Archived: Haslington Residential Home

Haslington 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.

Haslington is a two storey large Victorian house. Haslington can accommodate up to 46 people who require nursing or personal care and who are living with dementia. People's bedrooms are provided over three floors, with a passenger lift in-between. The three floors are for people with different dependency levels. The top floor is considered medium dependency, the middle floor is considered high dependency and the ground floor is considered low dependency. There are 31 people at the home at the time of the inspection. Both men and women live in the home. Some people are not able to verbally communicate their feedback and experiences of living in the home.

At our previous inspection on 24 and 25 January 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to ensuring that effective systems were in place to monitor the quality of the service and meeting people's needs and preferences to provide consistent care. Quality audit systems were not completely robust in identifying all shortfalls within the service and ensuring that any shortfalls identified were fully rectified. Activities were being provided but people and relatives told us that this was an area that still required improvement. Available activities were not being consistently communicated to people.

We asked the registered provider to take action to meet the regulations. We received an action plan on 3 April 2017, which stated that the registered provider would take action to become compliant with the regulations by the 10 July 2017. Improvements had been made in relation to meeting Regulation 12. However, further improvements were still required in relation to Regulation 17.

At this inspection, we found the service ‘Inadequate’ and the service is therefore in ‘special measures.’

At the time of this inspection, the service was being managed by the registered provider. The registered manager had been off sick since 12 January 2018. The registered provider failed to notify CQC of the absence of the registered manager within the required timescale of 28 days. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the home. 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 home is run.

People's needs had been assessed. However, care plans did not have appropriate risk assessments that were specific to people's needs that would give staff appropriate guidance. Specific guidance documents about how to manage epileptic seizures, challenging behaviour and skin integrity were not provided for staff. Care plans were not detailed and did not meet people’s needs in a person centred way. The registered provider had not responded to changes in people’s needs quickly or appropriately.

People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

There were no effective quality audit systems in place to enable the registered provider to assess, monitor and improve the quality and safety of the service.

There were limited activities located around the service for people to be engaged with. Not everyone was engaged in activities during our inspection. People told us they were bored and relatives were not satisfied with activities in the service. We made a recommendation about this.

There appeared to be enough staff to support people, but they were not appropriately deployed. We observed that staff were visibly present and providing support and assistance on the middle floor. On the top floor, however, we observed that there were periods when people were completely unattended to by staff. We have made a recommendation about this.

Staff showed they were caring. However, we observed that people’s privacy and dignity was not always respected.

People were safe from the risk of abuse at Haslington Residential Home. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. There were systems in place to support staff and people to stay safe. Medicines were managed safely and people received them as prescribed.

People were supported by staff that had been recruited safely and had checks undertaken to ensure they were suitable for their role. Staff received regular training and supervision to help them meet people's needs.

The registered provider ensured the complaints procedure was made available if people wished to make a complaint. People, relatives and staff told us that the registered provider was approachable.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A registered manager was in post at Haslington Residential Home. 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.

At our last inspection on 25 April 2016, we found six breaches of the Health and Social Care Act 2008 (Regulated Activities). These breaches were in relation to meeting people’s needs and preferences and to provide consistent care, fire evacuation plans, keeping accurate and up to date records, effective systems in place to monitor the quality of the service, recruitment practices. The provider sent us an action plan stating that they would address all of these concerns by 26 August 2016. At this inspection the service was compliant with breaches involving fire evacuation plans, keeping accurate records and recruitment practices.

At this inspection, we found that the registered provider had not fully addressed the issues relating to ensuring effective systems were in place to monitor the quality of the service and meeting people’s needs and preferences to provide consistent care. The registered manager had updated the auditing system that was in line with current regulations but these were not completely robust in identifying all shortfalls within the service and ensuring that any shortfalls identified were fully embedded within practice. Activities were being provided but people and relatives told us that this was an area that still required improvement. Activities were not being consistently communicated and reported to people.

The registered provider had not ensured that all potential risks had been mitigated. There were no risk assessments for activities that staff had to undertake. There was no risk assessment available to ensure residents’ health, safety and wellbeing were protected and maintenance practices were not ensuring consistent regular checking of all equipment.

Staff were not safely managing medicines. Medicine checks were not being carried out on a regular basis to ensure that stock levels were accurate.

People’s needs had been assessed. Care plans had appropriate risk assessments that were specific to people’s needs and gave staff appropriate guidance.

People were protected against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns.

There were appropriate levels of staff to provide support for people’s care needs. The registered manager would identify if more staff were required and there was evidence to show that there had been a recent increase in staffing levels. The registered provider had safe recruitment practices.

The registered provider had put in place emergency evacuation plans. However, there was not identified learning from fire drills. We have made a recommendation about this in our report.

The principles of the Mental Capacity Act 2005 (MCA) were not being completely adhered to. MCA assessments were generic and not decision specific. The registered manager had identified this in an audit but this had not been fully embedded into practice. We have made a recommendation about this in our report.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

Staff had a full training program that gave them knowledge to provide support and care for people living at the service. The registered manager was testing staff for their competencies.

People were supported to have a healthy and nutritious diet. Staff could identify when people required further support with eating and appropriate referrals were made to health professionals and staff were seen to be following the guidance provided.

The service had been designed for those living with dementia. There were the use of bright colours, clear door signs and textured walls.

People and their relatives told us they were involved in the planning of their care. However, this was not made clear in people’s care plans. We have made a recommendation about this in our report.

People had freedom of choice at the service. People could decorate their rooms to their own tastes and choose to participate in any activity. Staff respected people’s decisions. However, there were not completely effective communication methods in place for menus. We have made a recommendation about this in our report.

People’s private information was not always kept secure. We found that care plans were left unattended in a communal area and the secure storage unit was, at times, not locked correctly.

The provider had ensured that there were effective processes in place to fully investigate any complaints. Outcomes of the investigations were communicated to relevant people.

The registered manager was approachable and supportive and took an active role in the day-to-day running of the service. Staff were able to discuss concerns with them at any time and were confident these would be addressed appropriately. The registered manager was open, transparent and responded positively to any concerns or suggestions made about the service. The provider produced a yearly survey for people living at the service and their relatives.

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

There was a registered manager in post who had applied for registration with the CQC. 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 provider had ensured that appropriate action had been taken to make the environment safe. Accidents and incidents were being reported by staff and investigated by the registered manager. The registered manager carried out an accident and incident audit so that any trends or patterns could be identified.

People’s needs had been assessed and detailed care plans developed to meet these needs. Care plans contained appropriate risk assessments that were specific to the person’s need and reduced the risk of harm.

Staff were deployed to provide personal care to people throughout the day and night. However, the manager was not using a formal tool to assess the staffing levels on an ongoing basis to ensure they reflected individuals changing needs. We have made a recommendation about this in our report.

This inspection was carried out on 25 April 2016 by three inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. It was an unannounced inspection. There were 40 people using the service at the time of the inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider had not ensured that effective recruitment procedures were followed to ensure that staff working in the home were suitable to work with people who used the service.

The registered provider had not ensured that all areas of people’s needs were planned for to ensure they were met in the way people preferred. This was particularly in relation to people’s social needs and hobbies, their personal care and their night time care needs.

The registered provider had not ensured good governance of the service. There was not a clear fire evacuation procedure in place or individual evacuation plans. This meant that staff may not be clear about how to evacuate people from the building if there was a fire. There was a lack of effective systems for monitoring and improving the quality and safety of the service. The registered provider had not ensured that accurate and complete records were kept about the care provided to ensure people’s needs were met.

The registered provider did not have appropriate knowledge 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.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Sufficient numbers of competent and experienced staff were deployed in the service. The registered provider did not use a system for establishing the numbers of staff required to meet people’s needs to ensure it is responsive and provided at all times. We have made a recommendation about this in the report.

Medicines were stored and disposed of safely and correctly. Staff were trained in the safe administration of medicines.

The premises were clean and the risk of the spread of infection was appropriately managed and minimised.

Staff were skilled in meeting people’s needs. They had the opportunity to receive training relevant to their roles and the needs of people using the service. All members of staff received regular supervision sessions and had an annual appraisal of their performance. Staff felt supported in their roles and were clear about their responsibilities.

The service was well maintained and the manager had ensured it was decorated in a way that met the needs of the people that used it. The use of signage and contrasting coloured areas helped people find their way around. We made a recommendation that the registered provider review the provision of garden space for those on the middle floor to ensure it meets people’s needs and preferences.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People were happy with the quality and range of food they received. Staff knew about and provided for people’s dietary preferences and restrictions. People were promptly referred to health care professionals when needed.

Staff sought people’s consent before providing care. Where people were unable to consent or to make decisions the principles of the Mental Capacity Act 2005 were applied to ensure decisions were made in people’s best interests. The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.

Staff treated people with respect and ensured their privacy was maintained. The staff promoted people’s independence and encouraged people to do as much as possible for themselves. People had positive experiences which were created by staff that understood their personalities and took time to chat with them and provide assurance. Staff were kind and caring in their approach toward people. Staff knew people well and understood how to support people, who lived with dementia, when they needed additional reassurance.

People were involved in their day to day care. People’s care plans were reviewed with their participation and relatives were invited to attend reviews that were scheduled. The service responded in a timely way to changes in people’s needs.

Below is a summary of what we found. Many of the people who used the service had dementia. This meant they were not always able to tell us their experiences. We spent time observing how people interacted with the staff and management of the service.

The summary is based on our observations, discussions with people using the service, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. The service was safe, clean and hygienic and equipment had been maintained and serviced regularly.

We looked at the recruitment of new staff. Staff files showed that recruitment procedures ensured that suitable staff were employed to provide care to people who lived in the home.

Is the service effective?

People's health and care needs were assessed with them, and they, or their representatives were involved as far as possible in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in each person's care plan.

Where people lacked capacity to make important decisions for themselves, families or advocates and relevant health and social care professionals were involved in best interest meetings to make sure that appropriate decisions were made in regard to their health and welfare.

Where appropriate Deprivation of Liberty Safeguards were in place for people who lived in the home. These had been reviewed at intervals to make sure that no one was subject to restrictions on their liberty unnecessarily or for longer than was necessary to ensure their safety. This meant that people's rights were protected.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were caring and friendly in their approach to people and they responded quickly when people needed help and support. People told us, 'Everyone is so kind'. "They really look after you here".

Staff knew people well and were able to describe people's preferences, interests and diverse needs. This meant that care and support was provided in accordance with people's wishes.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Their comments included, 'A good atmosphere, home from home.' 'They try to make every resident feel comfortable and special.' 'Excellent care for the residents'.

Is the service responsive?

We saw that staff responded promptly when people needed support or reassurance during our visit.

We looked at minutes of relatives meetings and responses to the latest annual survey. These showed that the service listened to and took action in response to comments and suggestions made by people who lived in the home and their relatives.

Is the service well-led?

The service had an effective quality assurance system. Records seen by us showed that identified shortfalls were addressed promptly.

Staff were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

The manager was accessible and approachable. We saw that people were comfortable talking with the manager during our visit.

Most of the people living at Haslington Residential Home had dementia and therefore not everyone was able to tell us about their experiences. However, we took the oppurtuntiy to speak with some of the people who used the service and who were able to speak with us. They told us that they were well cared for and the staff were "wonderful". One person said that they had just had a "lovely lunch and I am now off to have a walk around the garden before I have a snooze".

We had the pleasure of listening to one person who lived at Haslington Residentital Home who wanted to sing for us during the inspection. We saw many people smiling and there was a feeling of general calmness within the home. We observed professional and empathetic interactions between staff and people.

We saw that some information was available which advised people who used the service what was available for lunch but this did not state that they could request other alternative options. We spoke with five people who used the service. They told us that they enjoyed their meals.

We observed that a picture board was displayed, which provided information about the activities provided in the home. We observed that some people were participating in activities.

Records were now available which confirmed that meetings were taking place with people who used the service or their representatives which enabled them to share their views. We found that the provider had acted upon people's views and feedback resulting from a feedback survey which was distributed in March 2012.

At this inspection we found inconsistencies in some of the care records maintained by the service.

Five people we spoke with told us they were happy with the care that they received and they liked the staff. We observed staff speak with people in a friendly and respectful manner. We also spoke with one person's carer who also said they were happy with the care provided at the home.