Hurstway Care Home

Hurstway Care Home is a nursing home providing personal and nursing care to up to 42 people. The service provides support to older adults including those living with dementia. At the time of our inspection there were 29 people using the service. Hurstway Care Home is a purpose built home consisting of two separate floors. People have their own bedrooms and en-suite bathrooms. They have shared use of lounges, dining areas and a garden.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

Some hazards and health and safety issues around the home had not been identified or addressed. Monitoring of some people’s risks around weight loss and skin integrity was not robust. Some gaps in medicines administration records were found and stock counts were not always accurate. Staffing levels were appropriate to people’s needs.

Care plans lacked detailed guidance for staff around supporting people with some medical conditions. Some relatives told us they had not been involved in developing or reviewing people’s care plans. We saw some improvement in the personalisation of people’s rooms, but the home décor was tired and in need of redecoration and repair. People told us they enjoyed the food.

Systems and processes in place to monitor and identify risk were not always effective. In some cases risks had been identified but not addressed in a timely way. Relatives told us communication with staff was not always effective. Staff were positive about the new management team and the changes being introduced.

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

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 February 2022) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement for the last three consecutive inspections and prior to that was rated inadequate.

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about the management of skin health and the risk of pressure wounds. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the management of skin health and the risk of pressure wounds, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe, Effective and Well-Led.

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 remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective and Well-Led sections of this full report. The provider took action to address the concerns identified during the inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to governance and management of safety and risk in the home at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Hurstway Care Home is a nursing home providing personal and nursing care to 29 people aged 65 and over at the time of the inspection. The service can support up to 42 people across two floors in a purpose-built setting. The service specialises in providing care to people living with dementia.

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

People and their relatives told us they felt safe. One person said about their loved one; “I know she’s happy and safe, she’s fine.” We found some improvements were needed around medicines management. We saw that how staff time was managed during busy periods needed changing to improve safety and efficiency. Relatives told us and we saw that the home was clean.

We saw staff sometimes told people what they were doing rather then asking them. An activity coordinator had just been recruited to help people engage in more meaningful pastimes and hobbies. People were supported to eat healthy foods. Staff told us although they didn’t all feel they got supervision; the manager was very supportive.

Systems to monitor safety and quality of care had not identified some issues which could negatively impact on people’s experiences. People received support from healthcare professionals when their needs changed. We saw that staff communication could be improved. Relatives and staff spoke positively about the registered manager.

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

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 02 June 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, staff training and cleanliness. As a result, we undertook a focused inspection to review the key questions of safe effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains 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 Hurstway Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to shortfalls in the management of the service at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Hurstway Care Home is a care home providing personal and nursing care for up to 42 people, some living with dementia, in one adapted building. The service accommodates people across two floors. At the time of the inspection 27 people were living there.

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

At the last inspection we had identified multiple breaches in regulations 12 safe care and treatment, 13 safeguarding service users from abuse and improper treatment, 16 receiving and acting on complaints, 17 good governance, 18 staffing and regulation 18 registration regulations 2009 notifications of other incidents.

We found at this inspection sufficient improvements had been made to meet the breaches under regulations 12, 13, 16, 18 and registration regulation 18. However, there were some further improvements required. This meant the service remained in breach of regulation 17 good governance.

Care plans and risk assessments had been, or were in the process of being, reviewed. There was some further improvement to be made to ensure people's assessed needs and identified risks were consistently and accurately recorded. Relatives felt their family members were safe. Risks associated with COVID-19 were assessed and mitigated. Medicines were managed safely. Staff understood safeguarding and safeguarding concerns were referred to the local authority. Incidents and accidents were monitored for future learning. There were enough staff on duty to meet people's needs and recruitment processes were in place to safely recruit staff.

Staff felt supported by the new manager and told us the running of the home had improved since its last inspection. Staff had started to receive supervision to help them in their roles and training had been completed or in the process of being arranged for them. We found there was good communication with healthcare agencies. We saw kind interactions with people.

Everyone spoken with said the new manager had improved the service's communication. The manager understood their regulatory responsibilities. There was ongoing improvement required to the service’s quality assurance processes to ensure the service was monitored effectively.

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

Rating at last inspection and update

The last rating for this service was inadequate published 15 September 2020 (update published 13 January 2021) and there were breaches of regulations. The enforcement action taken included imposing conditions on the provider’s registration to promptly address the issues identified. At this inspection we found some improvements had been made.

This service has been in Special Measures since 15 September 2020. During this inspection the provider demonstrated that some improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now meet legal requirements.

This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. The ratings from the previous comprehensive inspection for those Key Questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to regulation 17 good governance at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hurstway Care Home on our website at www.cqc.org.uk.

Since the last inspection we recognised that the provider had failed to have a registered manager in place and had failed to notify us of serious incidents. This was a breach of regulation and we issued two fixed penalty notices. The provider accepted the fixed penalties and paid them in full.

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.

The Hurstway is a care home providing nursing and personal care to older people and people with physical disabilities. The care home is registered to provide support to 42 people. At the time of the inspection 37 people were living at the home. The accommodation is provided over two floors each of which has its own communal areas and a small kitchen.

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

Care and treatment was not provided in a safe way. The providers systems failed to identify risks to people or if risks were identified they were not managed effectively.

Systems in place failed to safeguard people from the risk of abuse. Support for staff to carry out their role was not effective. Staff were not always following current government guidance in relation to COVID19 to prevent the risk of infection.

People received their medicines when needed.

There was a lack of provider oversight which meant risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm. The systems in place failed to identify the areas for improvement found at this inspection.

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

Rating at last inspection and update

The last rating for this service was Good (Published April 2019).

Why we inspected

The inspection was prompted due to concerns about the service in relation to safeguarding incidents, whistleblowing concerns and concerns that we were not being notified of incidents at the service. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. We only looked at safe and well led during this inspection. We did not look at the key questions of effective, caring and responsive. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding, staffing, complaints, governance and failure to notify. Immediately after the inspection we wrote to the provider and requested they provided us with urgent information telling us what they were doing regarding safe care, the management of risks, infection control and management oversight.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This means we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the 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.

People’s experience of using this service:

The service continued to meet the characteristics of good.

• The risks to people’s health and wellbeing were assessed and action taken to reduce them. People were protected by staff who understood how to protect them from avoidable harm. There were enough staff deployed to keep people safe. People’s medicines were well managed and staff understood how to reduce the risk of the spread of infection. There were systems to learn from mistakes including the detailed analysis of accidents and incidents.

• Staff received training to enable them to do their jobs well. People were provided with care and support which protected them from discrimination. They were supported to maintain a healthy diet and had access to other health and social care agencies when needed. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The environment was adapted to meet their needs.

• There were kind and caring relationships between people and staff which were based on dignity and respect. People felt involved with decisions and that staff respected their wishes. Families were welcomed at any time.

• People had care and support provided which met their preferences. Complaints were handled appropriately and line with the provider’s complaints policy. People did not currently receive end of life care but people had discussed their wishes with staff.

• Staff enjoyed working at the service and felt respected and valued. People could give their views about how the service could develop and improve. The provider’s quality assurance processes were effective in identifying potential risks to people’s safety. There was a continued focus on learning, development and improvement.

More information is in the full report.

Rating at last inspection: The service was last inspected on 24 February 2016 and was rated good.

Why we inspected: This was a scheduled inspection based on the date the service was registered.

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.

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

Hurstway Care Home provides personal and nursing care to up to 42 people. Some of the people that lived there were living with dementia others suffered from illnesses associated with old age or physical disability. At the time of our inspection there were 37 people living there.

There was 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.

People were protected from harm because staff understood their responsibility to take action to protect people and the provider had systems in place to minimise the risk of abuse.

People were involved in planning their care and management of any risks identified in relation to the care they received. People received care and support from staff that were trained and supported to carry out their roles.

There were sufficient staff available to meet people’s needs and recruitment processes ensured that suitable staff were employed.

People were supported to receive their medicines as prescribed.

People were supported to make choices and decisions about the care they received. People’s human rights were protected by staff that were caring and that ensured that privacy and dignity was maintained.

People received food and drinks and support from healthcare professionals to ensure they maintained good health as far as possible.

People were supported to maintain contact with people important to them and were able to express their views about the service.

Systems were in place to monitor the quality of the service provided.