Hardwick Dene

We found the following examples of good practice.

External health and social care professional visitors had to show their vaccination status and complete a rapid COVID-19 test before visiting the home. They also had to wear the correct personal protective equipment (PPE) before entering.

Staff supported people to use computer tablets and phones to video call and/or communicate with family and friends. This promoted people’s social well-being.

Staff and people at the home were taking part in whole home COVID-19 testing. Staff were tested for COVID-19 once a week and had rapid COVID-19 tests daily during the outbreak of COVID-19. Staff staggered their breaks to promote and maintain social distancing.

Staff were observed to be wearing their PPE correctly including face masks. Staff were bare below the elbow and were wearing a minimum amount of jewellery with long hair tied up that promoted good infection control. Infection prevention and control was discussed with staff and the registered manager during staff’s supervisions.

Housekeeping staff cleaned throughout the home regularly. This was to promote and maintain good infection control practices.

The provider had given monetary vouchers to staff as a thank you for all their hard work during the COVID-19 pandemic.

Hardwick Dene is a residential care home providing personal and nursing care to 31 older people at the time of the inspection. The service can support up to 47 people in seven units each having separate adapted facilities.

We found the following examples of good practice

The service was not allowing any visiting at the service at the time of this inspection, unless for exceptional circumstances for example, if a person was receiving end of life care.

The building was clean and free from clutter. The deputy manager told us that staff were undertaking cleaning of high touch points on a regular basis. We witnessed this during our inspection.

Whole home testing for COVID-19 was in place for people, visitors and the staff.

Phone calls and video calls were available to people to stay in contact with friends and relatives.

Chairs in communal areas such as the dining room had been spread out to promote social distancing.

• People who used the services were not protected against the risks associated with unsafe management of their medication.

• The provider failed to maintain accurate and complete records in respect of each person’s care and treatment.

We carried out a focussed inspection on 24 May 2017 and found that the provider had made enough improvement for them to no longer be in breach of the regulations. However the service remained rated as requires improvement.

At this inspection on 5 December 2017 we found the service had made further improvements and is now rated good.

Hardwick Dene is a ‘care home’. People in care homes receive accommodation and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Hardwick Dene accommodates 50 people in one adapted building. At the time of our unannounced inspection there were 39 older people and people living with dementia living at the service.

The Care Quality Commission (CQC) records showed that the service had a registered manager. However, they were not in post during this inspection. They had left the service and needed to cancel their registration. There was an acting manager in place to carry out the day-to-day running of this service. They had started their application with the CQC to become the 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.

Staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff were knowledgeable about how to report poor care practice and suspicions of harm. Information and guidance about how to report concerns, together with relevant contact telephone numbers was displayed as a prompt to staff, people who used the service, and their visitors to refer to. Pre-employment checks were in place to make sure that new staff were considered suitable to work with the people they were supporting.

People were assisted to take their medication as prescribed.

Processes were in place and followed to make sure that infection control was promoted and the risk of cross contamination was reduced as far as practicable.

The service had adaptations in place to help people with limited mobility such as handrails, sloping floors instead of steps, a stair lift and a passenger lift.

Staff were available to support people’s individual needs in a caring, patient and respectful manner. People’s privacy and dignity was maintained and promoted by the staff supporting them.

People and their relatives were given the opportunity to be involved in the setting up and review of their individual support and care plans. Staff encouraged people to take part in activities and trips out into the local community. People’s friends and family were encouraged by staff to visit the service and were made to feel welcome.

People were supported by staff and external health care professionals, when required, at the end of their life to have a comfortable and dignified death.

People had individualised care and support plans in place which recorded their needs. These plans informed staff on how a person would like care and support to be given, in line with external health care professional input. Individual risks to people were identified and assessed by staff. Plans were put into place to minimise these risks as far as practicable to enable people to live as independent and safe a life as possible.

People’s health and nutritional needs were met. People were assisted to access a range of external health care professionals and were supported to maintain their health and well-being.

Staff were trained to provide effective care which met people’s individual needs. The standard of staff members’ work performance was reviewed by the manager through supervisions, spot checks and appraisals.

Compliments about the care provided were received and complaints were investigated and action taken to make any necessary improvements. However, complaints records did not demonstrate that the manager always followed the provider’s policy around how all complainants should receive a formal acknowledgement of their complaint and a formal response following the investigation.

The manager sought feedback about the quality of the service provided from people, their relatives, and staff. There was an on-going quality monitoring process in place to identify areas of improvement required within the service. Where improvements had been identified, actions were taken to make the required improvement. Learning from incidents took place to reduce the risk, as far as practically possible, of recurrence.

Records showed that the CQC was informed of incidents that the provider was legally obliged to notify us of.

Further information is in the detailed findings below.

After this comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. They told us that these improvements would be completed by 31 March 2017.

We undertook this unannounced focused inspection on 24 May 2017 to check that the provider had followed their plan and to confirm they now met legal requirements. This report covers our findings in relation to those requirements. It also covers additional concerns raised with the Care Quality Commission (CQC) prior to the inspection. These concerns were that the provider did not make sure that there were sufficient staff to meet people’s needs and concerns around the cleanliness of the service and infection prevention control.

At our focused inspection, we found that the provider had followed their plan and legal requirements had been met. This was because the majority of improvements required had been made.

Hardwick Dene provides accommodation and personal care for up to 50 people including those people living with dementia. Accommodation is located over two floors. There are communal areas for people and their visitors to use. There were 36 people living at the service when we inspected.

At the time of this inspection there was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

People’s medicines were stored and disposed of safely. Accurate records were held. People were supported to take their medication as prescribed and medication was managed by staff whose competency had been assessed. However, people’s ‘as and when required’ medication protocols did not always detail what steps staff were to take prior to the administration of this medication for pain relief or to manage people’s anxieties.

The majority of people’s records, including records to monitor their assessed risks, were accurate and complete. Care plans informed staff of people’s individual needs and recorded people’s choices, and any assistance they required. Risks to people who lived at the service were identified, and plans were put into place by staff to minimise and monitor these risks.

There were infection control procedures and cleaning schedules in place to reduce the risk of cross contamination and promote infection control prevention.

We saw that there was a sufficient number of staff to meet the needs of people living at the service during our inspection. Consistent agency staff were used to fill any staff shortfalls, whilst the registered manager recruited new staff. A dependency tool (people’s assessed dependency support needs) was used by the registered manager to determine safe staffing levels.

Whilst improvements had been made we have not revised the rating for the key questions; is the service safe? Is the service well-led? To improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

Accommodation is located over two floors which are accessible via a lift or stairs. There are communal bathroom and toilet facilities for people who do not have en suite facilities within their room. There are two areas within the home, Buckden / Willow which accommodates people living with dementia and Goodwin for people with more advanced/ complex dementia. There are a number of communal areas within these areas, including lounge / dining areas, a reminiscence room and an outside garden area for people and their visitors to use.

This unannounced inspection took place on 15 November 2016.

At the last inspection on 19 January 2016 there were breaches of the legal requirements found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to improvements required. Improvements were needed to ensure that people were protected from the risk of receiving care that was inappropriate and did not meet their needs. People were also not protected against the risks associated with inadequate monitoring and the assessment of the quality of the service provided. The provider sent us an action plan telling us how they would make the required improvements.

During this inspection we found that the provider had made some improvement in regards to the previous breaches.

The home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the home. 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 home is run.

Arrangements were not always in place to make sure that people were supported and protected with the safe management of their prescribed medicines. Detailed ‘step-by-step’ guidance for staff about ‘as required’ medicine was not always in place. People did not always have their prescribed medicines available.

People had individualised care and support plans in place which recorded their care and support needs. Although staff were able to demonstrate their knowledge of the people they supported; the documented information available to staff was minimal. This increased the risk of people receiving care that was not based on their needs.

Individual risks to people were identified by staff. Plans were put into place to minimise these risks to enable people to live as independent and safe a life as possible. These documents prompted staff on any assistance a person may require. However, monitoring records for people deemed to be at risk of weight loss or dehydration were not always documented in detail or in a consistent manner by staff.

The registered manager sought feedback about the quality of the service provided from people living at the home. They had in place quality monitoring checks to identify areas of improvement required. However, these checks had not identified the areas of improvement required found during this inspection.

Safe recruitment checks were undertaken before new staff were employed and this meant that people using the service received care from suitable staff. We saw that there was a sufficient number of staff to meet the needs of people living in the Buckden / Willow area of the home. However, there was not enough staff to meet the complex needs of people living within Goodwin area of the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that there were formal systems in place to assess people’s capacity for decision making. However, this guidance was limited, as there was no documented evidence on the steps to be taken by staff to empower people to make their own decisions. Applications had been made to the authorising agencies for people who needed these safeguards. Staff had a basic understanding of the key legal requirements of the MCA and DoLS.

People who lived at the home were supported by the majority of staff in a kind and respectful way.

There was an ‘open’ culture within the home. People, their relatives, and visitors were able to raise any suggestions or concerns that they might have with staff and the registered manager and felt listened too.

People were supported to access a range of external health care professionals and were supported to maintain their health. People’s health and nutritional needs were met. Some people were not always offered a choice by staff on the snacks and drinks provided.

Staff were trained to provide effective care which met people’s individual support and care needs. Staff understood their role and responsibilities to report poor care and suspicions of harm. Staff were supported by the registered manager to develop their skills and knowledge through regular supervisions, appraisals and training.

Notifications are information on important events that happen in the home that the provider is required to notify us about by law. The registered manager was aware of and provided us with notifications of all of the important events they needed to notify the Care Quality Commission about.

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.

This inspection was unannounced and took place on 19 January 2016.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Some staff had yet to receive training in this subject and some of those spoken with during this inspection were not able to demonstrate that they were aware of the principles of the MCA or DoLS and their obligations under this legislation.

Care plans did not contain all of the relevant information that staff required so that they knew how to meet people’s current needs. We could not be confident that people always received the care and support that they needed.

The provider had a recruitment process in place and staff were only employed within the home after all essential safety checks had been satisfactorily completed.

People’s privacy was not respected at all times. Staff were seen to knock on the person’s bedroom door and wait for a response before entering. However, we found that two bathroom/toilet doors were unable to be locked. People’s dignity was not always protected because a visitor and a member of staf were heard talking about people without involving them in the discussion.

People were provided with a varied and balanced diet. However, the lunchtime experience in Goodwin was not positive and people had to wait to receive their lunch. Staff referred people appropriately to healthcare professionals. People received their prescribed medicines in a timely manner, and medicines were stored in a safe way, although the records were not signed by the person administering the prescribed medicine.

The provider had a complaints process in place and people were confident that all complaints would be addressed.

The provider did not have effective quality assurance systems in place to identify areas for improvement. Therefore they were not able to demonstrate how improvements were identified and acted upon.

We found two 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.