Hadfield House

We found the following examples of good practice.

A robust screening process was in place for all essential visitors to the home. This included completion of a health screening questionnaire, temperature check, evidence of a recent lateral flow test and a vaccination check for visiting professionals.

Prominent and clear infection prevention control (IPC) signs were displayed throughout the home to remind people about the correct infection control procedures.

There was plenty of PPE available and we saw this being correctly used by staff. Staff had completed training in infection control and hand washing.

The home was accessing regular COVID-19 testing for staff and residents. All staff and residents had been fully vaccinated against COVID-19.

Visiting was not always conducted in line with current government guidance.

Hadfield House is a large converted Victorian house, overlooking Alexandra Park and within one mile of Oldham Town Centre. There are two storeys with bedrooms on both ground and first floors. Set back from the road, the home has gardens to the front, and a secure paved 'sensory garden' at the side containing raised beds, garden furniture and lighting which was directly accessible from the dining/lounge area. The service is registered to provide personal care and accommodation for up to 28 people living with dementia and mental health conditions. At the time of our inspection there were 26 people living at the home.

Hadfield House is a ‘care home’. 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.

We last inspected the service on 3 and 4 October 2017, when we rated the home requires improvement overall and identified breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment; premises and equipment; fit and proper persons employed and good governance. Following the inspection, the provider sent us an action plan which stated the breaches would be addressed. At this inspection we found significant improvements in all areas.

At this inspection we found that the provider had improved the environment in order to mitigate risks to the health and safety of service users and was compliant with this regulation. Mobile hoists were no longer being used for people living at the home and therefore were no longer causing an obstruction. All first-floor windows had restrictors fitted during the last inspection, we saw restrictors were still in place. We found that any cupboards that stored hazardous chemicals were kept locked.

Medicines were stored and managed safely. We found there were plans in place to administer ‘when required’ medicines to inform staff when and how to administer medicines that were not required routinely. Creams were stored appropriately.

We recommended that the service review the recording of thickeners used to adapt the consistency of fluids, to ensure that records were more detailed. The registered manager put new documentation in place during the inspection.

Staff employed since the last inspection had been recruited safely and the service had completed all the necessary checks to ensure that staff were suitable to work with vulnerable people.

Audits were taking place to monitor and improve the quality of the service provided. The service had a clear record of actions recorded and reviewed on a regular basis by the registered manager.

At the last inspection we found the provider did not have a formal risk assessment in relation to legionella. However, we found the provider had completed routine sampling to help control the risks of legionella and carried out appropriate water temperature checks and flushes. The provider had carried out an assessment and was taking the necessary steps to reduce the risk of exposure to legionella.

We recommended that the provider review best practice in relation to formally assessing the risks of legionella and carry out a written risk assessment. The provider had started this process before we completed the inspection.

There was 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.

The manager had been registered since October 2010.

The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their responsibilities to report any possible abuse.

The home was clean, tidy and homely in character. During the inspection areas of the home were being refurbished with new flooring. Since the last inspection the dining/lounge area had undergone a significant transformation and we observed this was now a light, airy space that people enjoyed.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities. This helped to protect the health and welfare of staff and people who used the service.

People were given choices in the food they ate and told us it was good. People were encouraged to eat and drink to ensure they were hydrated and well fed.

We observed meaningful interactions between staff and people who used the service. People told us staff were kind and caring.

People's day to day health needs were met by the staff and the service had effective relationships with external healthcare professionals.

Care records showed that people's needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.

We saw from our observations of staff and records that people who used the service were given choices in many aspects of their lives and helped to develop their independence where possible.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and they were regularly reviewed.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of their responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

Hadfield House is a large converted Victorian house, overlooking Alexandra Park and within one mile of Oldham Town Centre. There are two storeys with bedrooms on both ground and first floors. Set back from the road, the home has gardens to the front, and a secure paved ‘sensory garden’ at the side containing raised beds, garden furniture and lighting which was directly accessible from the main lounge. The service is registered to provide personal care and accommodation for up to 28 people living with dementia and mental health conditions. At the time of our inspection there were 27 people living at the home.

We last inspected the service on 3, 4 December 2015 and 9 February 2016, when we rated the home requires improvement overall and identified breaches of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment, premises and equipment and good governance. At this inspection we found the provider was still not meeting the regulations. We found ongoing breaches in relation to premises and equipment, safe care and treatment and good governance. We have also identified a new breach of the regulations in relation to fit and proper persons employed. You can see what action we have told the provider to take at the back of this report. We have also made a recommendation in relation to the provider reviewing good practice guidance on developing dementia friendly environments and made a further recommendation to ensure the registered provider appoints a competent person to undertake a legionella risk assessment.

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.

Medicines were not always stored and managed safely. We found there were no plans or 'when required' (PRN) protocols in place to inform staff when and how they should administer people medicines that were not required routinely. During the tour of the home we found pain relief gel was inappropriately stored in a person’s bedroom. During sampling of medicines we found an antibiotic solution had expired and was incorrectly stored in the medicines cupboard, which meant the person could have taken this expired medication. We passed on this information to the registered manager who said they would investigate this further.

The provider did not have an effective recruitment and selection procedure in place and did not carry out all the relevant checks when they employed staff.

During our tour of the building we noted several potential safety hazards. We found on the first floor 12 bedroom windows did not have the appropriate restrictors in place; to prevent the window opening to be restricted to 100 mm or less, as outlined in Health and Safety Executive guidance. During the inspection the provider ensured window restrictors were fitted in all first floor bedrooms, this meant the risk was addressed. We found the linen store room on the first floor stored hazardous substances, such as cleaning products and hair perm solution and had been left unlocked. We found two hoists were stored in two people’s bedrooms and one person had an old armchair that was directly blocking their toilet. The inappropriate storage presented as a possible trip hazard.

During this inspection, we found other issues affecting the safety of the environment. The provider did not have a risk assessment in relation to legionella. However, we found the provider had completed routine sampling to help control the risks of legionella. Legionella is a type of bacteria that can develop in water systems and cause Legionnaire's disease that can be dangerous, particularly to more vulnerable people such as older adults.

We found the safeguarding procedures were not robust enough at identifying the process the home needed to follow if they suspect abuse. However, staff had access to the local authorities safeguarding policy and knew how to recognise and respond to suspected abuse. We saw the registered manager had reported safeguarding incidents appropriately when we contacted the local authority safeguarding team prior to the inspection.

Overall people and relatives spoken with were positive and complimentary about the service they received at the home. People told us that they felt safe and were well cared for.

During our inspection we saw staff were attentive and responded to people who might need assistance in a timely way. There were sufficient numbers of staff on duty to provide people with the support they needed. We observed positive and caring interactions between staff and people living at the home. People were comfortable in the presence of staff and to request help if they needed it.

Care plans were complete and regularly reviewed. We saw any changes to care plans were reflected in handover documents to help ensure all staff were aware. Information on preferences, social history and interests were recorded.

The home was generally clean and tidy, although we found a malodour in communal areas of the home and in one person’s bedroom. The registered manager confirmed a number of the carpets were due to be replaced in the forthcoming weeks.

Staff had received appropriate training and supervision to support them in their roles. Staff, with the support of the management team, identified their professional needs and development and took action to achieve them.

We received positive feedback from people about the food provided. Kitchen staff were aware of people's dietary requirements, and they told us they devised menus based on what people had previously enjoyed.

We saw that a variety of activities and entertainment had been available to people, in order to provide stimulation and motivation. However, some people felt the home needed to arrange more activities in the community. The registered manager acknowledged this feedback and confirmed this would be discussed further with the people and the activities coordinator.

The provider had submitted applications to the supervisory body to request authority to deprive people of their liberty where they lacked capacity and this was in their best interests. However, we found staff had limited understanding of the Mental Capacity Act 2005 and were not always aware of the people who were being restricted or deprived of their liberty. We have made a recommendation in this area.

A process was in place for managing complaints and the home's complaints procedure was displayed so that people had access to this information. People and relatives told us they would raise any concerns with the manager.

Audits on the home's quality were not accurate which meant systems to improve the quality of provision at the home were not always effective. We found the home in breach of the regulation in relation to good governance as there were not effective systems in place to monitor the quality of the service.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the home where we spoke with the registered manager, observed staff interactions with people using the service and we looked at some records. We also talked, in private with five members of staff, five people who used the service, four visiting health care professionals and three visiting relatives or friends. Everybody we spoke with was positive about the care and support provided.

The full report contains the evidence to support this summary.

Is the service safe?

The people we spoke with during the inspection visits were positive about the care provided by the home. Visitors told us they thought their relatives were safe. Visiting health care professionals told us they had no reasons to be concerned about the safety of people with whom they had contact. People who used the service told us they felt safe at the home.

Staff who we spoke with told us they believed people using the service were protected from abuse or exploitation. Staff also told us they understood the need to be vigilant and, to whistle blow if necessary. One health care professional described the home as having 'a nurturing environment'.

We undertook a tour of the building. This included communal areas and a small selection of people's bedrooms. No obvious hazards to people's health and safety were seen. Staff were provided with disposable gloves and aprons to help minimise the risk of cross infection.

People were provided with ample food and drink.

Staff members spoke positively about the support they could get from their colleagues and the registered manager. They also told us they were not asked to undertake tasks they were not trained for or did not feel confident to do.

Is the service effective?

Each individual's care needs were assessed and reviewed. A care plan was developed on the basis of the assessment.

Staff were made aware of the up to date needs of each individual. Staff told us that communication within the home was good. They also told us there was good teamwork. One member of staff said 'the staff and manager all work as a team, [there is] a nice atmosphere'.

People who used the service and their relatives where appropriate could contribute to decisions about the best way to meet their needs. People who used the service and visitors who we asked, all told us they were listened to by the staff at the home.

People had good access to health and social care professionals in the community. The health care professionals who we spoke with were all complimentary about the staff's attitude. Their comments included: 'staff engage very well and take on board recommendations wholeheartedly'; 'staff always do what I ask'; 'staff are very helpful' and 'the manager knows each resident and is very directly involved'.

Is the service caring?

Observations of interactions between staff and people using the service indicated a warm and caring atmosphere.

All people who used the service and their relatives spoke positively about the caring attitude and approach of the staff. Comments included: staff were 'wonderful' and staff were 'friendly and they treat me well'. One visitor when asked what the best thing about the home was, said 'I like the staff who are dead friendly and lovely'. One visiting health care professional said they thought the best thing about the home was 'the attitude of the staff from the manager down'.

One staff member told us they thought the best thing about the home was 'all the staff and residents get on really well. It's a nice little happy home'.

Is the service responsive?

We did not look specifically at the service's complaints procedure at this visit. However, people using the service and visitors who we asked during our visits said they believed they would be listened to if they had a complaint. Staff were confident that the registered manager would respond positively to any issues which were raised.

People who used the service and their relatives said that they were comfortable talking to staff and believed that their views were listened to.

There were quality monitoring and quality assurance systems in place. There were monthly residents meetings which were described by a visiting health care professional as 'an open forum'. Issues raised either individually or in the meetings were noted and, if appropriate changes were made to aspects of the service.

Is the service well led?

The registered manager had been in post for several years, as had many of the staff. Information from visiting health care professionals was that staff were committed and good at taking on board any recommendations. One also commented that 'the manager knows each resident and is very directly involved'.

The registered manager provided strong leadership and provided staff with a clear sense of what good practice was. Staff told us that the registered manager was approachable and supportive, but would not tolerate poor practice.

People were treated with respect and had their dignity maintained.

Peoples' care needs were recorded and reviewed on a regular basis. People were involved in discussions about how best to meet their needs, and were confident their views were listened to. Comments from people using the service included "if we questioned [the way in which our care needs were met] they [staff] would respond and in the right way".

Medication appeared to be safely stored and appropriately administered. People told us they were confident they got the right medication at the right time.

Staffing levels appeared appropriate to meet the needs of the people living at Hadfield House. People using the service told us they did not have to wait unnecessarily for any support they needed.

There were effective systems in place to monitor and assess the quality of the service provided. These included ascertaining the views of the people living at the home.