Haydon-Mayer

Haydon-Mayer is a residential care home providing personal and nursing care to older people, who may be living with dementia, to up to 32 people. At the time of our inspection there were 24 people using the service, living in a large, adapted building.

People’s experience of using this service and what we found

People told us they were happy living at the service and felt safe. However, people’s care plans did not always contain detailed accurate information for staff to support people consistently and safely.

Medicines were not managed safely. The guidance for staff about when to give ‘when required’ medicines was not accurate or person centred, placing people at risk of not receiving their medicine when they needed it.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, documents assessing people’s capacity had not been completed accurately, staff did not have full understanding of fluctuating capacity. This did not impact on people’s daily lives.

Checks and audits had been completed, but these had not identified the shortfalls found at this inspection.

There was a system in place to protect people from discrimination and abuse. Staff were recruited safely and there were enough staff to meet people’s needs. People received care and support in line with their choices and preferences. People’s wishes for their end of life care had been discussed and recorded.

Accidents and incidents had been recorded and analysed for any patterns and trends, action had been taken to mitigate the risk of them happening again. Relatives told us the registered managers were open and transparent when things had gone wrong.

People and relatives told us they knew how to complain and were confident the registered managers would deal with their concerns appropriately. When complaints had been made, these had been recorded and investigated following the provider’s policy.

People, relatives and staff had been asked their opinions on the service and any suggestions they may have for improvements, these suggestions had been acted on.

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

Rating at last inspection

The last rating for this service was requires improvement (published 12 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 9 December 2019. There were no breaches of legal requirements, but shortfalls were found, and improvements were required in care plans and management of the service.

We undertook this focused inspection to check they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed and remain requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Haydon-Mayer on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines, risk management and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

¿ Staff had received additional training in the correct use of personal protective equipment (PPE). This had been followed by refresher training from nursing staff to ensure staff continued to use the PPE provided correctly.

¿ Staff had moved the furniture in the communal areas to support social distancing and had encouraged people to have time in their room. This limited the number of people in communal areas and minimised the risk of them breaking social distancing guidance.

¿ People were supported to maintain relationships with their loved ones through the use of phone and video calls. Visits had also been arranged when appropriate using the garden area and with visitors wearing PPE to keep people safe.

Further information is in the detailed findings below.

Haydon Mayer is a residential care home providing personal and nursing care to 23 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

People’s experience of using this service and what we found

People’s loved ones told us they were happy and well cared for at the service. However, we found people’s care plans lacked detail about their support and end of life care plans were generic, not reflecting people’s wishes. When people’s needs changed guidance for staff was not updated, which put people at risk of being supported in a way with did not meet their needs or preferences.

Audits had been completed to monitor the quality of support. However, they had not always been effective and had not identified the shortfalls found at this inspection. Staff worked closely with other professionals to meet people’s needs. People, their relatives and staff were given opportunities to express their views about the service. They told us that the provider and manager were accessible and open to ideas.

People were supported by staff who used their knowledge of people to tailor their interactions. People could have visitors at any time who could join them for meals or activities. People took part in a range of activities including both one to one and group sessions. People had food which met their needs and which they enjoyed. When people were unwell staff contact the relevant health professional and supported them to manage long term health conditions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff encouraged people and their loved ones to have a voice in their care. People could access information in a range of formats. Relatives told us some staff went above and beyond to make their loved one happy and give them peace of mind.

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

Rating at last inspection

The last rating for this service was good (published 18 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Haydon-Mayer is a nursing home for up to 32 older people, some of whom may be living with dementia. On the day of the inspection there were 30 people living at the service. Haydon-Mayer is located in the town of Herne Bay. It offers residential accommodation over several floors and has two communal areas together with a conservatory on the ground floor which is also used as a dining area.

The service had a registered manager in post. 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.

We carried out an unannounced comprehensive inspection of this service on 5, 7 and 8 April 2016 and Haydon-Mayer was rated ‘Requires Improvement’. There were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. We issued requirement notices relating to safe care and treatment, fit and proper persons employed and person centred care. We asked the provider to take action and the provider sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Improvements had been made and the breaches had been met.

Staff knew how to recognise and respond to abuse. The registered manager was aware of their responsibilities regarding safeguarding and staff were confident the registered manager would act if any concerns were reported to them.

Staff completed incident forms when any accident or incident occurred. The registered manager analysed these for any trends to see if any adjustment was needed to people’s support. Risks relating to people’s health and mobility had been assessed and minimised where possible. Regular health and safety checks were undertaken to ensure the environment was safe and equipment worked as required. Regular fire drills were completed.

There was enough staff to keep people safe. Staff were checked before they started working with people to ensure they were of good character and had the necessary skills and experience to support people effectively.

Staff had the induction and training needed to carry out their roles. They had received training in people’s healthcare needs. Staff met regularly with their manager to discuss their training and development needs. They had received training in topics relating to people’s needs.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. DoLS applications had been made to the relevant supervisory body in line with guidance.

People were supported to eat and drink healthily. Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. Staff followed guidance and advice given by health care professionals. People’s medicines were managed safely.

People and their relatives said that staff were kind and caring. Staff knew people well and their likes and dislikes formed part of their care. People were supported to dress how they wished and wear jewellery when it was important to them. People were treated with dignity and respect.

Staff were responsive to people’s needs. Detailed assessments were carried out before people moved into the service. People’s care plans were reviewed monthly by staff to ensure they reflected the care and support people needed.

People took part in a variety of activities within the service. People and their relatives told us musicians and entertainers regularly visited the service to perform and they enjoyed participating in bingo. There was a complaints policy in place and people’s relatives said they knew how to complain if they needed.

Staff and relatives told us they thought the service was well-led. Staff told us they were well supported by the registered manager and there was an open and inclusive ethos within the service. The registered manager told us, “Our aim is to make sure people have their last days being looked after in the way they want.”

The registered manager was experienced in working with older people and providing person centred care. CQC had been informed of any important events that occurred at the service, in line with current legislation.

The registered manager regularly carried out audits to identify any shortfalls and ensure consistent, high quality, personalised care. People’s relatives, staff and other stakeholders were regularly surveyed to gain their thoughts on the service. These were collated and analysed and action was taken when necessary.

Haydon-Mayer is a nursing home providing accommodation for up 32 older people who may have mental and physical difficulties and require nursing care. At the time of the inspection, 25 people lived at the service.

The service had a registered manager. 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.

Nursing staff managed and administered medicines for people. Medicines were not always administered, stored, and disposed of safely. People had not always received their medicines as prescribed.

Staff were recruited using procedures designed to protect people from unsuitable staff. However, robust recruitment checks were not always being carried out.

Person centred care planning records showed inconsistencies therefore; people may not have received care and support that met their needs.

Staff were trained to meet people’s needs. They met with management and discussed their work performance at one to one meetings and during annual appraisal, so they were supported to carry out their roles.

There were sufficient numbers of staff to meet people’s needs. Staff were available throughout the day, and responded quickly to people’s requests for help. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. Staff were supported by the registered manager and felt able to raise any concerns they had or to make suggestions to improve the service for people.

People demonstrated that they were happy at the service by smiling and chatting with staff who were supporting them and greeting the manager warmly. Staff interacted well with people, and supported them when they needed it.

People were protected against the risk of abuse. People told us they felt safe. Staff recognised the signs of abuse or neglect and what to look out for. Both the registered manager and staff understood their role and responsibilities to report any concerns and were confident in doing so.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood when an application should be made. They were aware of the Supreme Court Judgement which widened and clarified the definition of a deprivation of liberty. The service was meeting the requirements of the Deprivation of Liberty Safeguards.

There were risk assessments in place for the environment, and for each person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Nursing staff carried out on-going checks of people’s health needs, and contacted other health and social care professionals for support and advice.

People were provided with a diet that met their needs and wishes. Menus offered variety and choice. People said they liked the food. Staff respected people and we saw several instances of a kindly touch or a joke and conversation as drinks or the lunch was served.

Staff encouraged people to undertake activities and supported them to become more independent. Staff spent time engaging people in conversations, and spoke to them politely and respectfully.

The providers and the registered manager investigated and responded to people’s complaints. People knew how to raise any concerns and relatives were confident that the registered manager dealt with them appropriately and resolved them where possible.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; questionnaires; and daily contact with the registered manager and staff.

The providers and registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The providers and registered manager understood the requirements of their registration with the Commission.

We found 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.

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?

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

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice is identified and people are protected.

Is the service effective?

The service was effective. People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw that where appropriate people had signed and confirmed that they had been involved in writing them and they reflected their current needs.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as, 'The staff are very helpful' and 'The staff are kind and are always good to me'.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

People knew how to raise a concern, if they were unhappy. Two people told us that they had raised concerns with the manager and that they were satisfied with the outcome. People can therefore be assured that their concerns would be listened to and action taken as necessary.

Records showed that the service was responsive to people's changing needs. For example, when a person felt unwell their doctor was called.

Is the service well-led?

The service was well-led. The company and the manager had systems in place to provide ongoing monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

We noted that people at the home were comfortable, dressed appropriately and able to move freely around the home. Problems had been addressed with regard to the smoking area and we observed the new system working effectively.

People told us that they liked living at the home because it "was very comfortable, and one person told us she "felt well looked after by the staff". People told us that the staff were always kind and considerate. People who used the service told us that the staff had been busy but their needs had still been met.

We saw that people were responsive in the company of staff. They were able to let staff know what they wanted and we saw that staff responded in a caring and positive way. During the inspection we found that there were appropriate numbers of suitable staff and staff were given the support they needed to carry out their role effectively.

People knew how to make a complaint or raise a concern and told us that staff would act on items raised and resolve them quickly.

People using the service told us that they enjoyed staying at the home. They said the staff were polite and respectful.

One person told us; 'I have been here for two years, it's a nice home, they really look after me and I feel safe. I would not wish to live anywhere else'. A relative commented; 'My relative is very well looked after, they receive the best care here'