Hall Park Care Home

We found the following examples of good practice.

¿Staff had a designated area to change and put on personal protective equipment. The registered manager told us how they had zoned different areas when they had an outbreak of COVID-19 to enable them to contain the spread of the virus..

¿ There was a personal protective equipment (PPE) station by the main entrance that also offered gloves, masks and aprons for people if required. Safe arrangements were in place for professional visitors and COVID-19 vaccination status was checked as well as lateral flow testing. Visitors to people living at the service were also requested to carry out lateral flow tests to reduce the risk of people contracting the virus.

¿ Staff had a separate entrance to use that meant they did not have to pass through the main areas of the service and went straight to an area where they were able to change their clothes before starting their shift.

¿ Isolation, cohorting and zoning was used to manage the spread of infection. This meant people self-isolated in their bedroom’s rooms where necessary.

¿ There was plenty of PPE including masks, gloves, aprons and hand sanitiser available.

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.

¿ We saw cleaning schedules and audits were carried out and cleaning took place throughout the day.

¿ Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe. All staff had completed training in relation to infection control and had received training about the correct use of PPE including donning and doffing.

Hall Park is a care home providing personal care for up to 62 people. There were 32 people living at the home at the time of our inspection. 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.

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

Staffing levels were not adequate to effectively support people. People were not always kept safe due to the lack of suitably trained staff.

Risks were not always managed and monitored. Risk assessments were in place but there were not enough staff to mitigate risk.

Management and leadership were not consistent. Changes in management were frequent and people lacked confidence in management.

People and their relatives were not engaged with in a meaningful way. There was no consistency in managers approach to people.

Management were not always open and honest with people and their relatives which had led to a lack of confidence in approaching management.

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

Medicines were managed and monitored well. Records were clear and staff had been trained and assessed in giving medication to people.

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 1 February 2019)

Why we inspected

We received concerns in relation to the management of falls. As a result, we undertook a focused inspection to review the key questions of safe 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 effective.

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

The overall rating for the service has changed from good to 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 Hall Park on our website at www.cqc.org.uk.

We have identified breaches in relation to safe care and treatment, good governance and staffing levels 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 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.

• People were isolating in their bedrooms and outside each bedroom there was a supply of PPE and waste management. Improvements were required to ensure PPE was stored correctly and that hand sanitiser was readily available. The provider took action to address this.

• Additional cleaning of frequent touch points such as door handles, and hand rails were being completed. Action was required to ensure cleaning standards were maintained. The provider took action to address this.

We found the following examples of good practice.

• The service had a COVID-19 outbreak at the time of the inspection and was therefore closed to non-essential visitors. Measures were in place for essential visitors, who were required to have a temperature checked and a COVID-19 lateral flow test. Personal protective equipment (PPE) , hand sanitiser and COVID-19 information was available in reception and a clinical waste bin for used PPE.

• People were supported to maintain contact with their friends and family via telephone and Skype calls. Prior to the current COVID 19 outbreak, staff facilitated pre-planned visits. An outdoor pod had been created to safely support people to see relatives or friends.

• Relatives and friends were kept informed via telephone and email of information about people’s health, care and welfare needs.

• The provider had ensured staff had an ongoing supply of PPE.

• Staff had received training in the prevention and control of infections. The management team completed daily walk arounds to ensure staff were compliant with PPE.

• The provider had a COVID-19 and business continuity plan, and associated risk assessments to mitigate risks.

• Both staff and people who used the service received regular COVID-19 testing and had received the COVID-19 vaccination.

We found the following examples of good practice.

¿ The provider had developed robust “meet and greet” protocols for visitors to the home. Staff took visitors temperatures and completed a simple screening questionnaire to ensure visitors were well at the time of the visit. Personal protective equipment (PPE) was available in the reception area in case visitors did not have their own PPE.

¿ People were supported to stay safe when they met their friends and/or family members by ensuring meetings were carried out in line with national guidance.

¿ Changes had been made to meal times and communal environments to promote social distancing.

¿ There were detailed risk assessments to manage and minimise the risks COVID-19 presented to people who used the service, staff and visitors. The manager carried out daily walk rounds to ensure the home was clean and staff followed the PPE guidelines.

¿ The provider implemented comprehensive guidance and a flow chart to ensure all staff knew what to do in case there was an outbreak of an infection.

¿ Staff used a separate entrance to the home that led them in to the staff room. Staff changed their uniforms at the start and end of their shift to reduce the risk of cross infection.

¿ People were not admitted to the home unless they tested negative for COVID-19. There were procedures in place to isolate new admissions for a further two weeks to ensure they were free of the virus.

¿ The home took part in the whole home testing process. People at the home were supported to decide if they wanted to take part in testing. If people were unable to make this decision for themselves, best interest discussions were held with relatives and other professionals involved in their care.

¿ Wellbeing support was offered to staff should they need it. This included signposting staff to a confidential helpline if they had any anxieties about working during the COVID-19 pandemic. The provider had also given staff bonuses and small gifts to say thank you for their hard work.

¿ Cleaning schedules had been increased and additional audits had been implemented to monitor cleanliness and staff compliance with the provider's infection control policy. Cleaning of the communal areas and touch points was completed more frequently.

Further information is in the detailed findings below.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring, that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was in place. 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 continued to feel safe and staff ensured that risks to their health and safety were reduced. We found that sufficient staff were deployed to safely meet people’s needs and that staff had received training to ensure they had the knowledge to protect people from the risk of avoidable harm or abuse, whilst providing care.

People were protected from the risk of an acquired health infection, as the service employed dedicated cleaning staff to ensure the environment was clean and had appropriate policies and procedures to monitor and reduce the risk

Systems were in place to support people to take their medicines safely. Staff received relevant training and felt well supported. People were asked for their consent to their care and appropriate steps were taken to support people who lacked capacity to make decisions.

People were supported to eat and drink enough to maintain good health.

There were positive and caring relationships between people using the service and the staff who cared for them. Staff promoted people's right to make their own decisions about their care where possible and respected the choices they made. People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated with dignity and respect by staff who understood the importance of this.

People received person-centred and responsive care from staff who had a clear understanding of their current support needs. Care plans were in place, which provided information about the care people required.

People knew how to make a complaint and there was a clear complaints procedure in place.

When people were at the end of their life the service had effective measures in place to support them and ensure their wishes and needs were met.

An open and transparent culture enabled people and staff to speak up if they wished to. The management team provided strong leadership and a clear direction to staff.

There were robust quality monitoring procedures in place. The management structure of the service was clear.

Further information is in the detailed findings below

Hall Park Care Home provides accommodation to older people in the Nottingham area. It is registered for a maximum of 62 people. There were 58 people receiving care and support at the home at the time of our visit.

On the day of our inspection there was a registered manager in place. 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 felt safe and the home offered a safe environment for people to live. They were supported by staff who understood how to report allegations of abuse. Risk assessments were in place to identify and reduce the risk to people’s safety. Staff were in place to keep people safe and medicines were stored and handled safely.

People were supported by staff who received a comprehensive induction and training programme. Staff told us they felt well trained and supported by the registered manager and they were knowledgeable about the people they cared for.

People’s rights were protected under the Mental Capacity Act 2005. People received sufficient to eat and drink and had a good experience at meal times. People had access to other healthcare professionals and received effective care that was relevant to their needs.

People were treated with kindness and compassion and spoke highly of the staff. Staff interacted with people in a friendly and caring way. People’s privacy and dignity was protected and they felt able to contribute to decisions made about their care. Information was available should people wish to receive support from an independent advocate if they needed one.

People’s care records focused on people’s wishes and respected their views. Staff responded to people’s needs promptly. They encouraged people to participate in activities that were available in the home which reflected their needs. A complaints process was in place and staff knew how to respond to complaints.

People, relatives, staff, and healthcare professionals all complimented the registered manager. People were encouraged to contribute to the development of the service. The registered manager actively sought people’s views and acted on them. There were systems in place to monitor and improve the quality of the service provided. The service was led by a registered manager who had a clear understanding of their role and how to improve the lives of all of the people at the service. They had a robust auditing process in place that identified the risks to people and the service as a whole and they were dealt with quickly and effectively.

Due to concerns at the previous inspection, we checked that people in the service were consenting to the support they were offered. We saw the service had now arranged for people or their representatives to sign documents to denote their agreement.

Is the service safe?

People told us they felt safe. Staff were confident to raise safeguarding concerns and were able to describe the steps to take if they were concerned any abuse had taken place. There were sufficient numbers of staff on duty to meet the needs of the people in the service. The premises were secure from anyone entering unannounced, and care records were retained in secure areas and only accessed by authorised staff.

Is the service effective?

People can be reassured their needs will be met at this service. Each person had a detailed care plan that described their support needs. Staff had a good understanding of people's needs and they knew people in the service well. One relative told us, "They're all nice staff. I like it here.'

Is the service caring?

People told us they were supported by caring staff. We saw staff showed patience when they were with people. One staff told us, 'We like to spend time with people, listen to them.' We saw people were not rushed to make their own decisions. A survey which had been sent to families in 2014 was complimentary and positive.

Is the service responsive?

People's support needs were assessed before they arrived at the service. Care records reflected people's individual needs and described staff interventions. People and their relatives were invited to meet with their keyworkers each month to review their care plans where necessary. People had access to hobbies that were important to them. Healthcare professionals were readily available if necessary.

Is the service well-led?

The provider had systems in place to monitor the quality of the service being provided. These included feedback by the use of monthly audits, complaints received and surveys issued. All findings were evaluated and actioned. Staff had a good understanding of the aims of the service. All care records we viewed were current. All risks had been assessed, and safeguards put in place where necessary.

We spoke with nine people who used the service. One person said, 'Carers are very nice and helpful. They respect our privacy and dignity.' Another person said, 'I have the choice. I can go to bed and get up when I want. I like to be independent. They only help me when I needed it.' A third person said, 'It's a nice home. The carers treat me with kindness and they respect my privacy and dignity.'

We found that the service treated people with dignity and respect. However, we were concerned that consent to care and treatment was not always sought from people who used the service.

We found that people were cared for and their individual needs were being met by the service. However, we were concerned that people's nutrition and hydration needs were not always met.

We found that people who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We saw staff interactions with people who use the service were mainly caring and polite. We found there were enough staff available to meet people's individual needs.

We found the service had an effective quality assurance system in place. People told us they were supported in commenting on the service they received. We found a number of shortfalls regarding the record keeping, there were gaps in the information to identify if the person's needs had been met.

We spoke with four relatives of people using the service. We were told, 'I am happy with the care my relative receives, the staff are very nice.' One relative commented that staff made efforts to keep them informed of their relative's health, 'The staff communicate well and always update me with things.'

During our visit we observed staff to be kind and patient when interacting with people using the service.

We spoke with four people who were using the service during our visit. The people we spoke with felt that there were many different ways they could give their opinion of the quality of service. People also felt that their opinions were listened to and responded to effectively. The provider may find it useful to note that not everybody felt the resident's meeting forum was as effective as it might be.