We carried out a review of the data available to us about Halwill Manor Nursing Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Halwill Manor Nursing Home, you can give feedback on this service.
We found the following examples of good practice.
Staff were following current infection prevention and control guidance to help people to stay safe. There were suitable risk assessments and an up to date infection control policy and procedure in place. The registered manager ensured staff understood why every measure was in place.
Personal Protective Equipment (PPE) was readily available around the building. We saw there was a good supply of PPE for staff to use. Staff were observed to be wearing PPE appropriately and disposed of it in clinical waste bins. People’s temperatures were taken on a daily basis to help monitor for signs of Covid 19. Whole home testing was undertaken, with frequency of testing people and staff in line with current guidance.
Staff had completed training to ensure they knew how to keep people safe during the Covid-19 pandemic. Staff had also been supported by external health professionals to ensure safe infection prevention and control measures were in place.
Infection prevention and control audits were carried out to ensure the premises was meeting infection control measures. A cleaning schedule for all areas of the home was in place and implemented to ensure the whole home was effectively cleaned on a regular basis.
Staff supported people to occupy themselves whilst maintaining their safety. Staff helped people to stay in touch with their families. Alternative forms of maintaining social contact were used for friends and relatives; for example: keeping in touch using video calls.
Facilities were in place to wash hands or use hand sanitiser on entering and leaving the home. Visitors were limited. There was a booking in system in place to stagger visits and allow time for cleaning. A visitors’ screen had been introduced to allow visitors to visit people safely. This enabled safe visits to go ahead which ensured no contact with other people and minimal contact with staff.
Visitors were supported to wear a face covering when visiting, and wash hands before/after mask use. All visitors were screened for symptoms of acute respiratory infection and other signs of Covid-19 before being entering the home. There was prominent signage and instructions to explain what people should do to ensure safety. Information was easily accessible on arrival or before visits to ensure visitors followed guidance, procedures or protocols to ensure compliance with infection prevention control.
The registered manager communicated with people, staff and family members regularly to make sure everyone had an understanding of precautions being taken, and how to keep people safe.
Halwill Manor Nursing Home is registered to provide nursing and personal care for up to 25 older people. This includes people who are living with dementia. The home has been run by the same providers for 30 years and is an adapted building with facilities over two floors. At the time of the inspection, 22 people were in residence but placements were already arranged for two further people.
People’s experience of using this service and what we found
People received a safe service. Staff received safeguarding training and knew what to do if they suspected people were at risk of harm. Other risks to people’s health and welfare were well managed. Risks were assessed and plans put in place to keep people safe. The numbers of staff on duty for each shift were based upon the collective care and support needs of each person in residence. This ensured the staff team could safely provide care and support to each person. Pre-recruitment checks carried out before new staff worked at the home ensured they were suitable to work with vulnerable people. Medicines were well managed and people received their medicines as prescribed. People were protected by the homes infection control policy and procedures.
People received an effective service which met their care and support needs. Staff training ensured they had the relevant skills to meet people’s care and support needs. Staff were regularly supervised to ensure they worked well. People had access to the healthcare support they needed. This included their GP, district nurses, speech and language therapists (SALT) and other allied healthcare professionals. People were provided with a healthy, balanced diet that met their own individual preferences.
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 service was meeting the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.
People received a service that was caring and centred around their own specific needs. People were relaxed and comfortable in their home. Health care professionals and one relative gave us positive feedback about the way people were looked after. The staff team had a good understanding of each person’s individuals' needs. People were treated in a warm and respectful manner at all times.
The service was responsive to people’s health and social care needs. Their care plans were regularly reviewed and adjusted to take account of any changes in their care and support needs and health status. The nursing staff ensured referrals were made to appropriate health and social care professionals as needed. The service continued to look after people who developed end of life and palliative care needs. The nurses were able to look after people who became very ill and endeavoured to prevent hospital admissions. The service would work in partnership with family and healthcare professionals to achieve this.
People were able to participate in a range of meaningful activities that were based upon their activity profile. The staff took time to find out about people’s life history, their occupation and interests and hobbies. People and their families were encouraged to make their views known about all aspects of the service and were listened to, the service making changes where appropriate.
The service continued to be well led. The registered manager, nurses and team leaders provided good leadership for the staff team. There was a clear focus on continually seeking to improve the service people received. Links had been forged with other services for example the Alzheimer’s Society and the National Activity Providers Association to ensure they remained up to date with best practice.
The service had good quality assurance systems in place with regular audits being undertaken. These identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published May 2017).
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.
At the last inspection April 2015, we gave the service an overall rating of ‘Good’. However we rated the ‘safe’ domain as requires improvement because we found a breach of regulations. This was because the provider had not ensured medicines were safely managed at the service. At this inspection we checked that they had followed their action plan and to confirm that they now met legal requirements. We found improvements had been made and medicines were being safely managed. At this inspection we found the service remained good.
Why the service is rated good.
Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed. Improvements were being made regarding the monitoring that topical creams had been administered as prescribed.
People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had received training and developed skills and knowledge to meet people’s needs. Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate.
Individual risks to people’s safety had been assessed and care plans written to show how these were being addressed. The home had a contingency plan and had also developed individual personal evacuation plans to support each person.
There were adequate staffing levels to meet people’s needs. People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes. People where possible and appropriate family members were involved in developing and reviewing their care plans.
People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.
Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were supported to eat and drink enough and maintain a balanced diet. People were positive about the food at the service.
The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. There had been no complaints received at the service since our last inspection. Where there were niggles or concerns action was taken to resolve them.
The premises and equipment were managed to keep people safe.
Further information is in the detailed findings below.
The inspection visits took place on 14 and 17 April 2015 and were unannounced. The home was last inspected on 14 October 2013 and was meeting all the required standards we checked at that time.
Halwill Manor Nursing Home provides personal and nursing care to a maximum of 25 people. Most live with the condition of dementia. There were 25 people using the service at the time of the inspection.
The home has 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.
Medicine management was not robust. Although medicine management had been reviewed a discrepancy was found in the number of tablets recorded to what was actually in stock. Staff were also putting medicines into pots and carrying them on a tray and so increasing the potential for mistakes. Some medicines had been recorded into the home, not needed, but were still in stock over three months later. Changes to people’s medicine records had not been dated or signed which increased the risk of medicine errors.
Staff numbers and deployment met people’s needs in a safe way and were under regular review, taking into account people’s needs and staff opinion.
People were protected by the arrangement for prevention of abuse. This included staff training, robust recruitment and an openness to notify external agencies of any concern.
The home environment and equipment was well maintained and kept in a safe state. Improvements to the environment were planned and in progress.
There was a strong emphasis on staff training. Staff were encouraged and supported to undertake qualifications in care and they benefitted from a broad range of training opportunities. Staff received supervision and support to succeed in their role.
The provider had acted in accordance the Mental Capacity Act (2005) and Deprivation of Liberty safeguards to promote decision making and protect people's rights.
CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). People at the home were not being deprived of their liberty unlawfully.
People received a diet which promoted their health and welfare. Dietary concerns were identified and action taken as necessary. There was on-going nutritional assessment and management.
One staff member said, “People are loved here not just cared for.” People, their families and health care professionals reported staff to be kind, friendly and caring. Staff understood how to engage with people as individuals and in a person centred way. People’s dignity and privacy were promoted.
End of life care was provided in accordance with people’s wishes and with regard to their dignity and comfort.
People’s needs were assessed and their care was planned with them or with people who knew them best on their behalf. People’s hygiene and personal care needs were well met and their health was promoted. Staff could describe people’s needs and how to meet them, in detail.
People said they had no reason to complain but felt any complaint would be dealt with effectively.
The service was well led by a registered manager and provider working together to manage any risks and looking at how to continually improving the service.
We found one breach of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.
For this inspection we did not need to visit the home as there had been only positive comments from people using the service and a health care professional during our inspection of 10 June 2013. We therefore asked the provider to provide us with documentation as evidence that the home's training arrangements were sufficiently robust to ensure that no staff missed essential training.
We received a copy of the home's training matrix which clearly identified which training had been completed, which was still required and which was underway. We saw that essential training needs were now being met at the home. This meant that people could have confident that their care and treatment needs were being met by trained and competent staff.
We saw the standards of care ensured people's dignity and that health care needs were met. People had equipment available to ensure their safety and comfort and this was well maintained. Staff had good strategies where people had challenging behaviour. Care was planned and reviewed.
Recruitment procedure would ensure people's safety but was not followed through in each case. People thought the staff were very good but one said "some of the young staff don't think." We found that staff were formally supervised and new staff received a comprehensive induction but update training did not always happen and some training was very out of date.
People had been given the opportunity to voice their opinion about the home. Actions had been taken based on the comments. Another review was due. A comment in the 2012 feedback survey said, "We will never forget the love and care she was given."
We saw that the provider had taken steps to ensure the environment was much safer for people. Hazards had been identified and made safe, examples being fire safety, trip hazards and hot water. One person told us that the home was comfortable and warm enough, adding, "If people are cold staff give them a blanket".
We saw that people's property was now handled in a respectful way as individual wardrobes had been provided. There had been a lot of investment in the building and furnishings, providing a more pleasant and safe environment. These included a new fire safety system, carpeting, handrails and toilet seat raise.
We met and observed six people sitting in a lounge. Staff offered them choice; they were friendly and respectful and care was provided appropriately. Staff were discreet when they assisted a person to the toilet and gave reassurance when moving a person with a hoist. A GP with knowledge of the home had said that he was always impressed by the compassion that the care staff showed.
We saw that the management (unregistered manager, provider and provider administrator) roles were now better defined and from this better systems of working were in use. These included auditing of the environment, accidents and the handling of medicines. These checks had led to positive changes, including new equipment and the prioritising of work.
Following that inspection we were provided with a satisfactory report on how the home intended to improve outcomes for people. At that time we also received information that a person was being restrained in their chair. That concern was investigated by the local authority safeguarding team, and followed up at the time, but we reviewed the situation during this visit. We found that the person was now safe and their legal rights upheld.
During this visit we were assisted by an expert by experience. This is a person who, through their own experiences, work with us to find out what it is like for people using the service. The expert's findings are included within this report. During the visit the expert spoke with seven people and two visitors. Most of the people were living with some form of dementia and conversation was limited. Three people were constantly on the move throughout the ground floor and did not communicate verbally.
We looked closely at the care of one person, meeting them, visiting their room and looking at records of their care. We also toured the building with the manager to see if previous safety concerns had been dealt with.
We looked in detail, with the manager, at the action plan which had been supplied following the last inspection. We also asked the provider how they monitored the quality of the service they provided, especially regarding health and safety.
Without exception people and their families told us that they were happy with the service being received and they liked the staff and had confidence in them. Comments included 'I get on very well with all the staff'. We found that people were being addressed in a more respectful way and their preferred name had been recorded so that staff were fully aware.
We found that people were being treated in a more individual way, for example, a book recording every person's bowel actions had been discontinued and those records were now kept in their individual file. The 'bath list' was still in use but no longer on display. However, some people sharing a wardrobe still had their clothes piled high together showing no respect for their valuables or individuality. Some had signed consent to sharing a room and wardrobe but some had not and one person was having their movements monitored without this being part of their plan of care or having agreed to it.
We found that people were better safeguarded against abuse and the risk of abuse because the manager was fully aware how to respond to any concerns. However, people did not know who the manager was and so might not take those concerns to them. We found that three people were involved in the quality monitoring and management of the home; roles and responsibilities were confused and conflicting and this affected the service provided in that things did not always get done.
We found that the home had achieved their action plan in some areas, but not in others. The date that had been provided for completion of the improvement plan was 15 March 2012 and we had not been informed that this deadline could not be met.
We saw that some people liked to walk around the home and we found several hazards, which might cause an injury. These included fire doors held open with a wedge or furniture, poorly taped floor carpet posing a trip hazard, hanging wiring, steep stairs with no hand rails and a hot water outlet where the water could scald and the thermometer in use was defective. We contacted the Health and Safety Executive and Devon and Somerset Fire and Rescue with our concerns.
People's family said they were very happy with the service provided. One said: "I would come here myself". Another said: "He gets all the care he needs and the nurses are very friendly". We found that the standards of personal and health care promoted people's health and welfare, family were kept well informed on people's behalf and involved in some care decisions.
Some of the guidelines relating to the safe handling of medicines were not being followed and this could impact on people's well being.
There was some friendly and sensitive interaction between care workers and people using the service and one person was seen to smile when the manager engaged with them. However, people's dignity, privacy and independence was not properly promoted. Care workers were heard to say: "Hello darling, it's lunch time" and "Good girl". We saw examples of people being treated as a group rather than individuals. This included the use of a 'bath list' openly displayed in a corridor where any person passing would see it ' lacking confidentiality. We saw examples of conditions which had not been agreed upon, including the shared use of a wardrobe. We found examples of some dirty equipment and equipment storage impinging on people's living space.
People were being safeguarded from abuse in that staff know how to respond should they see incidents which concerned them. However, it was not realised that should a person using the service assault another person the appropriate agency (local authority safeguarding team or the police) must be informed, as would be the case for any other person.
People had their needs met by a sufficient number of staff, including domestic and office support.
People were given the opportunity to comment on the service and where changes were requested action plans had been produced and changes were being progressed. There had been much investment in the building. However, much remains to be done to ensure a safe, pleasant and suitable environment for people with dementia.