Archived: Hereford House

Updated 13 April 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the home, and to provide a rating for the home under the Care Act 2014.

We visited the home on the 11 and 17 February 2015. This was an unannounced inspection. The inspection team consisted of two inspectors. During the inspection, we spoke with six people who lived at the home, two visiting relatives, four care staff, the chef, activities coordinator, laundry assistant, the deputy manager and the manager.

Before our inspection we reviewed the information we held about the home. We considered information which had been shared with us by the local authority, looked at safeguarding alerts that had been made and notifications which had been submitted. A notification is information about important events which the provider is required to tell us about by law. We also contacted the local authority to obtain their views about the care provided in the home.

We usually ask the provider to complete a Provider Information return (PIR). A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not ask for a PIR on this occasion because we carried out the inspection at short notice.

We looked at areas of the building, including people’s bedrooms, the kitchens, bathrooms, and communal lounge. Some people were unable to talk to speak with us. Therefore we used other methods to help us understand their experiences. We used the Short Observational Framework for Inspection (SOFI) during lunchtime. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During the inspection we reviewed the records of the home. These included staff training records and procedures. We looked at nine care plans and risk assessments along with other relevant documentation to support our findings. We also ‘pathway tracked’ people living at Hereford House. This is when we looked at their care documentation in depth and obtained their views on how they found living at Hereford House. It is an important part of our inspection, as it allowed us to capture information about a sample of people receiving care.

Updated 13 April 2015

We inspected Hereford House on the 11 and 17 February 2015. Hereford House is a residential care home that can provide care and support for up to 29 people. On the days of the inspections, 27 people were living at the home. The age range of people living at the home varied between 45 – 90 years old. Hereford House provides support for people living with varying stages of dementia, physical healthcare needs, diabetes, sensory impairment and long term healthcare conditions.

Accommodation was arranged over three floors with a communal lounge and dining area. Although care and support is provided for people living with dementia, the home is not specialised in dementia care.

A manager was in post, but they were not the registered manager and had only been in post two months. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider. The home has been without a registered manager for eight months.

At the last inspection in September 2014, we asked the provider to make improvements to the recordings of their risk assessments and care plans. An action plan was received from the provider which stated they would meet the legal requirements by 22 January 2015. Improvements had been made, but we continued to have concerns with the recording of risk assessments. We also identified further areas of concerns throughout the inspection.

People’s needs had been assessed and care plans devised and implemented. However, care plans and risk assessments lacked sufficient guidance and detail to enable staff to provide safe, effective and responsive care. Despite concerns with documentation, we saw that people received the care they required. However, this remained an area of practice that required continued improvement.

People’s medicines were stored safely and in line with legal regulations. People told us they received their medicines on time, however, guidance for the use of ‘as required’ (PRN) medicines were not available. We have identified this as an area of practice that required improvement.

The deployment of staff within the home required improvement. People told us they felt safe and commented the home was sufficiently staffed. However, we observed care practice which could potentially place people at risk. For people living with dementia, they were often seen sitting in communal areas with no staff interaction. This could place people at risk of un-witnessed falls due to not having staff around. We have identified this as an area of practice that required improvement.

Not all staff had received training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Mental capacity assessments were not recorded in line with best practice guidelines and staff were not consistently aware of who was subject to a DoLS authorisation and what it meant for the individual. We have identified this as an area of practice that required improvement.

Systems were in place to analyse, monitor or review the quality of the service provided. However, these were not being completed on a regular basis and there were no mechanisms to assess the standards of care. Feedback was not regularly sought from people or their visiting relatives. Incident and accidents were not consistently recorded or monitored for any emerging trends or patterns. We have identified this as an area of practice that required improvement.

Staff spoke highly of the training opportunities provided and commented they felt supported and valued by the provider. However, two members of staff had not received the training required to provide effective care to people. We have identified this as an area of practice that required improvement.

People spoke highly of the opportunities for social engagement and activities. An activities coordinator was in post three days a week and regularly took people out and about, shopping and to places of importance to them. However, on the days the activities coordinator was not present, there was a significant lack of stimulation and engagement for people. We have made a recommendation for improvement in this area.

People felt their privacy and dignity was upheld. However, we observed elements of practice which did not uphold people’s dignity. We have made a recommendation for improvement in this area.

Staff had received safeguarding adults training and had a firm understanding of what constituted adult abuse. However, staff were not clear on how to raise a safeguarding alert. We have identified this as an area of practice that requires improvement.

Staff demonstrated a fondness for the people they supported. From observing staff interacting with people, it was clear they had spent time with people, getting to know them, gaining an understanding of their personal history and building friendships with them. People were provided with a choice of healthy food and drink ensuring their nutritional needs were met.

People spoke highly of Hereford House, the staff and the manager. One person told us, “I couldn’t be anywhere better.” Staff understood the principles of privacy and recognised that people had the right to take positive risks and live autonomous lives. People looked comfortable in the company of management and the manager was committed to the on-going improvement of Hereford House.

We found a number of breaches 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.