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Archived: Honresfeld - Care Home with Nursing Physical Disabilities Requires improvement

Reports


Inspection carried out on 01 September 2015

During a routine inspection

Honresfeld is a large period building that has been extended to provide 28 single bedrooms for people with physical disabilities who are over the age of 18 years. The home provides 24 hour nursing care and has a wide range of equipment and facilities to assist people with their care needs. This was an unannounced inspection which took place on 1 September 2015. On the day of the inspection 23 people were accommodated at the home.

We last inspected this service on the 25 February 2015 and found the service did not meet the regulations for medicines management, Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 or for staffing levels, Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We issued compliance actions that required the provider to make the necessary improvements in relation to the management of medicines and staffing. Following this inspection the service sent us an action plan to tell us how they were going to meet the regulations.

The home had 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. However, on the day of our inspection the registered manager was absent from duty and the deputy manager was on annual leave. The nurse in charge and other administrative staff helped us conduct the inspection.

We found one breach 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 this report.

People who used the service told us that Honresfeld was a safe place to live and they were well looked after.

Staffing levels had improved and were sufficient to meet the needs of people using the service.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We found that recruitment procedures were thorough so that people were protected from the employment of unsuitable staff.

The home was clean and appropriate procedures were in place for the prevention and control of infection.

Members of staff had a good understanding of the needs and preferences of people who used the service.

People were registered with a GP and had access to a full range of other health and social care professionals.

Several members of staff had been trained in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) so they knew when an application should be made and how to submit one.

All the people we asked told us the meals were good and they were offered a choice of menu at mealtimes.

People who used the service told us they liked living at the home and received the care and support they needed.

People were supported by staff to make decisions about their care and daily routine.

Leisure activities were routinely organised within the home and in the local community.

Structured Induction training was in place for new members of staff. Training for all staff was ongoing in order to ensure they were kept up to date with current practice.

An effective system for staff supervision so that staff could formally discuss work related issued and training was not in place.

Visitors were welcomed into the home at any time.

Leisure activities were routinely organised within the home and in the local community.

A copy of the complaints procedure was displayed in the home and included in the service user guide supplied to each person on admission to the home.

People who used the service and their representatives were given the opportunity to express their views about the service by completing a questionnaire and attending regular meetings.

In the absence of the registered manager members of staff were supported by the deputy manager, the registered manager from another Leonard Cheshire home and more senior managers from within the company.

The arrangements in place for monitoring and assessing the quality of the service provided had not identified and addressed the shortfalls we found with the management of medicines, care planning and staff supervision.

Inspection carried out on 24th February 2014

During a routine inspection

This was an unannounced inspection which took place on 24 and 25 February 2015.

We previously inspected this service on 24 July 2014 and found that one of the five regulations we assessed was not being met. We made a compliance action that required the provider to make the necessary improvements in relation to assessing and monitoring the quality of service provision.

Following the inspection of 24 July 2014 the provider sent us an action plan telling about the action they were going to take in order to ensure compliance with the regulations.

Honresfeld is situated in Littleborough and is registered to provide personal and nursing care and accommodation for up to 28 adults over the age of 18 years with physical disabilities. There are 28 single occupancy bedrooms. This was an unannounced inspection which took place on 24 and 25 February 2015. There were 24 people living in the service at the time of our inspection.

The home had 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.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Although people who used the service told us they felt safe they expressed concerns about staffing levels and the frequent use of agency nurses.

Current staffing levels were inadequate which meant that people’s care and support needs were not being met safely.

We saw that the systems in place for the management of medicines did not properly protect people who used the service.

We found that recruitment procedures were thorough so that people were protected from the employment of unsuitable staff.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

Members of staff received regular training in order to ensure they had the skills and knowledge to provide effective care for people who used the service. However, the registered nurses expressed concern about the lack of training available for them in procedures relating to catheter care.

Although people who used the service had differing views about the meals provided we were told that alternatives to the menu were always available.

People were registered with a GP and had access to a full range of other health and social care professionals.

People who used the service told us they liked living at the home. We saw that members of staff were respectful and spoke to people who used the service in a courteous and friendly manner.

We saw that care plans included information about people’s personal preferences. These plans were reviewed regularly and updated when necessary to reflect people’s changing needs.

Leisure activities were routinely organised within the home and in the local community. A computer with internet access was also available for people to use at any time.

People who used the service and their representatives were encouraged to express their views about the service by completing an annual survey. Regular meetings were also held for people to discuss leisure activities and trips out.

We saw that systems were in place for the registered manager to monitor the quality and safety of the care provided.

Members of staff had some concerns about how the home was being managed. We have alerted the company’s operations manager to these issues to enable further investigation.

Inspection carried out on 24 July 2014

During a routine inspection

During our inspection visit we spoke with two people who used the service, one visitor, a volunteer helper, four members of staff and the manager. We also looked at records to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

We saw that people were treated with dignity and respect. Two people told us the home was a safe place to live. One person said they would tell the manager or a member of staff if they were unhappy about anything. One visitor told us people were safe at the home and said, “There’s always staff at hand.”

Safeguarding procedures are robust and members of staff understood their role in safeguarding the people they supported. Relevant staff had received training about the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards to understand when an application should be made, and how to submit one.

We saw that equipment used at the home was serviced regularly to ensure that it was safe and fit for purpose.

Is the service effective?

People’s health and care needs were assessed with them or their relatives and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. Care plans were reviewed regularly and amended to reflect people’s changing needs.

We found that people’s care records included an assessment of their nutritional status so that appropriate action was taken if any problems were identified. All the people we asked told us that the meals were good.

Discussion with care workers and examination of records confirmed that a rolling programme of training was in place so that all members of staff were kept up to date with current practice.

Is the service caring?

We saw that members of staff were attentive to people’s needs and offered appropriate encouragement and assistance when necessary.

People who used the service told us they liked living at the home and received the care and support they needed. One person said, “The staff are lovely, they’re the best carers I’ve ever been with.” Another person said, “I’m really happy here the care is brilliant.” A volunteer helper said, “There’s a happy atmosphere and no smells.”

People’s personal preferences, interests and diverse needs had been recorded in their individual care plans.

People who used the service and their representatives were given the opportunity to complete satisfaction questionnaires annually in June. The manager evaluated these surveys in order to identify any areas for improvement.

Is the service responsive?

Leisure activities were organised both inside and outside the home. These included quizzes, reminiscence, arts and crafts, bingo, pamper sessions, films and exercises. People were supported by members of staff to go out for meals and visit other local attractions. One person said, “There’s plenty to do.”

Regular meetings were held for people who used the service. At these meetings people were encouraged to express their views about the care and facilities at the home including leisure activities and meals.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Members of staff had a good understanding of their roles and responsibilities and the ethos of the home. This helped to ensure that people received a good quality of service.

The quality assurance system required further development in order to ensure that all aspects of the care provided at the home were properly monitored. This included infection control and care planning.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to assessing and monitoring the quality of service provision.

Inspection carried out on 19 December 2013

During a routine inspection

In this report the name of a registered manager appears who was not present 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 visitor and two people who were using the services. Everyone told us they liked the environment and felt it was clean and well maintained. One visitor said “It has recently been painted making it brighter and more welcoming. I love the individuality; it’s not like an institution”.

The people we spoke with confirmed they had interaction with healthcare professionals. One person told us “The staff always take me to hospital”.

One person said “the staff are caring, professional and nice. I am happy with the care”.

Inspection carried out on 30 November 2012

During a routine inspection

We spoke with two people who were living at the home. They told us the staff were good and treated them well. Both people confirmed staff asked them for verbal consent. One person said “I am involved with the care plans and staff discuss these with me.” Another person told us “I am involved in the individual service plans and the staff talk me through these.

Both people were positive about the environment and living with the other people. Neither person had any issues related to the medication process and confirmed they got their medications as required. There were positive comments about the staff and the service that was being provided.

One person said “The staff are nice, helpful and supportive.”

Neither person had any complaints. One person told us “If I ever need to raise anything, I speak with the staff who deal with it immediately.”

In this report the name of a Registered Manager appears who was not present 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.

Inspection carried out on 5 March 2012

During a routine inspection

We visited Honresfeld - Care Home with Nursing Physical Disabilities on the 5 March 2012. At the time of our visit, there were 25 people living there. We spoke with a number of people who offered mixed comments about their experiences of living at the home. We heard the following comments about the staff:

“They help you properly”;

“Staff are lovely, they are great”;

“As a rule staff are extremely good and respect my privacy and dignity”;

“Staff are all right. I don’t get on with some. It’s just their attitude”;

“Staff are okay, respectful but occasionally some staff are not as helpful as they could be”.

A visitor to the home said they thought the home was very good and that “Most staff go that extra mile” for people living in the home.

All the people we spoke with told us that they frequently had to wait between 15 and 30 minutes for personal assistance when they used the nurse call system. People told us, that the home needed more staff and they thought the home was often short staffed. We heard that people had to wait for assistance both during the day and at night. We also heard that opportunities to get out into the community were reduced or cancelled due to staffing issues.

People told us that the food was okay and that there were choices at the meal times. One person told us that the quality of food provided was dependent on which cook was on duty.

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