Archived: Hereford House

During the inspection, we spoke with seven people who lived at the home. We also spoke with the manager, care staff and the activities coordinator. We also obtained feedback from the local authority after the inspection.

At the last inspection in June 2014, we found Hereford House non-compliant with care and treatment, safeguarding, supporting workers, quality assurance and records. We found that compliance had been achieved in all areas apart from records. The provider has been asked to make improvements and a further compliance action has been set.

Below is a summary of what we found. The summary describes what people who lived at the home told us, what staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is it safe?

Risks to people were assessed and risk assessments developed. Risk assessments included mobility, breathing and communication. However, risk assessments did not record the measures and actions required to safely deliver care and support to people.

Training records confirmed that staff had received safeguarding training. Staff we spoke with demonstrated an understanding of safeguarding, the identification and reporting of any suspected abuse. People told us they felt safe living at Hereford House and would approach staff or management with any concerns.

The Care Quality Commission (CQC) is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). In order to understand the legislation, staff would be attending training commissioned by the local authority. Staff we spoke with had a basic understanding of their legal requirements and their own responsibilities under the legislation.

Recruitment practices were safe and the relevant checks had been completed before staff worked unsupervised at the home.

Is it effective?

Care plans had been devised and developed. Care plans contained personalised information such as the person's likes and dislikes. However care plans did not reflect people's involvement or how the person was involved in the formation of their care plans. People were not consistently signing their care plans to acknowledge their consent.

Pressure relieving equipment was adequately maintained. Documentation confirmed that all pressure relieving equipment was checked either, hourly or daily to ensure it provided the support people required. Staff demonstrated an understanding of the importance of maintaining pressure relieving equipment.

People received appropriate support from healthcare professionals when required. Examples seen, included referrals to other professionals such as General Practitioner's (GPs), speech and language therapists (SALT) and the tissue viability nurse. People confirmed that if they ever felt unwell, the GP would be contacted.

Is it caring?

People spoke positively about the staff and felt that their privacy and dignity was maintained. They said staff were respectful and compassionate. Staff demonstrated a kind and caring approach when we heard them discussing people's needs and wishes.

Throughout the day we saw that people looked happy and relaxed in the care of staff at Hereford House. Care staff demonstrated patience and understanding. We saw that care staff responded to people's care needs promptly when required.

People were dressed in accordance with their individual lifestyle choice. We saw that staff encouraged people to decorate their rooms and to bring items of importance.

Is it responsive?

Information was available on how to make a complaint and people told us they would feel happy approaching staff with any concerns.

Staff meetings were held. These provided staff with the forum to discuss their concerns, explore practice issues and air their opinions.

Hereford house employed a dedicated activities coordinator. They worked three days a week and provided wide range of activities. People spoke positively of the activities provided but expressed that they would like more activities that were meaningful to them.

Is it well led?

A registered manager was not in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The manager provided day to day leadership but had not yet registered with the commission.

The home had quality assurance systems intended to monitor and improve the service provided. Monthly audits were completed. Where any shortfalls were identified, a plan of action was implemented.

A business continuity policy was in place. This made sure that the home had a plan in place to deal with foreseeable emergencies. This would reduce the risk of people's care being affected in the event of an emergency such as flooding or a fire.

Care staff, people and their relatives, said they found management were approachable.

On the day of the inspection we were informed that the registered manager had left the service and a new manager had been appointed who had not yet registered with the Care Quality Commission. The new manager had only been in post three days on the day of our inspection.

We spoke with eight people who used the service and one visiting relative. During the inspection, we spoke with the provider, the manager, deputy manager and two care staff.

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity, kindness and respect. One person who used the service told us, "It's lovely here."

People told us that they felt safe in the care of Hereford House.

The service was aware of the requirements of the Mental Capacity Act 2005. Staff had received training and the manager demonstrated a sound understanding.

Systems were not in place for staff to learn from incidents, accidents and near misses.

Not all staff had received the training required to safely deliver care and treatment.

People were not always safeguarded from the risk of abuse or harm.

Risk assessments associated with people's care delivery were not accurate or fit for purpose.

The Care Quality Commission (CQC) is required by law to monitor the Deprivation of Liberty Safeguards (DoLS). We found that the manager demonstrated a sound understanding of DoLS but care staff had not received training. We saw one incident where a person was banned from entering the dining room at meal times. This could be seen as a deprivation of liberty and the local authority were completing an investigation. We found that the person could now freely access all areas of the service.

Is the service effective?

People we spoke with felt happy with the care provided.

People's health and wellbeing was monitored and where required referrals to healthcare professionals were made.

The service had a quality assurance framework but identified action plans were not consistently met.

Pressure relieving equipment was not adequately maintained therefore placing people at further risk of skin integrity breaking down.

Care plans and risk assessment lacked information on how to provide safe care and support to people.

Is the service caring?

People spoke positively about the staff and felt that their privacy and dignity was maintained. They said staff were respectful.

People's preferred names were recorded in their care plans and people told us that staff always used these names.

People were dressed in accordance with their individual lifestyle choice.

We saw that the service encouraged people to decorate their rooms and to bring items of importance.

Is the service responsive?

The service employed an external activities co-ordinator but we received mixed feedback from people who used the service about the opportunities of social interaction and activities.

There was a complaints policy and procedure in place if people or their representatives were unhappy, but we could not see that complaints were handled appropriately and in a timely manner.

Where's people's health had rapidly deteriorated we saw that the service took appropriate action.

Is the service well led?

The service had a business continuity policy in place. This made sure that each service had a plan in place to deal with foreseeable emergencies. This would reduce the risk of people's care being affected in the event of an emergency such as flooding or a fire.

First aid equipment was not regularly checked to ensure the service had the equipment required in the event of a medical emergency.

The service sought feedback from people who used the service.

Supervisions and appraisals were not regularly provided to care staff to enable professional development.

The people we spoke with told us they were happy with the care they had received and with the staff team. One person who used the service told us, "The staff treat me very well. They treat me with dignity and respect.' Another person who used the service told us, "I like it here, I can do what I want and the care is good.' Staff we spoke with had a good understanding of the support needs of the people who used the service. One member of staff we spoke with told us, "Everyone has a caring nature and we care about the residents.'

Staff we spoke with confirmed that they felt supported and had received relevant training, which included the safeguarding of vulnerable adults. Staff told us that they understood the signs of abuse and were aware of how to raise concerns.

The people who use the service were in safe and secure premises that promoted their wellbeing.

We saw evidence that the provider had an effective recruitment and selection procedure in place to ensure that staff were qualified to do their jobs.

The provider had also ensured that sufficient numbers of staff with the right skills and abilities were employed to meet the needs of the people who use the service.

Both people living at the home and visiting relatives made specific mention of individual staff members but said that all the staff were kind and caring. One person said "I can't think of a nicer place to live. I used to live on my own in Brighton and be lonely but now I am here and everything is seen to for me. I feel quite lazy, I don't do anything and get waited on all the time."

People we spoke to all said that the food was particularly good. They said they can "always have a nice cup of tea and piece of cake when they don't feel like something heavy." Our observations confirmed that food was very much a high point of the day and that people really did enjoy their meals.

People were encouraged to maintain their independence as far as possible. Some go out to the local shops or entertain visitors, others take part in activities within the home or just chat with staff.