated to us, that they felt safe living in the home. Some people told us that they would rather live at home but that they did feel safe and well looked after at Halvergate House. We saw that the building was clean and well maintained. Garden areas provided safe secure surroundings for people to enjoy time outside. Equipment used at the home was generally clean and well maintained. People were provided with their medication when they needed it.

We found appropriate vetting of staff was in place, combined with on-going staff support, training and appraisal. This meant that the provider took reasonable steps to ensure that vulnerable adults were protected from the risk of abuse. Staff were up to date with their safeguarding training.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to people living in care services. At the time of the inspection one person required these safeguards and an application had been submitted to ensure they were protected. Proper policies and procedures were in place so that people who could not make decisions for themselves were protected. Relevant staff had been trained to understand when DoLS should be implemented.

Is the service caring?

People we spoke with said that staff treated them with respect and consideration. We noted staff used kind, attentive approaches. People felt that staff listened to them and took time to explain things. One person told us, "They know my quirks." We noted that people, or family members, were consulted about care and support received. We observed that people received encouragement, advice and had questions answered politely by staff. They were given time to think about what it was they wanted to say or ask.

We found that the provider took steps to ensure people were involved, as much as possible, in discussions about their daily living challenges. This included making sure people living in the home were provided with access to other sources of help and advice. This told us that the provider took account of people's mental health needs as well as physical needs.

People's needs were assessed and care and support was planned and delivered in line with their individual care plans. The care plans we looked at were personalised and detailed and provided a good level of information for staff providing their care.

Is the service responsive?

People told us that the provider responded to their changing needs in a timely manner. People's care and social needs were assessed and reviewed on a monthly basis or as and when needed. Where changes to people's needs occurred, the service referred to other health and social care professionals for advice and guidance if required. All changes were well documented and recorded.

There were daily activities available for those wishing to take part. No one was pressured to take part in activities if they did not want to.

One person we spoke with told us, "I don't want to be here really. I know it's only temporary and there is no place like home. But they do look after me well. They often ask me if I am okay and is there anything I need."

People who used the service and their family members or representatives, were asked for their views about the care provided and these were acted on by the provider.

Is the service effective?

People using the service that we spoke with said, or indicated to us, that the care and support provided was of good quality. They indicated their satisfaction with living in the home. However some people said they sometimes found life difficult there. They went on to say that this was because they wanted more freedom to come and go. However they acknowledged that this was not always possible. Some people told us how much they enjoyed the activities but felt sad that not all people there could join in.

The majority of people we spoke with did accept that the care provided was in their best interests. From our observations we saw that care and support was effective and consistent. The staff demonstrated an in-depth knowledge of people living in the home. People were supported to be as independent as possible.

We saw that staff knew the people they were supporting and that the people were content. We noted that if something was not right that staff responded quickly to resolve matters.

Is the service well led?

Views of people using the service and, where possible, their families were obtained. Staff told us that they felt supported and had received sufficient training to carry out their role effectively. They added that if they felt they needed further or additional training or support that they were confident this would be arranged by the provider. We looked at extensive training certificates for three staff members and looked at the forecasted training for 2014 / 2015. This told us that the provider took reasonable steps to keep the staff updated and trained to a high professional standard.

There were quality monitoring systems in place and audits and spot checks took place to ensure that people received a good service.

Staff were clear about their roles and responsibilities. They spoke of how they worked as a team with the needs of the person central to the work they did.

All staff we spoke with had a good understanding of the whistleblowing policy. However, some staff did state that they felt they might not have their concerns listened to or acted on by the management team.

Quality assurance processes were in place to assess the standard of care provided and we saw results of recent surveys. These included questions about care and support, housekeeping and catering. We noted that management fed back to people who had responded to surveys on comments and suggestions where possible. People living in the home told us that their views were generally listened to and acted on.

During our inspection we spoke with eight people residing in the service, of these six were living with dementia, three people's relatives and eight staff which included the registered manager. We also left comment cards at the service which provided another forum for the people who used, worked at or had contact with the service to share their views with us on the level of service being provided.

Comments were received from seven people. One person commented that, 'All the staff put the wellbeing of the residents first.' Another person wrote, 'I cannot praise the staff enough for their patience and care in nursing my (relative) who is in the last stages of dementia' They are attentive at all times and I cannot praise the staff enough for their help at a very difficult time for both my (relative) and myself. I give them 12 out of 10.'

All the people we spoke with were happy with the care they received. One person told us, "I feel at home' It is built to fit us; there is always someone there to help.'

People told us that the service was well led. Relatives told us that the staff and management communicated with them well. They felt staff fully involved them in any decisions and would listen and act on any information given. One relative said that they had developed, 'A good relationship with the care and nursing staff as well as the cleaners and catering.' Another relative told us that they had, "Peace of mind,' that their next of kin was being looked after.

People were protected from harm because their individual risks had been assessed and managed. Staff received training in dementia which enabled them to provide safe and professional care.

Care records showed that staff were responsive to changes in people's needs. We saw that health and social care professionals were consulted with, and staff worked with other providers to ensure people received the right care at the right time.

The manager had an effective way of monitoring and assessing the service provided to people. People told us they felt safe, listened to and were involved in the decisions regarding their care and the running of Halvergate House.

Whilst we spoke informally to people and their visitors during our inspection, we did not need to seek their views about the service. However, we observed lunch being served and eaten in one of the home's two dining rooms, spoke with staff and looked at a sample of records maintained about people using the service. We found that most improvements had been made and, where actions were in progress, these were being monitored.