Hartshead Manor

We found the following examples of good practice.

There were enhanced cleaning regimes and the home was clean throughout.

An indoor visiting area as well as an outdoor summer house were used for visitors to minimise the risks of COVID-19.

There was a dedicated infection prevention and control champion who ensured visitors and staff worked within current guidance to help prevent the spread of infection.

Hartshead Manor is a care home providing personal and nursing care to 46 people aged 65 and over at the time of the inspection. The service can support up to 55 people.

There is accommodation and communal areas located on both the ground and first floor. The home provides care and support to people who are assessed as having nursing and personal care needs in Garden View. There is also a unit, Willows, with 20 beds which provides personal care for people living with dementia.

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

People were safe. Risk assessments were detailed and reflective of current care needs. The premises and equipment were safe and clean. Medicines were managed and administered safely. There were enough staff to meet people’s needs and the recruitment of new staff was thorough.

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. Staff received induction, training and supervision. there were effective channels of communication for the staff team. People had access to other health care professionals as needed.

Staff were kind, caring and professional. People were treated with dignity and respect. Staff encouraged people to retain their independence. Confidentiality was respected.

Care records were detailed, person centred and regularly reviewed and updated. There were some inconsistencies in the information, this was discussed with the registered manager at the time of the inspection. The home employed an activities co-ordinator who arranged and facilitated a variety of activities for people. There was a system in place to manage complaints in the event people were dissatisfied with the service.

Staff were positive about the improvements at the home and the leadership of the registered manager. The registered manager understood their role and responsibility in ensuring people received high quality care. There were regular meetings with staff, relatives and people who lived at 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 and update

The last rating for this service was requires improvement (published 12 April 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

Hartshead Manor Care Home provides accommodation, care and support for up to 55 people over 65 years old including people living with dementia. At the time of our inspection, there were 44 people living at the service.

People's experience of using this service:

¿ People told us they felt safe and well cared for by staff. One person said, “I think they’re very good to me.”

¿ At this inspection, we found some improvements had been made in relation to the management of medicines, the mealtime experience of people living with dementia and how people’s weight loss was managed. However, further improvements were still required and the provider continued in breach of regulations.

¿ We found four breaches of the regulations in relation to safe care and treatment, consent, good governance and staffing. The provider was not always managing the risks involved with people using specialist seating equipment appropriately, checking the temperature of the water before supporting people to have a shower, ensuring the equipment used to help people to move was safe and information in people’s risk assessments was not always detailed or updated. The provider was not always completing decision specific mental capacity assessments and best interest decisions for people who lacked the capacity to make decisions about their care. Staff were not offered regular supervision and appraisal. The provider’s quality assurance processes in place were not effective in identifying the issues found at this service. Some of the issues found at this inspection had already been identified in our previous inspection. The management of the service continued to fail in their oversight and monitoring of the quality of the service and in implementing the changes needed for the service to be compliant with the regulations.

¿ We have made three recommendations in relation to the use of specialist seating equipment, checks on water temperatures and pressure relief for people at risk of developing pressure ulcers.

¿ We received mixed views about the staffing levels at the home.

¿ People enjoyed the meals and their dietary needs had been catered for. This information was detailed in their care plans.

¿ People were supported in accessing healthcare professionals.

¿ People and relatives felt staff were kind and caring and treated them with dignity and respect when providing care.

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

Rating at last inspection:

The service has been in special measures and has been inspected within six months as we state in our guidance. As insufficient improvements have been made and there remains a rating of inadequate for the key question of well-led, the service therefore remains in special measures.

Why we inspected:

When services are in Special Measures they are kept under review and we will inspect the service within six months. This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will continue to monitor the service to ensure that people received safe, high quality care.

Further inspections will be planned for future dates. We will follow up on the breaches of regulations and recommendations we have made at our next inspection.

Hartshead Manor is a care home for up to 55 people. At the time of this inspection there were 49 people living at the home (47 on second and third days). People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Hartshead Manor consists of one building with two floors and had one unit specialised in providing care to people living with dementia.

Hartshead Manor was last inspected on the 4 and 6 April 2017. At that time it was rated requires improvement overall and was in breach of regulations in relation to good governance because of lack of records of people’s food and fluid intake, inconsistent administration of prescribed drinks and poor auditing of water temperatures, care plans and medications. This was the third time this service was rated required improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve their well led domain to at least good. At this inspection we found not enough improvements had been made in the areas identified, the provider was in continuous breach and we found further concerns in relation to safeguarding, safe care and treatment, meeting nutritional and hydration needs and consent.

At the time of this inspection the service had a home manager who had not registered to manage the service. It is a legal requirement that the home has 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.

We found systematic and widespread failings in the oversight, monitoring and management of the service, which meant people did not always receive safe care.

We found concerns about how people’s nutritional and hydration needs were being met and the registered provider was not managing people’s weight loss safely. During this inspection we raised safeguarding concerns in relation to people losing weight.

The management of risks was not always consistent. We found people using specialist pressure relief chairs had not been assessed to use this equipment. We found manual handling risk assessments were not always person centred and lacked detail about how people should be moved.

Medicines were administered in a caring way however we could not be certain these were always administered as prescribed or stored safely.

Mental Capacity Act 2005 assessments and best interest decisions for some people living with dementia were in place however the relevant people had not always been involved. We saw relatives giving consent for decisions without having lasting power of attorney. There was no evidence people were being restricted or receiving care that was not in their best interests.

Staffing levels were not always sufficient to ensure people received the care they needed in a timely way, in particular during meal times.

There was a regular and varied programme of activities at the home and people spoke positively about the activities coordinator however we found people were not offered enough social stimulation throughout the day and spend long periods of time sitting in the lounges.

Staff told us they received training and supervision they needed to provide people with effective care and support however we found some staff had not had their competencies recently assessed and their supervisions were overdue.

The registered provider was in the process of implementing a new electronic system to manage people’s records of care. At this inspection we found notes related to people’s daily care and food and fluid were not always accurate of the care delivered.

People’s needs in relation to the protected characteristics under the Equalities Act 2010, were taken into account in the planning of their care. People's communication needs were assessed.

There were safe recruitment policies and procedures in place.

People and their relatives told us staff were kind and caring.

The registered provider kept links with the community and worked in partnership with local organisations.

Staff told us they felt supported by the management team and people spoke positively about staff. Our findings at this inspection indicate management’s oversight was not robust.

There were several systems in place to monitor the quality of care however these were not effective in identifying the issues found at this inspection.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Where regulations have been breached information regarding these breaches is at the back of this report. Where we have identified a breach of regulation which is more serious we will make sure action is taken. We will report on this when it is complete. Where providers are not meeting the fundamental standards we have a range of enforcement powers we can use to protect the health, safety and welfare of people who use this service.

When we propose to take enforcement action our decision is open to challenge by the provider through a variety of internal and external appeal processes. We will publish a further report on any action we take.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures. This is the first time the service has been in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

This inspection was prompted, in part, by notification of an incident which had resulted in the unexpected death of a person living at the home. This incident is being reviewed by the Care Quality Commission (CQC) in line with our specific incidents policy. Therefore, this inspection did not examine the circumstances of the specific incident.

The information received by the CQC about the incident indicated potential concerns about the way the service managed risk to people. This inspection included an examination of how those risks were managed. We found, since the specific incident, the registered manager had been responsive and had introduced new systems and processes to improve their assessment and management of risks.

Hartshead Manor is a nursing home registered to provide care for up to a maximum of 55 older people. There were 49 people living at the home at the time of our inspection. The home is a converted property providing bedroom and communal areas on both the ground and first floor. The home has a unit which is dedicated to supporting people who are living with dementia.

There was a registered manager in post and this person had been registered with the Care Quality Commission since March 2016. 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 felt safe living at Hartshead Manor. There was an up to date safeguarding policy and the registered manager and staff were aware of relevant procedures to help keep people safe. Staff had received safeguarding training and could describe signs that may indicate someone was at risk of abuse or harm.

Risks to people had been assessed and measures put into place to reduce risk. Since the specific incident, improved practices were in place to reduce risks. People’s care plans contained information to enable staff to safely move and handle people and we observed this in practice.

Medicines were stored safely and administered in a kindly manner. However, although we observed people received support to meet their nutritional and hydration needs, records did not always indicate whether people had been given their prescribed drinks, such as those for people nutritionally at risk.

Staff told us they felt supported and had received appropriate induction, training and ongoing support and supervision and the records we inspected supported this.

People were supported to have choice and control of their lives and we observed staff support people in the least restrictive way possible; the policies and systems in the service supported this practice.

We observed staff to be kind and supportive and people told us staff were caring. We observed people’s privacy and dignity was respected.

Care records were person centred and reviewed regularly. However, two care and support staff we spoke with were not aware of the content of care plans. Information was shared between staff to enable continuity of care but this posed a risk that staff were not always fully aware of people’s care needs.

Staff told us they felt supported by the registered manager. Regular meetings such as staff meetings and residents’ and relatives’ meetings were held. Regular audits and quality assurance checks took place, although these were not sufficiently robust and did not identify some areas found during our inspection which required action.

You can see what action we told the provider to take at the back of the full version of the report.

The registered manager sent us an action plan to show how these breaches would be addressed. We found improvements in all these areas at this inspection.

Hartshead Manor is a nursing home registered to provide care for up to a maximum of 55 older people. There were 50 people living at the home when we visited to undertake our inspection. The home is a converted property providing bedroom and communal areas on both the ground and first floor. The home has a unit which is dedicated to supporting people who are living with dementia.

There was a registered manager in post and this person had been registered with the Care Quality Commission since March 2016. 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 felt safe living at Hartshead Manor but not all relatives shared this view. Two relatives felt there were not enough staff.

Staff had a thorough understanding of safeguarding procedures and staff knew what to do if they thought anyone was at risk of harm or abuse. Risks to people had been assessed and measures were put into place to reduce risks. Staff were recruited safely and trained appropriately. Medicines were stored and administered in a safe way.

Records showed staff had received regular training and support, although one member of staff felt their induction was not adequate because, they told us, they had shadowed other staff for only three hours prior to commencing their duties. Staff received regular supervision. People received support to meet their nutrition and hydration needs. The home environment had improved and was more appropriate to meet people’s needs.

Care and support was not always provided in line with the principles of the Mental Capacity Act 2005 because a person was administered medicines covertly without appropriate assessments being in place.

Staff interactions with people were caring and people appeared at ease in staff presence. There was a pleasant atmosphere in the home. Some staff occasionally used terms that could be perceived as derogatory, such as, “The assists,” referring to people who required assistance.

Care plans were person centred and provided staff with information to provide personalised care and support. Care plans were regularly reviewed. People felt concerns were listened to and acted upon.

Some people who lived at the home, and their relatives, felt the registered manager did not know people well. Staff told us they felt supported by the registered manager. Regular meetings such as staff meetings and resident and relatives meetings were held. Regular audits and quality assurance checks took place, although these were not sufficiently robust. Up to date policies and procedures were in place.

The inspector also through observation and looking at records used the information they were given to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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 the time.

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?

We found that safeguarding procedures were in place and staff knew how to recognise, respond and report abuse.

We found the home to be clean, tidy and well maintained.

People were at risk of receiving medication which was out of date.

Is the service effective?

The service had a comprehensive induction process in place for new staff.

Care plans showed where people had seen medical professionals such as the G.P and chiropodist.

Care plans were not always reflective of people's changing care needs.

Is the service caring?

We did not observe staff consistently supporting people to make simple lifestyle choices.

People we spoke with said staff were kind and caring.

People who lived at the home told us staff were 'very good'.

Is the service responsive?

On the day of our inspection the activities organiser was on annual leave. There was no evidence of alternative arrangements being in place to support people's social needs in the absence of the activity organiser.

The service had a complaints procedure which was displayed in the entrance of the home.

We saw the complaints log did not evidence that each complaint had been fully investigated. We also could not see documented evidence of any action taken as a result of the complaint and the outcome..

Is the service well led?

There was no formal analysis of accidents or incidents.

There was a lack of recorded evidence that many of the providers systems for assessing and monitoring the quality of the service were completed on a regular basis. There was also a lack of recorded evidence that issues highlighted from these processes had been addressed.

There was no registered manager in post on the day of our 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 the time.

We spoke with a visiting relative who told us they had no complaints with staff but they felt the home sometimes seemed a little short staffed. They had no issues with how staff treated their relative. We also spoke with two people who used the service who told us they were well looked after, could get help when they needed it and felt safe in the home. Another person told us they had been to the pub for lunch the week previously and they were looking forward to a boat trip the next Friday.

We found people experienced care, treatment and support that met their needs and protected their rights. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. There were enough qualified, skilled and experienced staff to meet people's needs but the allocation of staff to units in the home needed review and people were not protected from the risks of unsafe or inappropriate care and treatment because records were inaccurate and inappropriate.

Four people told us they were satisfied with the care and treatment they had received at Hartshead Manor.

Four people living at Hartshead Manor told us they liked the staff and one commented the staff were 'excellent' and 'very respectful'. All indicated to us in different ways that they were informed about their care and treatment.

The acting manager explained they had only been in post for one week and had already identified some shortfalls in the care records. However our inspection demonstrated that people had not experienced care, treatment and support that met their needs and protected their rights. Systems had not been followed to ensure people had received the correct medication. Improvements were needed to the records to ensure people were protected from the risks of unsafe or inappropriate care and treatment.