Archived: Batley Hall Nursing and Residential Home

Batley Hall Nursing and Residential Home is registered to provide nursing and residential care for up to 51 older people, some of whom live with dementia. On the day of our inspection, 31 people were living in the home.

At the time of our inspection the home was being managed by a peripatetic manager who had been at the home for three weeks. We refer to them in this report as the ‘home manager’. A new home manager had been appointed and was set to start in September 2019.

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

We found poor examples of team working. Our conversations with staff and care records we looked at showed staff were not always supporting each other to provide a good service. Staff supervisions had been infrequent and a process to commence appraisals had recently started.

We saw minimal recording in response to complaints and concerns. Records did not show how complaints had been investigated and there were no written responses.

We saw incidents where staff did not have the skills to positively respond to behaviour which may challenge others. The registered provider had not given staff training in end of life care. The home manager told us they were addressing both these areas.

Staffing levels were reduced on an afternoon and we observed some people demonstrating behaviour which may challenge others when no staff were present. High levels of agency usage were deployed at the time of inspection. Safe recruitment procedures were being followed.

Improvements had been made to the safe management of medicines at this inspection. Systems to receive, store, administer and dispose of medicines were safe.

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.

People and relatives were happy with the service they received and consistently said the care and support they received from staff was good. Staff knew how to respect people’s privacy and dignity.

Electronic care records were used to show people’s needs, preferences and wishes. There was sufficient, person-centred information for staff to follow, although key information was not always easy to find.

Risks to people were assessed and handovers identified people most at risk and the associated reasons. Systems relating to fire management were up-to-date.

People told us they enjoyed the food and their dietary needs were being met. We observed people had a positive mealtime experience. Care records showed people received access to healthcare when this was required.

We have made a recommendation for the registered provider to review staffing levels and deployment of staff during the afternoon and evening periods.

Rating at last inspection and update

The last rating for this service was requires improvement (published 4 July 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made as the provider was still in breach of one regulation. The regulations were now being met in two areas where breaches were previously found. However, two new breaches of regulation were found at this inspection. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to good governance as management oversight was not evident over key aspects of the service. This demonstrated that systems to assess, monitor and improve the service were not sufficiently robust

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Batley Hall is registered to provide nursing and personal care for up to 51 older people, some of whom live with dementia. On day one of our inspection there were 37 people living at the home and on day two this number was 36. The home has three floors accessed by passenger lifts. Each floor has communal bathrooms and toilets, and there are shared lounge and dining areas on the ground floor. Outside there is a garden with seating areas.

Batley Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home did not have a registered manager. 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.

The home had a manager who formally left Batley Hall at the beginning of the same week we carried out our inspection. The senior operations manager had assumed day-to-day control of the service in their place.

People told us they felt safe living at Batley Hall and their relatives also felt assured their family member was safe. Staff had received safeguarding training and knew how to identify and report suspected abuse. We saw some complaints contained allegations of people’s care needs being neglected. These allegations had not been reported to the Care Quality Commission. We dealt with this outside the inspection process.

Care plans lacked evidence of personal history and they were found to be inconsistent in the detail recorded. The senior operations manager was taking steps to improve end of life care through training and better recording. The registered provider was operating within the principles of the Mental Capacity Act (2005) and applications to lawfully deprive people of their liberty (DoLS) had been submitted to the local authority.

Since our last inspection, staff were seen to be significantly more aware of the need to provide care which protected people’s privacy and dignity. The registered provider had ensured this was an area of focus through its training programme as this was a breach at the last inspection.

Training completion levels were seen to be high. Some staff supervision was taking place, although appraisals were not up-to-date. Staff felt they could approach the senior operations manager who was approachable and very supportive.

The registered provider’s monthly quality reports provided effective oversight of service delivery. We found concerns which we had identified during this inspection had already been highlighted and steps were subsequently taken to strengthen the management of the home.

Accidents and incidents remained a concern as there was a lack of evidence to demonstrate action had been taken to lower the risk of future occurrences. However, since our last inspection the registered provider had put in place more assistive technology to reduce the risk of falls.

We saw a number of examples where the senior operations manager had acted to learn lessons. A number of new initiatives had been put in place and we saw these were effective in identifying and meeting the needs of ‘residents at risk’. These new systems need time to become embedded and we will look at this again at our next inspection.

Staffing levels were seen to be sufficient to meet people’s care needs. However, we looked at the call bell response times for two days which showed people experienced waiting times outside the accepted range identified in the registered provider’s own policy. We discussed this with the senior operations manager who told us they would look at this..

People were satisfied with the activities provision which the senior operations manager planned to strengthen following our inspection.

In response to our concerns about the breakfast experience, the senior operations manager took action to make this more personalised and feedback on the second day of our inspection showed this had improved. People were complimentary about the food, although records relating to dietary requirements and food and fluid charts required improvement.

People were supported to receive access to healthcare which we saw demonstrated through care records and from our conversations with people and their relatives.

Recruitment processes were found to be safe. The assessment of risk and management of medicines required improvement. A controlled drug error occurred on the first day of our inspection and some topical creams were evidently not being applied.

Fire safety and the maintenance of the building was appropriately managed. The premises were clean and an infection control lead had just been appointed.

Feedback was actively sought to engage people, relatives and staff in the running of the home. The culture within the service had improved since the last inspection, notably through the involvement of the senior operations manager who was approachable and well-liked by people, relatives and staff.

Batley Hall Nursing and Residential Home is located in a quiet area of Upper Batley. The home provides accommodation, personal and/or nursing care for up to 51 people. Batley Hall is a 19th century building which has been modernised and refurbished. Accommodation is provided over three floors, which can be accessed using passenger lifts.

At the time of our inspection 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.

Information concerning accidents and incidents was recorded and there was evidence to show this had been analysed. However, actions to reduce levels of risk were not always evident.

There were insufficient numbers of staff in place to provide timely responses to people’s needs. Rotas showed that shifts were not always fully covered.

We observed occasions when staff made comments which did not respect people’s dignity, although people and their relatives shared positive feedback with us regarding staff and the care they received.

Adequate records of people’s food and fluid intake as well as repositioning charts were not kept. The registered provider had identified this in February 2017 and in subsequent visits. This had been mentioned to staff during meetings, although this was still a concern at our inspection. The quality director carried out an ad hoc ‘flash’ meeting with staff to address this on the second day of our inspection.

The registered manager had not notified us regarding an incident which the registered provider had found during a quality visit in June 2017.

Mental capacity was not always recorded appropriately in the records we looked at. Staff recognised the importance of giving people choice and gaining consent to provide care. Applications relating to the Deprivation of Liberty Safeguards (DoLS) had been made where needed.

We found examples of contradictory information in some people’s care plans such as in relation to their religion, gender and communication needs. Discussions regarding end of life wishes had not routinely taken place.

Staff provided mixed feedback regarding the support they received from the registered manager and whether they had a visible presence in the home, however; people and relatives spoke positively about the registered manager.

Medicines were mostly well managed as the storage, administration and disposal processes were effective. Staff access to protocols for the use of ‘as required’ medicines and body maps required improvement. People had access to healthcare services when they needed this support.

Most people were complimentary about the food they received, although one person told us food was not always served hot. We observed a positive mealtime experience where people were offered choice. The home had been awarded a 'Healthy Choice Award,' by Kirklees Council for being committed to good standards of food hygiene and healthy food options.

The majority of staff training was found to be up-to-date. Staff supervisions and appraisals were taking place. Staff meetings were taking place on a regular basis, although there was very limited evidence of the staff ‘voice’ in the recording. People and relatives provided positive comments about staff who they felt were capable and responsive to their needs.

Information on how to make a formal complaint was available. Records concerning a complaint received showed this had been appropriately responded to. Meetings for people and their relatives demonstrated they were involved in decisions about the running of the home. ‘Resident’ surveys had been carried out in October 2016 and provided mostly positive feedback.

Building maintenance and fire safety was appropriately managed as relevant checks had been completed.

We looked at the recruitment of three members of staff and found this process was safe as relevant background checks had been carried out. People and their relatives told us they felt safe at this service. Staff we spoke with were able to describe abuse and knew how to report this.

There was a varied programme of activities both within the home and through trips provided. People were satisfied they received sufficient stimulation.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

The home provides accommodation for up to 51 people who require nursing or personal care. Batley Hall is a 19th century building which has been modernised and refurbished. The home has gardens and a patio area for people to use. Accommodation is provided over three floors, which can be accessed using passenger lifts. There were 47 people living at the home at the time of the inspection.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

All of the people we asked told us they felt safe living at Batley Hall Nursing and Residential Home. Relatives we spoke with told us they felt their family members were safe.

Staff and the registered manager had a good understanding of different types of potential abuse and were aware of safeguarding reporting procedures.

Risks to people were assessed and risk reduction measures were in place to help minimise risks to people.

Some important information was missing from some people’s care plans and a personal emergency evacuation plan. The meant some people’s needs were not accurately recorded which placed those people at risk of harm. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff received training and support and regular supervision to in order to perform their duties effectively. Staff and the registered manager felt supported.

Care and support was provided in line with the principles of the Mental Capacity Act 2005, although some staff lacked knowledge in this area.

People received support to meet their nutrition and hydration needs.

Staff interactions with people were caring and people appeared at ease in staff presence. People and relatives told us staff were caring. Staff treated people with dignity and respect. People’s cultural and religious needs were considered.

Care plans were person centred, enabling personalised care to be provided to people. Care needs were regularly reviewed and people were invited to be involved in reviewing their care needs.

The registered manager held regular meetings with staff and people who lived at the home. Feedback was sought and acted upon.

We found the registered manager to be open and receptive to feedback during the inspection. Audits took place but these were not sufficiently robust to identify some areas which needed addressing.

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

When we visited the home on 12 September 2013 we found the provider did not have suitable arrangements in place to ensure people who lived at the home gave consent to their care and treatment. There were also insufficient numbers of suitably qualified, skilled and experienced staff to support people in meeting their needs. We asked the provider to make improvements. We went back on this inspection to check whether improvements had been made.

During this inspection we spoke with nine people who lived at the home, two care assistants, the administrator, the registered manager and the quality assurance manager. We also looked around the home, including communal bathrooms, toilets and peoples' bedrooms. In one person's bedroom we saw there were holes in the wall. The person told us had these had been made by staff using a piece of equipment when providing care for them.

All nine people we spoke with told us they thought staff were very busy and/or the home was short of staff. One person said 'I have to wait a long time for staff to come when I press the buzzer. I'm not sure if the batteries have gone. There is only two staff on and they are busy. It feels like they only come into my room when they are doing something.' We saw that this person was unshaven and smelled of urine. There were also a number of dirty cups in their bedroom. We looked at documentation staff had completed of the visual checks they carried out on the person. We found the documents had the wrong person's name on and had not been completed consistently.

We spoke with two care assistants who both told us they were very busy and found they didn't have time to sit and chat with people. One staff told us 'It's non-stop for the full shift. People are safe but we don't have time to stop and chat with them.'

They also told us a high proportion of the people who lived at the home required either support with eating and/or two staff to assist them with moving and handling. For example, transferring from their room to a communal area or bathroom using a hoist and/or a wheelchair. This meant when staff were meeting these peoples' needs there may be none available in that area of the home to support other people.

When we visited the home on 21 February 2013 we found staff were not receiving regular management supervision to monitor their performance and accurate records relating to care and treatment provided were not being kept. We asked the provider to make improvements.

During this inspection we spoke with ten people who used the service, seven relatives/visitors and the manager.

Comments about the home and care received from people and their visitors included:-

'It's alright 'I like it here'

'Good atmosphere ' they look after you'

'Absolutely fabulous'

'Happy with the care'

'Care is very good'

'It's a good home'

'Good staff but they've not got time to come and chat'

Two visitors said they were happy with relative's care and one told us they had no concerns about the home.

When we looked around the home we saw that items such as hoists, wheelchairs and pieces of furniture were being stored in areas around the home, including corridors and stairwells. We looked in a shower room and saw there was a bed base, a mattress, a dining chair and several walking frames being stored. We were told by the manager there was a problem with storage space at the home.

The staff we spoke with told us it was good company to work for and they felt confident the service provided was good. Staff received appropriate training for their roles and told us they felt well supported. They understood the importance of their role to safeguard people using the service.

Comments from staff included:-

'It's a good team and the managers are supportive'

'Staffing is a bit of an issue, it means there's less time for the 'frills' like doing people's manicures'

'I really enjoy working here; people are well cared-for'

'I would be happy for a family member of mine to be cared for here'

One relative told us: - 'I've visited a lot of care homes and they've got it about right here'