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Hethersett Hall Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 8 August 2019

About the service: Hethersett Hall provides accommodation and support to a maximum of 70 older people, some living with dementia. It does not provide nursing care.

People’s experience of using this service:

Medicines were stored safely, but records for ‘as required’ (PRN) medicines were not always in place to show they were given appropriately. We have made a recommendation about this.

People’s care records were not always accurate, up to date and detailed with sufficient guidance for staff. This included records around people’s daily care, mental capacity and end of life. We have made a recommendation about following the Mental Capacity Act (MCA).

Not all risks to people’s health were fully covered in their care plans, however risks to people’s environment were mitigated.

Care plans were not always detailed with individual preferences and sufficient guidance for staff.

There were some effective quality assurance systems in place, but not all areas for improvement had been identified.

People had a range of activities which they engaged in and enjoyed, and they had positive relationships with staff.

Staff adapted their communication to interact with people in a way they understood.

Staff worked well as a team and were supported with training and supervision by a good leadership team.

People had access to healthcare and were supported to follow a healthy balanced diet and enough to drink.

Rating at last inspection: Good in all areas with outstanding in well-led (Published February 2017)

Why we inspected: We inspected this service in line with our schedule for services rated Good.

Follow up: We will continue to monitor the service according to our schedule for returning to locations rated Requires improvement.

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

Inspection areas

Safe

Requires improvement

Updated 8 August 2019

The service was not always safe

Details are in our Safe findings below.

Effective

Requires improvement

Updated 8 August 2019

The service was not always effective

Details are in our Effective findings below.

Caring

Good

Updated 8 August 2019

The service was caring

Details are in our Caring findings below.

Responsive

Requires improvement

Updated 8 August 2019

The service was not always responsive

Details are in our Responsive findings below.

Well-led

Requires improvement

Updated 8 August 2019

The service was not always well-led

Details are in our Well-Led findings below.