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Reports


Inspection carried out on 9 October 2019

During a routine inspection

About the service

Hallgarth is a residential care home providing personal and nursing care to 54 people aged 65 and over at the time of the inspection. The service can support up to 60 people.

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

People felt safe and were happy living there. There were enough staff to meet people's needs. Medicines were managed effectively. Staff followed infection prevention and control guidelines. The service was clean and tidy. Risks to people were identified and managed.

Staff sought people's consent before providing care and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Staff training in key areas was up to date.

People were treated with kindness and compassion. Staff respected people's privacy and dignity and people were supported to be as independent as possible. Staff had built positive and caring relationships with people and their families.

People received personalised care that was responsive to their needs and preferences. Staff knew people's needs well. People and relatives knew how to make a complaint. Complaints were handled appropriately. People had access to a range of activities which reduced the risk of isolation.

There were effective systems in place to monitor the quality of the care provided. People's feedback was sought regularly and acted upon. We received positive feedback about how the service was managed.

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 25 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Inspection carried out on 7 March 2017

During a routine inspection

The inspection took place on 7 and 9 March 2017 and was unannounced. This meant the provider or staff did not know about our inspection visit.

We last inspected the service in October 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

Hallgarth is a care home in central Durham providing accommodation and nursing care for up to 60 older people who require nursing and personal care. There were 58 people using the service at the time of our inspection.

The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run.

We found the service had risk management processes in place, protecting people against a range of risks through clear instructions to staff.

Whilst there was a consensus that staff faced a challenging workload, we found there were sufficient numbers of staff on duty in order to keep people safe. All people and relatives agreed that staff were attentive and put the needs of people first.

All staff were trained in areas such as safeguarding, health and safety, moving and handling, infection control, mental capacity, dementia awareness, dysphagia awareness and food hygiene. Nursing staff received additional training relevant to their role, such as phlebotomy (bloods) training.

We found that the management, administration, storage and disposal of medicines was safely carried out and adhered to National Institute for Health and Care Excellence [NICE] guidelines. Where we identified areas that could be improved the service responded promptly.

People who used the service, relatives and healthcare professionals agreed that the service was effective in their management of people’s healthcare needs.

All people who used the service we spoke with, relatives and visiting healthcare professionals agreed staff were caring in their attitudes.

There were comprehensive pre-employment checks of staff in place and effective staff supervision and appraisal processes.

The service was clean and regular checks were in place to sustain high levels of cleanliness and suitability of premises and equipment.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). The registered manager displayed a good understanding of capacity and we found related assessments had been properly completed and the provider had followed the requirements in the DoLS.

People’s nutritional and hydration needs were met. We saw that menus were varied and people had choices at each meal as well as being offered alternatives if they did not want the planned options. Mealtimes we observed to be calm with staff attentive to people’s needs. We saw that the service had successfully implemented a tool to manage the risk of malnutrition and people requiring specialised diets were supported.

There was a consensus of opinion that the quality of meals had deteriorated in the past six months. The registered manager agreed to review the manner by which people were offered and chose their meals. We also saw interviews for a new cook had taken place the day before our inspection.

Person-centred care plans had been established and documents to ensure people’s life histories, likes and dislikes were incorporated into their care planning. Regular reviews ensured people’s medical, personal and nutritional needs were met.

The service had an activities co-ordinator in place and a range of communal spaces suitable for group activities or for families to have quiet time with their relative. The activities co-ordinator had sourced a range of external activities providers and other com

Inspection carried out on 13 October 2015

During an inspection to make sure that the improvements required had been made

We carried out this focused inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hallgarth Nursing Home on our website at www.cqc.org.uk

We carried out an unannounced comprehensive inspection of this service on 08 July 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

Two breaches of legal requirements were found during that previous comprehensive inspection on 08 July 2015. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these requirements.

The service had 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.

We found that all records we reviewed such as care plans had been regularly reviewed and these provided information about people’s care, treatment and support needs.

We found the provider had introduced systems to ensure the management of medicines were safe.

We also found medicines which were prescribed ‘as required’ (PRN) were handled and used safely.

Inspection carried out on 8 9 July 2015

During a routine inspection

This inspection took place on 8 and 9 July 2015 and was unannounced. This meant the provider was did not know we were inspecting the home at that time.

We last inspected Hallgarth on 2 June 2014 and found it was compliant with our regulations.

Hallgarth is registered with the Care Quality Commission (CQC) to provide care for up to 60 elderly people including nursing care. At the time of our inspection there were 48 people living in the home.

A registered manager is a person who has registered with the 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 2008 and associated Regulations about how the service is run.

We found staffing levels at the home were appropriate for the number of people living there. However, staff were always busy and didn’t have much time to sit and chat with people who used the service. Following a conversation with the organisation’s managing director (MD), it was agreed that one additional carer would be on duty each day with immediate effect.

We found people’s medicines were not well managed and required improvement. This is a breach of Regulation 12 (1) (g) HSCA 2008 (Regulated Activities) Regulations 2014

We saw the home had in place personal emergency evacuation plans (PEEPs) displayed close to the main entrance and accessible to emergency rescue services.

Before our inspection we contacted healthcare professionals involved in caring for people who used the service, including; Safeguarding, Clinical Commissioning Group (CCG), Infection Control and Commissioners of services. Numerous concerns had been raised by these professionals. However, they subsequently told us following their own inspections to the service that some improvements had been made but more were needed. All told us that the new manager was very effective and had strived to make improvements to the service. Further monitoring visits were planned by these organisations. However, we saw that the registered manager worked in partnership with other professionals to make improvements to the service

We found the home had robust cleaning schedules in place to prevent the spread of infection.

The provider had worked within the Mental Capacity Act 2005. We saw that all people living in Hallgarth had undergone ‘consent to support’ and Mental Capacity Act assessments to identify their capacity to consent to their care. We also saw Deprivation of Liberty Safeguards were in place.

We observed staff speaking with people in kind, respectful and reassuring ways. People told us they felt their dignity and privacy were respected by staff.

We also reviewed five people’s care records, we found two plans were not completed in enough detail to reflect people’s care, treatment and support needs. We told the provider to make immediate improvements to ensure people’s care, treatments and support plans were up to date. This is a breach of Regulation 9 (1) (a) (c) HSCA 2008 (Regulated Activities) Regulations 2014

This is a breach of Regulation 9 (1) (a) (c) HSCA 2008 (Regulated Activities) Regulations 2014We spoke with 15 people who used the service and four relatives of people who used the service. We also spoke with the registered manager, the regional manager, four care staff and the cook.

During our inspection we observed how the staff interacted with people who used the service.

We saw a notice board which displayed information about the activities for that week. During our inspection we found lots of various activities taking place.

We found the provider had audits in place to measure and monitor the quality of the service.

We saw the provider had in place a complaints policy in place and this was clearly displayed for people to see.

We found two breaches under regulations associated with the Health and Social Care Act 2008, and Care Act 2014.

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

Inspection carried out on 1 July 2014

During an inspection in response to concerns

We carried out an out of hour's inspection due to concerns received by CQC regarding staffing levels during the night and the management of medicines. The concerns were raised with CQC on the 30th June 2014.

We arrived at the home at 11.15pm on 1st July 2014 and left at 2.00am on 2nd July 2014. We re-visited the home at 1.00pm on 2nd July 2014.

We looked at the information provided to us and looked at the information we held about the service. As part of our inspection we spoke with four night staff including the registered manager who arrived at the home at 12.54 am.

The focus of this inspection was to check that the provider had sufficient numbers of staff on duty during the night to meet the needs of people who used the service.

On the 2nd July 2014 at 100.pm, we re-visited the home to check that people who used the service received prescribed medicines safely. This included making sure all medicines were up to date and reviewed as people's needs and conditions changed. To make sure that clear procedures were followed in practice, monitored and reviewed. We also checked the safe storage, preparation, administration and disposal of medicines.

We spoke with a number of people using the service. Everyone commented positively about the care provided. Comments included “The staff here have an awful lot of dedication; they look after me very well". "Nothing is too much trouble for them, when I need assistance I never have to wait very long,” “The staff are very good and I always get my medicines on time and always at the same time every day". They put me at my ease” and “This is a good place to live". They look after my tablets very well. During the night I feel safe and I get lots of support each morning to get dressed. I am never rushed". It’s really nice and the staff are always there when you need them".

Inspection carried out on 14 April 2014

During a routine inspection

During our inspection we asked the provider, staff and people who used the service specific questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they were treated with respect and dignity by the staff. They said they felt safe. We found safeguarding procedures to be robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had proper policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. The manager told us about an application that had been submitted. We also found relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people were safeguarded as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk. Some bathrooms needed refurbishment. The regional operations manager told us there were plans in place to have these refurbished soon.

The registered manager set the staff rotas, they told us they took people’s care needs into account when making decisions about the staffing numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that any unsafe practice was identified; this helped to protect people who used the service.

Is the service effective?

There was an advocacy service available if people needed it, this meant people could access additional support when required.

People’s health and care needs were assessed with them, and they or their representatives were involved in writing their plans of care. Specialist dietary, social, mobility, equipment and dementia care needs had been identified in care plans where required. Some people said they had been involved in writing them and they reflected their current needs.

People’s needs were taken into account with signage and the layout of the service enabling people to move around freely and safely. The premises had been sensitively adapted to meet the needs of people with physical, memory and mental health impairments.

Visitors confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

People told us they were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. People commented, “I never feel rushed by the staff that help me, they don’t do everything for me and help me to do things for myself”. A relative said, “I visit my relative almost every day and the staff are good at listening to any concerns that I raise and always respond appropriately."

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised, we saw these had generally been addressed by the provider.

People’s preferences, interests, aspirations and diverse needs were recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People completed a range of activities in and outside the service regularly.

People we spoke with knew how to make a complaint if they were unhappy. Two people said that they had made a complaint and both were satisfied with the outcomes. We looked at how complaints had been dealt with, and found that the responses had been open, thorough, and timely. This meant people were assured that complaints would be investigated and action taken when necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system. The records we looked at showed any shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service.

Inspection carried out on 4 April 2013

During a routine inspection

We spoke with several people who used the service. Almost all spoke positively about the care they received.

People told us they could choose how to spend their day and the staff treated them with dignity and respect. One person said “They look after my privacy and dignity. They always knock on my bedroom door and call out before coming in.”

Everyone said they would have no hesitation in making a complaint if they were unhappy. One person said “If there was anything wrong, if I had any problems I would talk to the staff.”

However one person said "I sometimes have to wait too long when I ring the call bell, and I don't like the food very much." They said they had discussed these issues with the manager and some changes had been made regarding their food preferences.

Other comments from people included:

“I’m satisfied. They are very nice.”

“It’s a really good home.”

“They find out what I like and don’t like.”

“They provide a lot of entertainment.”

A relative said "I would recommend this home to others. I still think some improvements are needed, but things are getting better."

We watched how the staff supported the people in their care. We saw people were treated with dignity and respect. For example, when staff talked with people they made sure that they got down to their eye level. We heard staff address people respectfully, speaking quietly about private matters.

Inspection carried out on 9 August 2012

During a routine inspection

People who were able to speak with us told us the staff involved them in decisions about the home. One person told us, “I know what is going on. The girls tell us about everything going on here”. One person we spoke with told us the staff often discussed her care plans with her and told us she staff involve her in her care.

People told us they were happy at Hallgarth Care Home and that staff supported them well with their healthcare needs. People we spoke with told us they received regular medical care from their GP and from other healthcare professionals such as dentists, opticians, chiropodists and dieticians when required. One person told us, “They get the doctor for me when I am poorly”. Another person told us, “I had the doctor in when I was taken bad with my chest”.

Other comments from people who used the service included:

“Staff are kind and helpful.”

“They listen to what you had to say, but sometimes they are so busy they don’t have time to sit and talk to us.”

“I moved here because I like it better than my previous place.”