Haddon Hall Care Home

Updated 20 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Haddon Hall Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Haddon Hall Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A new manager had been in post for 3 months and told us they intended to submit an application to register.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service, and 17 members of staff including the manager, regional manager, chief executive officer, deputy manager, residential manager, home trainer, nurses, med techs, med techs are staff who had undertaken additional training in medicines and care assistants. We also spoke with 11 relatives about their experience of the care provided. We reviewed a range of records. This included multiple people's care records and medication records. We looked at 2 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 20 September 2023

About the service

Haddon Hall Care Home is a residential care home providing personal and nursing care to up to 75 people. The service provides support to older people, people living with dementia and younger adults. At the time of our inspection there were 61 people using the service.

Haddon Hall Care Home accommodates people in one building across 3 floors. Each floor has communal areas and outside balcony space. All bedrooms have ensuite bathroom facilities.

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

People were still not always protected from known risks to their safety, care plans did not always provide staff with enough information on how to support people with their skin integrity or hydration. Monitoring records in place for repositioning and fluid intake had not been fully completed or monitored. We found when people had experienced a fall, staff had not completed post fall observations and actions recorded as taken were not always evident in people’s care records.

Relatives and staff raised concerns with us about the staffing levels in the service. We reviewed the provider’s dependency tool and staffing rotas and found they did not consistently demonstrate the assessed number of staff had been deployed. Medicines were managed safely, and safeguarding systems were in place and followed by staff. Infection, prevention and control measures were found in place which reduced infection risk in the service.

Assessments of people’s needs had been carried prior to people using the service, however care had not always been delivered in line with people’s choice and preference. Where people had been assessed risks associated with eating and drinking, the monitoring of these risks had not been regularly reviewed to identify actions that may be required. Mental capacity assessments and best interest decisions were not always completed for all aspects people's care.

People were provided with a choice of balanced meals. Relatives consistently told us the food was good. Staff spoke positively about the training they had received, and effective systems were in place to supervise and support staff.

Systems and processes continued to not always be effective in identifying potential risks. Audits of monitoring charts had not always been thorough and did not identify the gaps in recordings we found. The provider’s policies had not always been followed in relation to fall prevention and this had not been identified by the audits carried out. The provider had not always learnt from feedback given and improved the quality of care. Whilst we found improvements in some areas, not all concerns we had found previously had been adequately addressed.

Relatives and staff spoke positively about the manager. People and their relatives had opportunities to provide feedback on the service in various ways such as in meetings, through questionnaires and in person and relatives told us they felt involved in the planning of people’s care.

Rating at last inspection and update

The last rating for this service was inadequate (published 9 May 2023). 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.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. 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 inadequate 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. 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 Haddon Hall Care Home on our website at www.cqc.org.uk.

Enforcement

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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 will mean 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 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.