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Inspection carried out on 28 February 2019

During a routine inspection

About the service: Haxby Hall is a care home providing personal care and accommodation for up to 49 people aged 65 and over, some of who may be living with dementia. At the time of the inspection 46 people were living at the service.

People’s experience of using this service: The provider had systems in place to safeguard people from abuse. Staff could recognise and report any safeguarding concerns if they suspected abuse. Relevant risk assessments had been completed. Medicines were managed safely. Accidents and incidents were monitored to identify and address any patterns or trends to mitigate risks.

Staff had appropriate skills and knowledge to deliver care and support people in a person-centred way. Staff recruitment was safe and staff understood how to keep people safe.

People and their relatives told us they were happy with the service they received and felt staff had a clear understanding of their needs and preferences. People were supported with good nutrition and could access appropriate healthcare services.

Staff cared about the well-being of people they supported and we received positive feedback about the kindness of staff. Relatives were made to feel welcome.

People described a range of activities and events both within the service and the local community, based on their interests and preferences. People and their relatives were supported to receive information in an accessible way either through easy read, large print and pictorial formats to enable them to be involved in their care and support.

Care plans had been developed and were regularly reviewed. These contained relevant information about how to meet people's needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice.

People were treated with respect and dignity and their independence was encouraged and supported. Where people required support at the end of their lives, this was carried out with compassion and dignity.

The environment supported people to have time on their own and time with other people if they chose this. Throughout the environment appropriate signage for people living with dementia was in place to support people to find their way around the service. Cleanliness and health and safety were well managed.

The registered manager and staff team worked together in a positive way to support people to remain as independent as possible and to be safe. Staff told us they were well supported by the registered manager and management team.

Checks of safety and quality were made to ensure people were protected. Work to continuously improve was noted and the registered manager was keen to make changes that would impact positively on people's lives.

The values of the organisation of working together, to improve and make a difference were embedded. This supported people to receive the positive service described.

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

Rating at the last inspection: At the last inspection the service was rated good (published 1 November 2018).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 21 September 2018

During an inspection to make sure that the improvements required had been made

We undertook an unannounced focused inspection of Haxby Hall on 21 September 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection on 3 August 2018 had been made. The team inspected the service against one of the five questions we ask about services: is the service well led. This is because the service had not been meeting some legal requirements. At this inspection we found the service had improved.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Haxby Hall 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.

The service provides accommodation for up to 49 older people who have personal care needs, some of which may be assessed as high dependency needs. There is a six-bedded safe unit for people with dementia care needs, which includes two respite beds for individuals requiring a short stay there.

There was a registered manager employed at this service. 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.

There was an effective quality monitoring system in place which included audits of each area of the service. Feedback was collected from people.

Information was shared with people through regular meetings and people were encouraged to share their point of view.

There were links with the local community through schools and by inviting people into the service.

Inspection carried out on 3 August 2017

During a routine inspection

We carried out this inspection on 3 August 2017. The inspection was unannounced.

There was a manager in post who was registered with the Care Quality Commission. A manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

Haxby Hall is a care home that is registered to accommodate up to 49 older people, some of whom may be living with dementia. The home is situated in Haxby, on the outskirts of the city of York. Bedrooms are located on the ground and first floors and there is a passenger lift to enable people to reach the first floor. On the day of the inspection there were 43 people living at the home.

At the last inspection in May 2016 we were concerned that some staff training was not up to date and we made a recommendation about this in the report. At this inspection we found that staff had attended training that was considered to be essential by the home. This included training on first aid, medication, infection control, safeguarding adults from abuse, fire safety and moving and positioning people. This meant we were no longer concerned about staff training achievements.

At the last inspection in May 2016 we were also concerned about staffing levels impacting on people’s opportunities for socialisation and taking part in activities. We made a recommendation about this is the report. At this inspection we found that people were taking part in more activities, both as a group and one to one, although some people felt there was room for further improvement. We were satisfied that the provider had taken action to improve this aspect of people’s care provision.

At this inspection we found that recording needed to improve. There were some minor omissions in care records, recording in monitoring charts was inconsistent and records of how the conditions of one DoLS authorisation were being met were also inconsistent. The manager carried out audits to ensure people were receiving the care and support that they required, and to monitor that staff were following the policies, procedures and systems in place. However, these audits had not identified some of the concerns we found during the inspection.

We saw that sufficient numbers of staff were employed to make sure people received the support they needed, although some people commented that additional staff would be beneficial. The nominated individual told us that additional staff would be employed at the home as part of the current review of older people’s services.

Staff had been recruited following robust recruitment and selection policies and people told us they felt safe living at the home.

Prior to the inspection we had received concerns about cleanliness at the home. The manager had asked an infection control nurse to carry out an audit to help them identify areas that required improvement. On the day of the inspection we found the home to be clean and hygienic, apart from the laundry room that needed to be de-cluttered. The following day we received confirmation from the home that this had been addressed.

People told us they were happy with the choice of meals provided at the home. People’s nutritional needs were assessed and there were appropriate risk assessments in place. People’s special dietary requirements were catered for.

Care planning described the person and the level of support they required. There were some anomalies in recording, although none of these had affected the care the person had received.

People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Risks to people were assessed and reduced where possible. Staff received training on

Inspection carried out on 20 May 2016

During a routine inspection

Haxby Hall is a residential care home in Haxby on the outskirts of York. The home is owned by City of York Council and is registered to provide accommodation for up to 49 older people who have personal care needs. The home is purpose built and is spread across two floors with lift access. There is an eight bedded unit at the back of the home for people who may be living with dementia. There is some parking on site.

We inspected this home on 20 and 25 May 2016. This inspection was unannounced. At the time of our inspection there were 42 people living at Haxby Hall.

The home was last inspected in February 2015 at which time it was compliant with all the regulations we assessed.

The registered provider is required to have a registered manager as a condition of their registration and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

During the inspection we found the service was safe. Risks were identified and risk assessments used to guide staff on how to provide safe care and support.

Staff understood their role and responsibilities with regards to safeguarding vulnerable adults and systems were in place to support them to identify and respond to safeguarding concerns.

Medicines were managed safely and in line with guidance on best practice.

There were safe staffing levels within the home; however, we received some negative feedback about how staffing levels could impact on the timeliness of care and support provided and on the support provided for people to engage in meaningful activities. We have made a recommendation about this in our report.

We identified that staff training had not been kept up-to-date and more robust systems were needed to evidence staff’s competencies, where training courses were not available. We have made a recommendation about this in our report.

People were supported to eat and drink enough and we received positive feedback about the food provided at Haxby Hall.

Staff provided effective support to ensure people had access to healthcare service where needed.

We received positive feedback about the kind and caring staff at Haxby Hall. People using the service were encouraged and supported to make decisions and the care and support provided maintained people’s privacy and dignity.

We found there were systems in place to manage and respond to complaints and to gather feedback about the service provided.

We received positive feedback about the management and there were systems in place to monitor the quality of the service provided at Haxby Hall.

The registered manager and registered provider were committed to developing and improving the quality of the care and support provided, particularly around dementia care.

Inspection carried out on 5 and 6 February 2015

During a routine inspection

The inspection took place on the 5th and 6th February 2015. The inspection was unannounced.

We last inspected the service fully in April 2014 and we issued two compliance actions for care and welfare and records. We carried out a further follow up inspection in September 2014. We found the service was compliant with care and welfare but still had further work to do in regards to quality monitoring and management systems. We held an internal meeting to determine how best to drive the improvements that were needed. We told the provider to send us monthly updates of their quality monitoring systems.

Haxby Hall is owned by City of York Council and provides accommodation for up to 49 older people who have personal care needs, some of which may be assessed as high dependency needs. There is a six bedded safe unit for people with dementia care needs, which includes two respite beds for individuals requiring a short stay there. The service is purpose built, and is sited close to the local amenities in Haxby.

Haxby Hall does not have a registered manager although the provider has put in place interim arrangements for the management for the service. 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.

Although people told us they felt safe they also told us that the current staffing levels were impacting on service delivery. Ten people raised concern about the number of staff on duty. Staffing levels were said to be insufficient and people expressed concern about the number of agency hours in use.

The home had clear systems and processes for managing safeguarding concerns and these were understood by staff. People had risk assessments included within their care records and checks were carried out on the premises to help keep people safe.

Where new staff were employed appropriate recruitment checks were completed.

Medication systems were appropriately managed and people told us they received their medication on time.

Staff received induction, training and supervision; however this was not always regular and may need to be reviewed.

There was limited evidence in care records to demonstrate that mental capacity was considered. Staff had not received training in this area although they were able to give some examples of when the Mental Capacity Act 2005 (MCA) legislation may need to be considered.

We received mixed comments about the food provided. Some people said it was good and others thought that there should be more choice available. We saw that some people were disturbed during their meal by personal care tasks which may impact on their mealtime being an enjoyable social opportunity.

People told us their health needs were monitored and that they could see a doctor or other health professional when they needed to.

People told us that they were well cared for and we observed people being spoken to kindly by staff throughout our visit. People told us they were treated with dignity and respect.

People had their needs assessed and following an assessment of their care needs a plan of care was developed.

People told us there were very few activities available and felt this was an area that could be improved upon.

People told us they felt able to raise concerns and complaints and felt confident that these would be acted upon.

The home did not have a registered manager, although management arrangements were in place. This included an overall manager and a senior carer who had taken on additional management responsibilities.

Quality monitoring systems had improved since our last visit and there were a number of audits and checks taking place. However this work was still in the early stages which we will continue to monitor in future visits to the service.

Inspection carried out on 17 September 2014

During an inspection to make sure that the improvements required had been made

We carried out this inspection to check that the provider had taken action to improve the two areas that we found non-compliant at our last inspection of the service.

Information found at inspection answers our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

The risk to people�s health and safety was mostly considered and people were consulted and included in decisions about risks they may want to take. However we found there were not always effective health and safety measures in place to protect people from harm.

Whilst the manager told us that people were kept safe because the service learnt from incidents and comments that may affect people�s health and well-being there were no records to evidence this learning.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events, and managing people�s health and safety.

Is the service effective?

People were involved in the assessment of their needs and their preferences and choices were discussed with them when they moved there. This helped staff to respect and meet those needs.

People�s health was monitored so that changes that required extra support could be more quickly identified. This also meant expert guidance could be promptly sought when necessary. This helped to promote people�s health and wellbeing.

Is the service caring?

Whilst people told us they were treated with kindness and compassion, they added that the staff were very busy, with little time to stand and talk. Their comments included �It�s alright here. I don�t think we�ll get better care.� And �Yes. You�re well looked after here. I didn�t want to move here, but I�ve been pleasantly surprised.� One person told us �There�s no time for conversation (with staff). We would like that.�

People�s privacy and dignity were respected and people�s independence was promoted. People were able to come and go as they pleased and staff supported people to make choices in their daily lives.

Is the service responsive?

Whilst people�s needs, preferences and choices were explored with them when they moved to the service there were limited opportunities for people to speak out about what mattered to them. Niggles that people reported to us at the last inspection were still present. This showed the service had not actively sought, listened to and responded to people�s views.

People we spoke with said they would raise a complaint if they were concerned. However, when questioned one person said they did not know who they would tell as �There�s nobody to tell. Everyone's too busy."

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to consulting with people about their care, treatment and support.

Is the service well-led?

The quality assurance system was undergoing change. Although the manager told us they would have a robust quality monitoring system in place by August 2014 we found this was not the case. New processes were being introduced but it was too early to tell whether this would bring about improvements to the way care was delivered. Records shown to us did not demonstrate that there was learning from accidents and incidents and there was a need for more consultation with people about how the service was being run.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring the service is well run and in monitoring the service delivery.

Inspection carried out on 15 April 2014

During a routine inspection

Haxby Hall is owned by City of York Council and provides accommodation for up to 49 older people who have personal care needs, some of which may be assessed as high dependency needs. There is a six bedded safe unit for people with dementia care needs, which includes two respite beds for individuals requiring a short stay there. The service is purpose built, and is sited close to the local amenities in Haxby. There is some parking on site. Written information about the service can be obtained by contacting the home directly.

Our inspection team was made up of two inspectors, and a specialist nurse. In relation to infection prevention and control management. They helped answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe at Haxby Hall. They trusted the staff who worked there and supported them. They told us the staff were kind and friendly.

We found people were kept safe because the service took action to manage and report safeguarding incidents promptly and effectively.

We saw people�s privacy and dignity rights were respected and their independence was promoted. This helped to make sure their human rights were protected.

The service understands that people have the right to take risks, as long as they understand the implications of that risk. People�s mental capacity was considered when risk was assessed, though records relating to this assessment could be improved.

The service overall was kept clean, though some hygiene practices could be better monitored. This would better help to protect people from the risks associated with the spread of infection.

We found some risk management processes could be improved to better demonstrate that the service was keeping people safe whilst promoting their health and wellbeing.

Is the service effective?

People were included in decisions about their care and the support they wanted. We found their care records overall reflected their preferences and choices and dietary likes and dislikes.

We observed that there were good interactions between the staff and people, with friendly and supportive care practices being used to assist people in their daily lives.

Whilst people�s independence and self-worth was promoted, some people told us they would like more help with some aspects of their day to day lives.

People were offered meals that were varied and nutritious. One person told us �The quality of food is excellent.� A range of snacks and drinks were readily available and offered to people; to ensure individuals received enough to eat and drink. Whilst people were assessed for the risk of becoming malnourished, this assessment process was not always robust.

Is the service caring?

People told us they were treated with kindness and compassion. Their comments included �I�m very happy with my care. There�s always someone here to help you.� Another said �The care is great and the staff are lovely.� Despite these comments we saw some instances where staff relied on people to ask for help. Two people said �The staff don�t clean our hearing aids. We wish they would.�

People overall told us they received good care and we saw the service liaised with healthcare professionals for advice and guidance, to ensure people received appropriate care.

Whilst people overall were satisfied with their care we noted some peoples� care records did not always contain up to date information about their care needs. This meant those people were at greater risk of receiving inappropriate, unsafe care. We told the provider to take urgent action and to send us information within two working days, to show that those people�s care had been properly reviewed.

Is the service responsive?

People told us they attended meetings where they could talk about how the service was being run.

The service had a complaints policy and people spoken with told us they thought any concerns raised with senior staff would be taken seriously and sorted out. However, people we spoke with raised a number of �niggles� with us about the service, which the provider was unaware of. This indicated systems in place to enable and encourage people to raise concerns may need improving.

People were consulted about the care and support they needed. This included asking about people�s preferences and choices, so that these could be met, wherever possible. Whilst people�s care needs were reviewed each month, this review did not always include a discussion with the individual. This meant people did not always have the opportunity to say whether their care and support needs were still being met.

Is the service well led?

People were involved and included in annual reviews about their care, so they could say what was working well and what could be improved. Residents meetings were held, where people had an opportunity to give their views about how the service was operating. Better records would help to show whether actions taken as a result of comments made, had brought about improvements.

The service had an �open door policy� where staff were encouraged to voice their concerns and opinions to senior staff. Staff meetings were held so that information could be shared and staff could provide feedback about how the service was being run.

The provider had a line management structure, and senior managers visited the service regularly to provide support and to monitor how the service was being run.

Whilst some information about the service was gathered each month there needed to be more robust reviews, analyses and records about this information. This would enable the provider to demonstrate that risks to people�s health, safety and wellbeing were well managed and effective. We have asked the provider to take action to improve the way the service is assessing and monitoring the quality of service provided.

Inspection carried out on 30 October 2013

During a routine inspection

We spoke with nine people who lived at Haxby Hall, with two visitors and a healthcare professional. The comments from all overall were positive. These included �The staff are alright. You don�t need to wait long when you need help.� And �I�m very happy here. It�s lovely.� A third person said �I�ve lived here a few years now. I get the right care for me.� The visitors we spoke with had no concerns. One said �The staff always contact me if my relative�s unwell. They (the staff) seem very competent.�

We saw people looked well cared for and we noted some people had developed new friendships since moving to live there. The atmosphere was friendly and there was a lot of light-hearted banter.

We found people�s consent was routinely sought before care or support was provided.

People overall received safe, consistent and appropriate care that met their needs.

Whilst people told us the service was kept fresh and clean, some underpinning processes needed improving in order to minimise the risk of a spread of infection.

People are cared for by staff whose backgrounds are properly vetted, to ensure they are suitable to work in the care industry.

Although the service has a complaints process, this could be made more available and accessible for people.

Not all the personal records including medical records are accurate, fit for purpose or provide sufficient guidance for care staff to refer to.

Inspection carried out on 9 January 2013

During a routine inspection

People we spoke with told us they made their own decisions and choices about how to spend their time. A person we spoke with said �I can go out and do what I want." We saw that people were treated with dignity and respect and their rights were being protected.

People had personalised care plans and risk assessments in place to help staff to maintain their health and wellbeing. A person living at the home said �I would not like to go anywhere else. I have got my life back and my health since coming here.� People�s care records were updated as people�s needs changed. This ensured that people�s needs were known and could be met.

There were policies and procedures in place to help to protect people from abuse. Staff received safeguarding training so that they were aware of the action they must take if they suspected abuse may be occurring. This helped to protect people.

Sufficient staff were provided to be able to meet people�s needs. People we spoke with were happy with the care and support they received. However staff we spoke with did comment that they felt staffing levels could be improved which would allow them to be able to spend quality time with people. The provider may wish to note this.

People's views were sought about the quality of the service being provided. People we spoke with said they were happy living at the home and with the service they received. A person said �I can raise my views.�