Hayward Care Centre

Hayward Care Centre is a care home with nursing for up to 80 people over three floors. People had their own rooms and access to communal rooms such as bathrooms, dining rooms and lounges. People had access to outside space as the home had large gardens around the building. At the time of the inspection there were 68 people living at the home, some of whom had dementia.

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

People’s medicines were not always managed safely. People did not always receive the medicines they had been prescribed. During June 2022 there were eight incidents in which people were either not supported to take their medicine at all, or they received a lower dose of medicine than they had been prescribed. We also found one person had no stock of their medicine and had missed 14 doses due to a delay by the supplying pharmacist.

The provider did not have effective systems to assess the quality of the service and make improvements. The registered manager had identified the high number of medicines errors and had included actions to address this on a service improvement plan. Despite the actions that had been taken, the number of medicine errors had increased since January 2022. No formal survey of people who used the service had been completed by the provider in the previous two years. During the inspection people told us it was clear there were insufficient staff to meet their needs. The provider had not obtained feedback from people about staffing levels to assess whether their staffing tool was effective.

People told us there were not always enough staff and they had to wait a long time to receive care. Staff told us there were not enough staff available to provide care in the way they wanted to. Our observations demonstrated staff did not always have the time to create positive social interactions with people living with dementia. There had been three occasions since October 2021 when the home did not have a registered nurse in the building for a period.

The home was clean throughout. Staff were wearing appropriate personal protective equipment (PPE). We were told the provider had good stock of PPE and staff had never been without supplies through COVID-19.

People had visitors when they wished, and people told us they liked living at the home. People told us they felt safe and they liked the staff.

Risks to people’s safety had been identified and risk management plans were in place to give staff guidance where needed. Staff reviewed them regularly and updated them when needed. Systems were in place to make sure health and safety checks were carried out.

Staff worked in partnership with local professionals to make sure people’s health needs were met. The registered manager knew who to contact in the local authority if they needed guidance on COVID-19.

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 23 September 2020).

Why we inspected

The inspection was prompted in part due to concerns received about management of medicines. 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.

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 deteriorated to requires improvement. 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 Hayward Care Centre 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 medicines management, staffing and systems for governance at this inspection.

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.

Hayward Care Centre is a residential care home providing personal care for 40 people at the time of the inspection. The service can support up to 80 people.

Hayward Care Centre is a large, purpose-built care home. The home provides accommodation across three floors. When we inspected there were people living on the ground and first floor, accommodated in four separate units. Each unit had been named after a local area and people had access to lounge and kitchen-dining spaces. People had their own private bathrooms and the home had spacious communal gardens.

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

Medicines were not consistently managed safely. We found shortfalls in the way medicines were returned to the pharmacy and how medicines were recorded on the administration records. National best practice guidance for the administration of medicines in care homes was not always being followed. Following our feedback, the deputy manager had been assigned to review all medicines systems and to deliver updated training to staff.

Some staff were not consistently following good practice guidance around hand-washing and infection prevention. All staff were wearing suitable face coverings and changing these regularly. There were infection prevention and control measures in place to reduce the risk of visitors bringing infections into the home.

Records about people’s care needs were mostly well-maintained. There were some inconsistencies when monitoring some people’s drinks to ensure they were hydrated. Records showed, People who required support to maintain their skin integrity were assisted to reposition regularly. Also, when people had fallen or had an accident, there was regular monitoring of their wellbeing following the event.

We saw people engaging socially with one another and with staff. There were measures in place in the lounges and dining areas to ensure people were sat socially distanced. people had been supported to maintain social contact with their relatives.

Staff gave us positive feedback about the support they had received to enable them to care for people. They acknowledged it had been a very challenging period while supporting people during Covid-19, but different staff told us, “I don’t think we could have done any better.”

Not all shortfalls were identified in the management audits of the service, however action to address these was taken promptly and thoroughly. A range of audits were completed to monitor the quality of the service.

There was a robust management structure in place to lead the service. Staff spoke positively about the support they had received. Staff and the management team knew people, their interests and routines well.

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 14 May 2019).

Why we inspected

This inspection was prompted due to receiving different whistle-blower concerns about the quality of care provided to people at the service. Concerns had been received about how people and staff had been supported during the Covid-19 pandemic. They also included reference to poor medicines management, infection control, and shortfalls in the leadership of the home. We wrote to the provider to ask them to investigate the concerns.

We undertook a focussed inspection of the key questions of safe and well-led only. 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.

While we identified some shortfalls in the safety of the service, we did not find enough evidence to substantiate all allegations we had received. The overall rating for the service has not changed, based on the findings at this inspection.

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

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.

Hayward Care Centre is registered to provide accommodation for up to 80 persons who require nursing or personal care. The service is arranged over four units and provided specialist dementia care in two ground floor units. People were accommodated in all units.

People’s experience of using this service:

• Some people, relatives and staff told us there were shortages of staff. We saw this had been raised at residents’ meetings and by relatives through surveys. When we carried out observations of interactions with people we saw that staff were not always visible. When staff were present they engaged with people and we saw signs this interaction was enjoyed.

• While medicines were well managed there were areas that needed to improve. Medicines prescribed to be taken ‘when required’ (PRN) lacked detail and for some people were not personalised. Although protocols described how people might present when agitated, they did not inform staff of steps they should take to relieve the anxiety before resorting to the use of medicines. For some people their PRN protocols for pain relief were not personalised because there was no detail on how individual people would express pain and what ‘body language’ people might display.

• People told us they felt safe living at the home. The registered manager made referrals to the local authority safeguarding team as required. The staff we spoke with were knowledgeable about the procedures for safeguarding people from abuse. They knew the types of abuse and the reporting of abuse.

• . Risk assessments were in place. The care plans reflected the risk and gave staff guidance on minimising the risk. Where people’s behaviour was triggered by anxiety and frustration care plans gave staff guidance on managing these situations. We observed staff following this guidance.

• People told us the types of decisions they made and who supported them with more complicated decisions. Staff were knowledgeable about the principles of the Mental Capacity Act (2005). Records were in place to demonstrate the decision makers. Deprivation of Liberty Safeguards (DoLS) conditions were followed.

• The performance of staff was monitored, and their skills developed. There was a system for supporting staff’s performance. Staff feedback about the quality of the training was variable.

• We saw good interaction between people and staff and with relatives. There was good support for relatives to have meaningful time with their families. We saw people were not rushed.

• Care planning systems had improved. Guidance to staff was more detailed and included people’s preferences. Staff knew people well and where there was input from healthcare professionals this was part of the care plan.

• Quality Assurance systems were in place. There was a consolidated action plan in place. Staff said improvements had taken place. There was learning from accidents and incidents. There was a reflection meeting and input from health and social care professionals. Records were kept secure.

Rating at last inspection:

At the last inspection dated 21 and 22 March 2018 the Hayward Care Centre was rated Requires Improvement. This report was published on 20 June 2018.

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. At the inspection dated March 2018 we imposed conditions on the provider. The provider was required to develop the service and make improvements. We monitored the monthly action plans submitted.

Follow up:

We recommended the provider ensures the Duty of Candour guidance was followed.

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

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

This is the third time this service has been rated as Requires Improvement since 2015 and we are considering what further action will be taken in response. Full details of CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 21 and 22 March 2018 and was unannounced. The registered manager was aware of the visit arranged for the second day of the inspection.

Hayward Care Centre 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.

Hayward Care Centre is registered to provide accommodation for up to 80 persons who require personal care. The service is arranged over four units Avebury, Bromham, Keevil and Potterne. Specialist dementia care is provided to people accommodated in Potterne. At the time of the inspection there were 68 people living at the service.

A registered manager was not in post. The current manager told us they will be applying to register as 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.’

Risk management systems were mostly effective. The staff we spoke with were knowledgeable about people’s individual risks and the actions needed to minimise the risks. Risks were assessed and for some people risk assessments were developed but lacked detail on how to minimise the risk.

There were people who expressed their anxiety and frustration using behaviours that staff found difficult to manage and placed others at risk of harm. Staff told us they had attended training to develop their understanding of people living with dementia. Emotional plans did not give staff guidance on how to respond to people when they became anxious. For example, staff were to give encouragement but did not specify how this was to be provided to gain the desired outcome.

The safety of the living environment was regularly checked to support people to stay safe. For example, fire risk assessments, fire safety equipment checks and fire training for staff. Some people on the first floor said their access to the garden would be better if their accommodation was in the ground floor. Currently people depended on staff to access the garden.

Steps were taken to ensure medicine systems were safe. People told us staff administered their medicines. Medicine profiles included a photograph of the person and essential information such as known allergies and how the person preferred to take their medicines. However, for some people photographs were not updated. Members of staff were not always signing records to indicate the medicines administered. Procedures on the administration of medicines to be prescribed “when required” were not always person centred.

Staffing rotas were designed using dependency tools. However, feedback from relatives was that at times there were staff shortages and there was reliance on agency staff. We observed some people needed high levels of attention which limited the time staff spent with others. This meant people’s preferences were not always considered. At times people in Keevil and Rowde were left in lounges without staff supervision and engagement was task focussed.

The staff we spoke with were knowledgeable about the day to day decisions people made. Mental capacity assessments for some people lacked detail on the best interest decision. There were inconsistencies with the assessments of capacity for restricting people’s freedom. Mental capacity and best interests for people in Avebury and Bromham were in place and correctly assessed. Some relatives expressed concerns about how staff managed situations for people that resisted personal care or to take their medicines when they lacked capacity to make these decisions.

Care plans were not person centred and were not reflective of people’s preferences. We found inconsistencies with the monthly evaluation and identified need. Plans in relation to people’s emotional needs lacked detail and were missing for some people. Advanced Care plans were not detailed about people’s future wishes and priorities of care.

While there were resources for activities there was limited capacity for one to one time. Most group activities occured on Avebury and Bronham. Outings were organised weekly but the number of people that could join the trips was limited to 11 people.

Quality Assurance systems were in place. While infection control audits had taken place and shortfalls were identified we found some areas were in need of better cleaning regimes. A health and safety inspection checklist was used to audit that procedures were followed. The findings of this inspection were consistent with some areas identified in the improvement plan. However, not all areas identified at this inspection were part of the improvement plan.

The views of people about the service were gathered and action was taken in response to their feedback. Where relatives raised concerns the manager responded in writing on the actions taken to resolve their complaints.

We saw people seeking staff attention and reassurance. People made positive comments about the staff and their skills. We observed staff approaching people in a caring manner but on occasions we overheard staff using language that was not respectful to people.

The staff were knowledgeable about the aims of the organization. They knew how these values were embedded into practice. Staff told us the team was stable and they worked well together. They told us the manager was approachable.

Safeguarding processes were in place and ensured people at the service were safeguarded from abuse. Staff’s knowledge was good on the types of abuse and the actions needed where there were concerns of abuse.

The training records provided showed staff had attended training which the provider had set as mandatory.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. You can see what action we told the provider to take at the back of the full version of the report.

At the last inspection on 11, 12 and 13 May 2015 we asked the provider to take action to make improvements on reporting important events to the Care Quality Commission, ensuring staff were supported and trained to meet people’s needs and to follow guidance from healthcare professionals. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Hayward Care Centre is registered to provide accommodation for up to 80 persons who require personal care. The service was arranged over five units and provided specialist dementia care in Potterne. The other units provided residential and nursing dementia care.

A registered manager was 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.

Risks were assessed and action plans were developed for identified risks. Members of staff knew the actions needed to minimise risks. However, we found staff had not consistently followed the guidance for monitoring people’s fluid intake. We found the fluid intake records we audited for two people were not completed on consecutive days. We also found the target intake was not recorded on fluid monitoring charts. This meant staff were not always aware of people’s target fluid intake and were not provided with an audit trail of people with poor intake of fluid. The registered manager described the systems to be introduced to improve recording.

We saw staff enabling people to make decisions from the options given. Staff said there were people who at times became aggressive towards each other and the staff. Clear guidance on how staff were to respond to incidents of aggression were in place. However, records showed staff were not following guidance. For one person staff were given guidance to administer, when required, medicines before delivering personal care but had not followed the guidance and the person had become anxious during these periods.

Staff said staffing levels were not appropriate on two units. We saw that on one unit, during the lunchtime meal, the staff were stretched and did not give people attention and assistance with eating their meals. Staff said there had been changes of staffing with the opening of a unit and for some staff this had created low morale. The staff said there was heavy reliance on agency staff. The registered manager said the staffing levels were consistent with the dependency needs of people.

Care plans were developed in line with people’s assessed needs and for some people their likes and disliked were included. Life stories were not in place for all of the people living with dementia but were to be developed with the introduction of a staff member who was to be the dementia lead. Structured planned activities were not taking place. Staff said activities were more ad hoc but were taking place such as baking and music.

The people able to respond to our request for feedback told us they felt safe and people we observed greeted staff in a positive manner and did not show signs of distress when staff were present. Members of staff were knowledgeable about the procedures for safeguarding people from abuse. They knew the types of abuse and the actions they must take for alleged abuse.

People were supported with their ongoing health. People had regular visits from their GP and there was partnership working with healthcare professionals such as the care liaison team. Medicine systems were safe. Staff said medicine systems had improved. Protocols in place gave staff instructions on administering medicines prescribed to be taken when required.

Staff said the training was good and a variety of courses were available. Some staff said specialist dementia training was needed to ensure all staff had developed the insight and skills needed for working with people living with dementia.

People’s rights were respected. Members of staff were respectful towards people and the approach used depended on the situation. For example, some people responded to humour while others were more receptive when staff used logic and reasoning.

Quality assurance systems were in place which included internal audits and the necessary action was taken to implement change. Where there were shortfalls action plans were developed on how improvements were to be made to meet set standards.