Archived: Hawksyard Priory Nursing Home

Hawksyard Priory Nursing Home is a nursing and residential home providing personal and nursing care to up to 105 people over three different floors. There is access to a church and gardens at the service. The service provides support to people with physical and emotional needs, some of whom are living with dementia. At the time of our inspection there were 54 people using the service.

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

People did not always receive safe care and treatment as action was not taken in a timely way to reduce risks following accidents and incidents. Where people were being supported on a one to one basis by staff due to risks, accidents or incident they did not always receive this. People were left for periods of time unsupported by staff placing them at risk of harm.

People who were at risk of choking were not supported by staff effectively to reduce this risk. People who required support to eat did not always receive this in line with their needs. Where people were at risk of dehydration and malnutrition this had not always been identified, and where raised by external professionals, action was not taken to reduce future risk in a timely way.

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

Why we inspected

The inspection was prompted in part due to concerns received about people’s safe care and treatment and the management of risk. A decision was made for us to inspect and examine those risks.

We use targeted inspections to follow up concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Enforcement and Recommendations

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 continued breaches in relation to people’s safe care and treatment. 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Hawksyard Priory Nursing Home is a nursing and residential home providing personal and nursing care to up to 106 people over three different floors. There is access to a church and gardens at the service. The service provides support to people with physical and emotional needs, some of whom are living with dementia. At the time of our inspection there were 61 people using the service.

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

People were not supported in a safe way by staff who had clear guidance and knowledge around their needs and the associated risks. People were not supported in a safe way to receive their medicines. People were not supported in a well maintained environment. People involved in accidents and incidents were placed at prolonged risk of harm as action was not always taken to mitigate future risks. At times, people had to wait for support and their needs were not always met.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. People were not always supported in line with their needs around eating and drinking. People and those important to them were not always involved in reviews around their care. People did not always have timely access to healthcare professionals.

People were not treated in a caring way by staff that promoted their dignity and respected their independence. People's preferences were not always included within their care plans. Quality assurance tools had failed to identify where improvements were required to people's care and support placing them at prolonged risk of receiving poor quality care. People's feedback was not acted on in a timely way.

We have made a recommendation around the recruitment process and deployment of staff.

People felt able to complain and relatives felt staff knew people.

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 09 March 2022).

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

The inspection was prompted in part due to concerns received about the management of risk and leadership at the service. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

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

Enforcement and Recommendations

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 people’s safe care and treatment, dignity, capacity and consent, the upkeep and safety of the environment, supporting people safely with their nutrition and hydration and the leadership and oversight 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 with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 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.

Hawksyard Priory Nursing Home is a nursing home providing personal and nursing care to 73 people aged 65 and over and younger adults at the time of the inspection, some of whom were living with dementia. The service can support up to 106 people across three floors.

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

At our previous inspection we found information was not always available for staff to support people who required support with their behaviours. At this inspection we found the provider had not taken enough action to address this. Risk management systems were not in place to reduce the risk of skin damage. People’s right to privacy and dignity was not always respected by staff.

At our previous inspection we found audits did not identify improvements required. At this inspection we found action had not always been taken to ensure the effectiveness of quality audits.

Systems and practices in place did not follow best practice with regards to infection prevention and control to reduce or mitigate the risk of avoidable infections.

Although some staff had not completed safeguarding training, they knew how to safeguard people from the risk of potential abuse. Not all staff had been provided with relevant training to meet people’s needs safely. People had a lack of meal choices.

People did not always receive care in line with their care plans, even though they had been involved in their care planning. Plans were not always reflective of their current needs. People’s care was not always delivered in line with their choice or preference. People had limited activities and stimulation at the home.

During the inspection we did not see evidence of consistent use and recording of Best Interest decision making to show people had been supported in their best interests. Following the inspection, the provider sent us information to show how external professional had been consulted where decisions had been made on people’s behalf.

Improvements were made since our previous inspection to the management of medicines. Medicine stock levels now matched people’s medicine administration records.

People were cared for by staff who had been recruited safely. Systems were in place to record and monitor accidents and incidents and showed action taken to reduce them.

The environment was suitable to meet people’s needs. The provider worked with other health and social care professionals to meet people’s needs. People’s communication needs were assessed. Complaints were listened to and acted on. People’s end of life care wishes was documented in their care plan and included specialist input.

Staff were supported to be open and honest when things went wrong. The provider engaged and involved people using the service, their relatives and staff to make improvements to the home. The provider also worked with external agencies.

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 26 February 2021) where there was a breach of regulation 17. 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. The service remains rated requires improvement. This service has been rated requires improvement or inadequate for the last eight consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about infection control, safeguarding, pressure care and incidents. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

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 good governance, safe care and dignity and respect 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 also 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.

Hawksyard Priory Nursing Home is a nursing home providing personal and nursing care to people aged 65 and over and younger adults. The service can support up to 106 people across three floors. At the time of the inspection the service was supporting 64 people, some of whom were living with dementia.

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

Care plans were in place, however for some people there was a lack of recorded information available for staff in regard to distressed behaviours. There were not always enough staff to support those living with dementia.

Where people were prescribed ‘as required’ medicines there were some incorrect stock levels. Audit processes had not identified issues with behaviour management protocols within care plans or differing stock levels for some ‘as required’ medicines.

People were protected from the risk of abuse and by trained staff that understood how to keep people safe and the process to report any concerns.

Infection control guidance was being followed to ensure people were being protected against the risks in regard to COVID-19.

Statutory notifications were received as required. Systems were in place to learn when things went wrong and other professionals were contacted for support.

The manager understood their responsibilities, including duty of candour. People and staff were felt able to approach the management team.

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 30 October 2019) where there was a breach of a regulation 17

The provider completed an action plan after the last inspection to show what they would do and by when to improve the service. Overall an improvement was noticed in other areas that were not looked at as part of this inspection and there was no evidence that people had been harmed. However, the provider was still in breach of regulation 17.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions were not looked at on this occasion but were used in calculating the overall rating at this inspection. The overall rating for the service has remained as 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 Hawksyard Priory on our website at www.cqc.org.uk.

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

Follow up

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

Hawksyard Priory is a nursing home providing personal and nursing care to 50 people aged 65 and over at the time of the inspection. The service can support up to 106 people in one adapted building split over three floors. The home provides support to people living with dementia.

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

People’s medicine records were not consistently completed accurately and risk assessments and plans for mitigation were not always in place for people at risk. People were supported by enough safely recruited staff, however some improvements were needed to staff deployment.

Actions were not consistently taken to make improvements where these had been identified through quality audits and some audits were not effective in identifying concerns. Checks on the environment were carried out and recorded, however the records lacked detail to show if current guidance had been considered. We have made a recommendation about window restrictors.

People were protected from the risk of abuse and cross infection by trained staff that understood the procedures to keep people safe. Where people were involved in incidents, there was a learning process in place to prevent them from reoccurring.

People had their needs assessed and plans put in place to meet them, these included clear plans for maintaining their health and wellbeing and input from health professionals. People had a choice of food and drinks and their needs were understood by staff. The home had been adapted to meet people’s individual needs, staff were trained and were providing consistent support.

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.

People were supported by caring staff who they had developed good relationships with. Staff offered people a choice and supported them with decision making. People were treated well, with dignity and respect and had their privacy maintained.

People received support in a person-centred way. Individual needs and preferences were understood by staff and people were supported to do things they enjoyed. Needs and preferences for when people were receiving end of life care had been considered.

People were supported in an inclusive environment. The manager understood their responsibilities including duty of candour. Notifications were received as required. There were systems in place to learn when things went wrong, and partnerships were in place with other professionals. People were involved in the service and felt able to approach the management team.

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 (report published 15 May 2019) and there were multiple breaches 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 sustained and the provider was still in breach of some regulations.

This service has been in Special Measures since 15 May 2019. During this inspection the provider demonstrated that 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement

We have identified breaches in relation to how the home is governed and managed 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People did not consistently receive safe care. Peoples needs were not effectively planned for, risk assessments were not followed and medicines were not managed safely.

The systems in place to monitor the quality of care were not effective and actions were not driving improvements. This was a sixth time the service had been inspected and had failed to achieve a good rating; people had been exposed to poor care for too long.

Staff were not consistently trained and able to support people’s needs. People were not consistently receiving effective support. People were not always supported by caring and responsive staff.

People felt safe and their privacy and dignity was protected. People could choose for themselves. People had their views sought about the care they received. There were sufficient safely recruited staff.

The service met the characteristics of Inadequate in most areas and was rated Inadequate overall.

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

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 2 October 2018).

Why we inspected: This inspection was brought forward due to information shared with us which meant people may be at risk.

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

Follow up: The overall rating for the service is inadequate and the service will be placed in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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. We will continue to monitor intelligence we receive about the service until we return to visit.

At this inspection we found improvements had been made but more were needed and the provider was not meeting the regulations for governance arrangements. You can see what action we asked the provider to take at the end of this report.

Hawksyard Priory Nursing Home 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.

Hawksyard Priory Nursing Home accommodates up to 106 people in one adapted building. At the time of the inspection there were 79 people using the service.

There was a registered manager in post at the time of our inspection. 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 have made recommendations about staff training on the subject of dementia and about the environment being adapted to support people living with dementia.

Governance systems were not always effective in identifying concerns and driving improvements. Risks to people were not always clearly documented and medicines were not always stored safely.

People were not consistently supported by sufficient staff to meet their needs at their preferred time. People were not always protected from the risk of cross infection.

Staff had received training, however further work was required to ensure staff competency was checked effectively. Staff felt supported in their role. Improvements were needed to ensure the environment was suitable for people living with dementia. People did not always receive consistent care.

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

People received support from staff that were caring however improvements were needed to make sure that this was consistent. People’s communication needs were not always planned for. People were respected, however sometimes care was received that was not always dignified.

People’s preferences were understood by staff however improvements were needed to ensure care records reflected people’s preferences. Peoples end of life wishes were not always clearly documented.

Staff were safely recruited. People were safeguarded from potential abuse. People were supported to meet their dietary needs. People were supported to take their prescribed medicines. People were supported to maintain their health and well-being.

People understood how to make a complaint and these were responded to. Notifications were submitted as required and the registered manager understood their responsibilities. We found improvements were needed to how people and their relatives were engaged in the service.

The location has previously been rated as Requires Improvement. At this inspection the provider had not made all the required improvements. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

Hawksyard Priory provides nursing and personal care for up to 106 people some of whom may be living with dementia. At the time of our inspection visit there were 86 people living in the home.

There were two registered managers 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.

Staff were aware of the signs to look out for that might mean a person was at risk of harm but were not clear on when they should report concerns outside of the organisation when this was needed. Individual risks had been assessed and staff understood how to provide support although this information was not always recorded to ensure consistent care. Where people needed support to make decisions, capacity had not been assessed to ensure that it was clear why people could not make specific conditions.

Each area of the home had its own staff team and this had been organised around the number of people who used the service. There was not always support in all areas to keep people safe. There were opportunities for people to engage with activities although some people felt they were would like more opportunities to engage with others and spent a large amount of time unoccupied. Staff felt supported by the registered manager but some staff felt that more supervision and training would help them to be able to support people more effectively. Quality assurance systems were in place although these systems had not identified these concerns and improvements were needed in the service.

People felt that staff were kind and caring. Staff treated people with respect and ensured their privacy and dignity was upheld. People received prescribed medicines when they expected and needed them. The provider had a complaints procedure available for people who used the service and complaints were managed and investigated.

People received support to manage their health and saw specialists where needed. Recruitment checks had been carried out to ensure new staff were safe and suitable to work with people who used the service.

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 the report.

Hawksyard Priory provides nursing and personal care for up to 106 people some of whom may be living with dementia. At the time of our inspection visit there were 91 people living in the home.

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.

Further improvements were needed to ensure medicines were managed safely. Some medicines and nourishment supplements were not recorded correctly to demonstrate people had these. Hygiene practices needed to be improved to ensure hands were washed and medicines were not handled by staff.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them. Where restrictions were placed upon people these had not always been identified to ensure any restriction was lawful.

People were supported to eat and drink and there was a choice of foods available. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed assistance, this was done in a caring and supportive way.

There was sufficient staff to meet the assessed needs of people who used the service. The staff were kind and treated people with dignity and respect and helped them to make choices about how they wanted to spend their time and be supported. People’s care needs had been assessed and reviewed to ensure they received care to meet their individual needs. The care records detailed how people wished to be cared for and supported and evidenced where people had been involved with any review. Staff received training to meet identified needs.

Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence

Health care professionals visited the service regularly to provide additional healthcare services to people and staff supported people to attend appointments and liaised with their GP.

People were confident they could raise any concerns with the registered manager or staff and were complimentary about the service provided. The registered manager was approachable and provided support to the staff team. People were encouraged and supported to provide feedback on the service and there were effective systems in place to review and improve the quality of the service provided.

You can see what action we told the provider to take at the back of the full version of the report.

We saw that people who lived at the service were happy with the care they received, and that they enjoyed activities and social events. One person told us: 'I have no qualms at all'. Another person told us: 'It's lovely here, really wonderful'.

When we last inspected in January 2013 we had concerns about nutrition and the choice of food and drink available. At this inspection we found that menus were on display and that there were drink stations on every floor of the home with a wide range of drinks available.

We found that the home was clean and tidy throughout with clear cleaning and maintenance schedules. This meant that people had small repairs carried out to their rooms in a timely manner.

We saw that the home had staff rotas based on the needs of the people who used the service. One person told us: 'They are usually swimming in staff here' Another person told us: 'They have plenty of staff you can always find someone'.

We found that the service took appropriate steps to audit the quality of care it provided.

We saw that the people's plans of care reflected individual needs and were personalised. One of the people who lived there told us, "The care is lovely. The staff listen to what you want". A visiting friend told us, "It's always wonderful here. My friend receives very good care. Everyone is so friendly". We had some concerns with the way some elements of the planned care was recorded.

We had some concerns about the way people were supported to eat and drink. One of the people who lived at the home told us, "The food is always excellent. I am always offered something I would like". Another person told us, "I don't get enough choice".

We saw that medicines were stored and administered properly, and that best practice guidelines were followed. We saw one visitor requested some pain relief for their relative. The visitor told us, "They come straight away if we need anything".

We saw that there was a detailed training matrix for all members of staff. One member of staff told us, "There is plenty of training and we can ask for more if we want. It's really good".

We found that there was a system for raising complaints and concerns. One relative told us, "I have no cause for complaint, but if I did I could raise it and it would be sorted straight away".