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Inspection carried out on 6 August 2020

During an inspection looking at part of the service

Hanwell House is a care home for up to 52 older people living with the experience of dementia. The service is owned by a private company. At the time of the inspection there were 50 people living at the home. The director of the company is also the registered manager. This is their only service.

We found the following examples of good practice.

¿ Visits to people living at the home were booked in advance for two people from the same household every week. This ensured there was time each week for as many people to have visits as possible. Each visit was for 30 minutes and face masks were worn. On arrival at the home the visitor completed a health screening questionnaire and had their temperature checked.

¿ The provider was very proactive in planning how their service would function during the lockdown. The planning started in January 2020 with high levels of PPE obtained directly from suppliers to ensure more than adequate supplies were maintained.

¿ Staff commenced training on the use of PPE when providing care from January 2020. The processes were enhanced to be above the guidance provided by the Government.

¿ The provider purchased a mini bus to collect staff so they did not have to rely on public transport.

¿ Steam cleaners had been purchased before the lockdown and they used them daily all over the home including floors, soft furnishing and carpets. Housekeepers used the steam cleaners in bedrooms and bathrooms. They also used a deep floor cleaner and a bottle of antibacterial liquid each time to clean all the floors around the home daily.

¿ If a resident was at the end of their life, a room had been identified near the fire exit to enable relatives to come into the home and visit the resident using full PPE.

Further information is in the detailed findings below.

Inspection carried out on 10 December 2019

During a routine inspection

About the service

Hanwell House is a care home for up to 52 older people living with the experience of dementia. At the time of our inspection 51 people were living at the service. The service is owned by a private company. The director of the company is also the registered manager. This is their only service.

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

People were happy living at the service and felt well cared for. They and their visitors told us staff were kind, caring and provided the support they needed. There was a relaxed and friendly atmosphere. Staff were attentive towards people and offered them opportunities to take part in a range of different activities.

The staff had created detailed care plans. These were personalised and gave clear information about how people's needs and preferences should be met. Risks to their wellbeing and safety had been assessed.

People's health was monitored, and they had access to healthcare professionals who worked closely with the staff to make sure people's needs were being met. Medicines were managed in a safe way, so people received their medicines as prescribed. The staff had worked with healthcare professionals to reduce the amount of sedative and behaviour controlling medicines people were prescribed. This had a positive impact on people's wellbeing.

People had enough to eat and drink. All food was freshly prepared at the service and reflected people's likes and preferences.

The staff were well supported and had the information, training and supervision they needed to provide effective care.

The registered manager worked alongside the staff in supporting people. They had a good overview of people's needs. People using the service and visitors told us they felt confident approaching the registered manager with any concerns.

There were effective systems for monitoring the quality of the service and making improvements. The registered manager had adapted the service and made improvements where they had identified specific needs. These included changes to the environment, changing the way staff were supervised and improving care planning. All accidents, incidents and other adverse events were investigated and analysed to identify any trends.

The environment was safely maintained and the staff made regular checks on equipment and the building so they could identify if any maintenance was needed.

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.

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

Rating at last inspection

The rating at the last inspection of 16 May 2017 (Published 14 June 2017) was good.

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.

Inspection carried out on 16 May 2017

During a routine inspection

The inspection took place on 16 May 2017and was unannounced.

The last inspection took place on 7 June 2016 when we rated the service Requires Improvement and found breaches of Regulations relating to person centred care, dignity and respect, safe care and treatment, safeguarding people from abuse, good governance and staffing. At the inspection of 16 May 2017 we found the provider had made improvements in all of these areas.

Hanwell House is a care home which provides accommodation and personal care for up to 52 older people. Nursing care is not provided. At the time of our inspection 47 people were living at the service. Some people were living with the experience of dementia. The home is run by Homestead Residential Care Limited, a private organisation. Hanwell House is the only location managed by the provider. The registered manager is also a director in the company.

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 and associated Regulations about how the service is run.

People were happy living at the home. They had good relationships with the staff and felt that their needs were met. Relatives were well informed and felt able to visit the home whenever they wanted.

The staff were happy working at the service. They felt supported and told us they had the training and support they needed. They worked well as a team. There was enough information for the staff on how to fulfil their roles and responsibilities. There were enough staff to keep people safe and they were recruited appropriately.

People were safely cared for. The risks to their wellbeing had been assessed and planned for. They received their medicines in a safe way and as prescribed. The environment was suitably maintained. The staff were aware of safeguarding procedures and knew how to respond if they suspected someone was being abused or at risk of abuse.

People's capacity to consent had been assessed and where they lacked capacity the provider had acted within the principles of the Mental Capacity Act 2005. People had enough to eat and drink and their nutritional needs, weight and problems associated with these had been assessed and were being met. People were supported to see healthcare professionals when they needed.

Care plans were clear, up to date and reflected people's individual needs. People took part in a range of different social activities, although some people would benefit from more engagement and being supported to access different leisure and social activities.

People knew how to make a complaint and the registered manager was available for people to speak with. People knew the registered manager well and felt comfortable approaching them. The staff notified the Care Quality Commission of significant events. The provider had systems for auditing the service and improving quality. The provider listened to the feedback from others and responded to this.

Inspection carried out on 7 June 2016

During a routine inspection

The inspection took place on 7 June 2016 and was unannounced.

The last inspection took place on 28 and 29 September 2015. At this inspection we found the provider was not meeting all the required Regulations. In particular we found that people were not always safe, care was not person centred, people had not consented to their care and treatment, people were not always treated with dignity and respect, staff were not always recruited in a suitable way and did not have the support and training they needed and the service was not always well led. The provider had supplied us with an action plan telling us they would make the necessary improvements. At the inspection of 7 June 2016 we found improvements had been made but further improvements were needed in some areas.

Hanwell House is a care home which provides accommodation and personal care for up to 52 older people. Nursing care is not provided. At the time of our inspection 43 people were living at the service. Some people were living with the experience of dementia. The home is run by Homestead Residential Care Limited, a private organisation. Hanwell House is the only location managed by the provider. The registered manager is also a director in the company.

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 and associated Regulations about how the service is run.

Most risks to people's safety had been assessed and the provider had taken action to minimise the risks of harm. However, some staff practices placed people at risk because they did not follow good practice guidance and did not always ensure people were being cared for in a safe way.

There were enough staff to care for people but they were not always deployed in a way which met people's needs.

The provider had ensured that restrictions on people's liberty were lawfully obtained with the exception of one restriction which people had not consented to and had not necessarily been made in their best interests.

Some of the staff were kind and caring and people reported that they felt well looked after. However, we observed some interactions which did not always respect people's dignity or privacy.

The provider had made improvements with regards to activity provision, but some people's social, leisure and emotional needs were not being met.

Not all records were accurately maintained or complete.

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

People told us they were happy, well cared for and liked living at the home. They felt safe and told us that their needs were met.

The staff told us they felt well supported and trained. They said they had the information they needed to care for people.

The manager had an in-depth knowledge of people's individual needs and the needs of the service. He was popular and people trusted him and felt that he made improvements where needed.

There was evidence that the provider had responded to the requirements we made at the last inspection and had made improvements in all areas.

Inspection carried out on 28 and 29 September 2015

During a routine inspection

The inspection took place on 28 and 29 September 2015 and was unannounced. At the last inspection on 14 August 2014 we found the service was not meeting the regulation relating to staff supervision and appraisal. At this inspection we found that some improvements had been made in the required area, however the provider was still not meeting the legal requirement fully. We also found areas where new breaches were identified.

Hanwell House is a care home which provides accommodation and personal care for up to fifty two people. Nursing care is not provided. The service specialises in the care and support of older people, some of whom are living with the experience of dementia. At the time of our visit there were 44 people using the service. The home is run by Homestead Residential Care Limited. The registered manager is also a director in the company.

There was a registered manager in post. 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 and their relatives told us they felt the service was safe. However we found that the service was not safe. Fire safety arrangements were not being followed and this placed people at risk in the event of a fire.

People were at risk of receiving unsafe or inappropriate care because staff did not understand what constituted abuse and the reporting procedures to follow in the event of a safeguarding alert.

Risks to people were not fully assessed and management plans were not always in place to minimise these risks. This placed them at risk of harm. There was no effective system in place to ensure information about accidents and incidents could be analysed so appropriate action could be taken to prevent them from happening again and to monitor for any trends or patterns.

Staff were not always recruited safely to make sure they were suitable to work with people who needed care and support.

Staff had not received the appropriate training, support and appraisal in order to carry out their roles effectively and to an appropriate standard, this meant that people were at risk of receiving unsafe or inappropriate care.

The service was not fully meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The majority of people at the service had their liberties unlawfully restricted. The provider’s systems of ensuring that the service enabled people to consent to care and treatment in line with legislation and guidance had not been effectively implemented.

People and relatives said the staff were caring. However, we found that people were not always supported by caring staff. Some staff did not speak with people when they were supporting them. For example, we saw some people being supported with their meals in a way which was not dignified or respectful. We saw other staff that were kind, caring and treated people with dignity and respect.

Care plans were not always in place regarding all the care needs people had and they were not person centred. There was no evidence as to how people, or their families or representatives, had been involved in the development and review of the care plan. People had limited opportunities to participate in meaningful activities or hobbies that were important to them

People were not protected against the risks of poor care and treatment because the provider did not operate an effective system to assess, monitor and improve the quality and safety of the service. The systems in place had not identified the shortfalls we found.

People lived in a dementia friendly care home environment which promoted their wellbeing and independence. Furniture, color schemes and lighting had been chosen in line with best practice guidance.

People received their medicine safely and by staff that had been trained.

People were supported to maintain good health and had access to health care services when they needed it.

People enjoyed the food and were provided with a variety of food to choose from. Staff monitored people’s weight and referred them on for specialist support, when they were concerned about their risk of malnutrition.

People, relatives and staff spoke positively about the registered manager. They said the registered manager was supportive, caring, and visible around the home and always made themselves available to discuss any issues or concerns people had.

We found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 15 August 2014

During a routine inspection

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, response and well-led?

Is the service safe?

People told us they felt staff kept them safe and this was confirmed by relatives.

Staff received some training and informal supervision which helped them understand how to meet the needs of people and keep them safe. Risk assessments had been carried out and plans put in place to reduce the risks to people of physical or emotional harm.

We saw records which showed all staff had attended training in safeguarding adults and the Mental Capacity Act (2005). Most care workers and managers we spoke with demonstrated a good knowledge of the principles of safeguarding and gave us examples of raising concerns and of the provider following these concerns up.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is the service effective?

People all had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Staff were aware of people�s preferences, interests, aspirations and diverse needs and supported people to meet these. The service had systems in place to monitor the care provided and to ensure people were happy with it.

Staff did not receive formal supervision or appraisals and there were no individual plans in place to help them develop. In addition, there were no regular staff meetings to discuss common issues, concerns or suggestions.

Is the service caring?

People we spoke with said they felt staff treated them with respect and dignity and involved them and their relatives in decisions about their care. We saw staff introducing themselves and interacting with people in a respectful and warm way. Care workers showed patience and gave encouragement when supporting people. People told us "The staff are very kind" and a relative said "I can't praise the staff enough." People told us they felt safe and secure and this was confirmed by friends and relatives. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Information about the service was provided both verbally and in writing and focused on people having choices and on helping them maintain their independence. People told us they had been given opportunities to ask questions and had any concerns listened to and acted on. Most people and relatives knew how to make a complaint if they were unhappy. They told us the service took complaints seriously and looked into them quickly.

The service worked well with other agencies and services to make sure people received the right care. People told us they were involved in reviewing their plans of care when their needs changed.

Is the service well-led?

The service had quality assurance systems, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff showed us they were clear about their roles and responsibilities. They had an understanding of the ethos of the service and the quality assurance processes which were in place. This helped to ensure people received a good quality service at all times.

The provider ensured that feedback from people themselves, relatives, staff and other professionals was received and this influenced the development of the service and improved care for people.

Inspection carried out on 22 August 2013

During a routine inspection

We spoke with two people who use the service and four relatives. People we spoke with confirmed their needs were being met at Hanwell House. Relatives we spoke with praised the manager and the staff for communicating well with them and the professional manner in which staff worked with people. Relatives commented "they always keep us informed and will phone if something has changed,� and "it�s a special place, people are treated as individuals". People who use the service had had their needs assessed and a care plan had been developed to reflect their care needs, routines and preferences.

There were systems in place to ensure medicines were prescribed and given to people safely. Prospective staff underwent employment checks as part of the recruitment procedure to make sure they were safe to work with people who use the service. Relatives commented that staff were skilled in their work and staff said they had the appropriate training to carry out their role as a carer. However, we did not see evidence of a supervision and appraisal system for staff.

Inspection carried out on 27 November 2012

During a routine inspection

During our visit we spoke with two people who use the service, two relatives and five staff. One person said �I like it here� and another told us they enjoyed the food. The relatives we spoke to said they were happy with the home and the care that people received. They said that whenever they turned up they were always greeted by staff and offered a drink. They told us the staff understood the needs of their relative and they keep them informed of any changes to their health or care needs. The staff we spoke with said they felt there were enough staff to meet people�s needs and that everyone worked well as a team.

The service used only fresh foods for the preparation of meals, and took into account people�s individual taste preferences and needs in relation to the foods provided.

The environment of the home was maintained, maintenance and redecoration was ongoing to ensure the home was safe and pleasant for the people who use the service.

Inspection carried out on 22 December 2010

During a routine inspection

People who use the service told us how satisfied they were with the accommodation offered, the food supplied, the staff employed and the care provided. Relatives of people who use the service told us they were very happy with how their loved one was being looked after, and told us the home compared very favourably with other homes they knew

We observed users of the service receiving good quality food and drink, and being stimulated by the playing of games, but being given the choice to opt out if they wished. People told us that they were well looked after. They praised the staff, the good food, the physical standards of the home including cleanliness, and the extent of stimulation offered. They said they were 'well looked after by lovely people'. They confirmed that there were always enough staff on duty and 'they can't do enough to help you.'

They said they felt safe living in the home. They like their bedrooms and the way they are furnished and decorated and that they are able to add personal touches to their rooms. They told us that there was never any problems with cleanliness in the home

People using the service told us that they could see their doctor whenever he needed to and this was arranged by the home.

It was a very cold day when we visited but several people who use the service told us the home was warm enough.

We observed users of the service being treated with dignity and respect, and having their privacy, independence and human rights promoted.

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