Archived: Hulton Care Centre

We found the following examples of good practice.

The providers procedures helped ensure all visitors were protected from the risk of infection. Temperature screening on entry was completed by staff, PPE and hand cleaning facilities were available for all visitors. Visitors were strictly limited to necessary professionals which helped minimise the risk of visitors spreading infection. Current government guidance was being followed which meant people living in the home would only be able to have visits from family and friends in very limited circumstances.

The management team had, as far as possible, kept staff teams separate between the two floors of the home. This helped minimise the number of staff people came into contact with on a daily basis.

The provider had ensured sufficient supplies of PPE were available for staff. Staff had received refresher training from the local infection prevention control team. The management team regularly reviewed and checked staff practice which helped maintain consistency.

The provider completed regular testing for staff and people living in the home, in line with current government guidance. In addition testing for people living in the home had been brought forward in response to any positive results for staff.

The housekeeping team had maintained the cleanliness and hygiene of the home to a good standard.

Staff had continued provide professional good quality care.

The service had a registered manager in place 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 last inspected Hulton Care Centre in May 2016. At that inspection we found a breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) in that the recruitment records for new staff did not contain enough information to determine their suitability to work with vulnerable people. At this inspection we found that safe recruitment policies had been adopted, with all employment checks undertaken. The service was no longer in breach of the regulations.

People who used the service were supported in a friendly, relaxed and comfortable environment. They told us that they felt safe, and staff working at Hulton Care Centre understood how to ensure people’s safety and protect vulnerable adults from abuse. Potential environmental risks were assessed as an ongoing process to help prevent any accidents or injuries occurring.

The service used a dependency tool to determine how many workers would be required to meet people’s needs safely, and we saw that there were adequate staffing levels with a good mix of registered nurses and care assistants. Staff were well trained and induction methods allowed them to get to know the people who used the service and how they liked their needs to be met. Regular training and supervision sessions allowed staff to update their knowledge.

The home was clean and odour free. Staff understood how to prevent the spread of infection and were observed using personal protective equipment. There was a supply of disposable gloves and aprons available, and colour coded cleaning equipment minimised the risk of cross infection.

When accidents and incidents occurred, these were appropriately recorded and reviewed so that future reoccurrences could be avoided. We saw that there were safe systems in place to manage and administer medicines, with checks on a daily basis to minimise errors occurring. Care records indicated regular contact with health professionals such as doctors, district nurses, and occupational therapists. The service was attentive to peoples nutritional needs, and followed advice from Speech and Language therapists and dieticians to ensure that food was served following their instructions. The weather during our inspection was hot, and people were regularly offered a supply of cold drinks.

People’s choices were respected, and where they lacked capacity best interest decisions were clearly documented in case notes. Where people were unable to give their consent to receiving care and support, the appropriate deprivation of liberty orders were in place. Care plans gave good instruction to staff to ensure needs were met, and when we spoke with care staff they could tell us about the people they supported, but care plans did not always record their background, culture or preferences.

The service made good use of the space available; communal areas were well planned to allow separate areas for different social interactions. Although there was a lack of storage space for large equipment such as mobile hoists, when not in use these were stored where they would cause the least obstacle. Bedrooms were personalised and decorated in accordance with the person’s wishes. People were treated with kindness and respect. The service had recently achieved a Daisy award for displaying high standards to support dignity in care, scoring 100% in their assessment, and ongoing training and supervision ensured good practice was ingrained. Many of the people who lived at Hulton Care Centre chose to spend much of their time in their own rooms; whilst their privacy was respected staff would spend time with them addressing their needs or providing stimulation or conversation. Care plans reflected peoples wishes at the end of their life, and we saw a number of cards sent from grateful relatives for the care, support and compassion shown to people who were cared for in death.

Risk assessments indicated where people were at risk, and care plans provided instruction to staff to minimise the risks identified. We saw that this had minimised the number of accidents or injuries, for instance, there were relatively few falls and nobody had developed pressure sores at the time of our inspection. Risk assessments and care plans were reviewed monthly.

The registered manager and area manager undertook regular checks and audits to ensure that the service maintained good standards of care and looked to improve the quality of service delivery. The home was well maintained and where complaints had been received there was evidence that these were dealt with appropriately. The registered manager was respected by staff, residents and their relatives, and had a visible presence throughout the home.

This was an unannounced comprehensive inspection, which took place on 19 May 2016.

During this inspection, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there were not robust recruitment procedures in place.

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

Systems for recruitment of staff were not always safe. One staff file did not contain any references and two other staff files did not detail a full employment history, including a written explanation for any employment gaps.

Arrangements were in place to ensure people’s rights and choices were protected when they were unable to consent to their care and treatment in the service. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA. However Deprivation of Liberty Safeguards (DoLS) authorisations could not be located during our inspection, but were found following the inspection and subsequently seen by the inspection team.

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. People who used the service and staff were complimentary about the registered manager and said the service was well run.

The registered manager and staff knew people well and were able to tell us about their likes and dislikes and how people liked support to be provided. Staff were patient, reassuring and friendly in their interaction with people who used the service.

People told us they felt safe at Hulton Care Centre. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding vulnerable adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of the responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor care to people.

Safe systems were in place for the management and administration of medicines. People had access to a range of health care professional to ensure their health needs were met.

There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to be able to deliver effective care.

Risks to people’s health and wellbeing were identified and direction was given to staff on how to reduce or eliminate those risks. Care records were detailed; person centred and contained good information about people’s support needs, preferences and routines. Care records were reviewed regularly. People who used the service and their relatives had been involved in planning and reviewing the care provided.

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care such as utility failures. Personal emergency evacuation plans had been developed and regular checks were in place to ensure staff were aware of the action they should take in the event of a fire at the service.

People told us that they enjoyed the food. We observed the food to be plentiful and well presented. Systems were in place to help ensure people’s nutritional needs were met. We observed people being appropriately supported to eat their meals.

The was a complaints procedure for people to use if they wanted to raise any concerns about the care and support they received. There was a system in place to record complaints and the service responses to them. People were confident that they would be listened to and action would be taken to resolve any problems they had.

We saw that the service had a range of policies and procedures to help guide staff on good practice. Staff told us they felt supported and enjoyed working for the service.

There was a system for gathering and acting upon people’s views and suggestions about the service and how it could be improved. There were systems in place for assessing, monitoring and reviewing the quality of the service.

This is a summary of what we found.

Is the service safe?

We saw that people were being cared for in an environment that was safe and clean.

Staff personnel records contained the information required by the Health and Social Care Act 2008. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living there.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure that people in care homes and hospitals are looked after in a way that does not restrict their freedom inappropriately. The safeguards should ensure that a care home or hospital only deprives someone of their liberty in a safe and correct way. This would only be done when it is in the best interests of the person and there is no other way to look after them. There were no authorisations restricting the freedom of anyone living at the home at the time we visited. The provider had policies and procedures in place and the DoLS Code of Practice was available for staff to refer to. Relevant staff understood when an application should be made and how to submit one.

Is the service effective?

The relatives we spoke with told us that they were happy with the care their family member received and that their needs had been met. They spoke positively about the care their family member received and the staff who supported them. It was clear from what we saw and from speaking with staff that they had a good understanding of the care and support needs of the people using the service. We saw from the training records we viewed that staff had received training to enable them to meet the needs of the people living at the home.

Is the service caring?

We saw that the staff showed patience and gave encouragement when they were supporting people and that people were able to do things at their own pace and were not rushed.

Is the service responsive?

People's needs had been assessed before they moved into the home. The records we saw confirmed that people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Throughout our visit we found the atmosphere was calm and relaxed. We observed how the staff and the people who used the service worked together and it was clear that there were good relationships between them.

We saw that people's rooms were spacious, light and clean. All rooms were en-suite. People had personalised their rooms with their personal belongings. Their names were on the doors. One room was dedicated to end of life care and had facilities for relatives to stay with their family member. There was a dining area, an activities area and two lounges. These were spacious and light with large windows and doors leading to the gardens. The gardens were large with seating areas. There was a lift and a ramped entrance for easy access.

Is the service well-led?

We found from speaking with staff that they had a good understanding of the home's values. They told us about their roles and responsibilities and they were clear about these. We saw that quality assurance processes were in place to make sure that the provider monitored the care provided and made improvements where necessary. For example, satisfaction surveys had been completed by people using the service and their families. The results had been analysed and comments had been acted on.

A variety of information was displayed, such as the names of the manager, nurse in charge and team leader for the day, names of staff who acted as co-ordinators for first aid, moving and handling and end of life care. We also saw a mission statement, philosophy of care, a dignity statement and a suggestions box.

We were made aware prior to our visit that a change in management at the home had taken place. The manager was making arrangements to register with the Care Quality Commission.

We spoke with three members of staff. Staff spoke positively about the appointment of the manager. Staff said they were happy in their work and that management fully supported them and encouraged them to develop their skills. One member of staff told us; 'There's been loads of improvements' and 'Morale was poor, but things are a lot better now'.

People were involved and consulted with about their care and support. Records directing staff in the safe delivery of care where kept up to date so that they accurately reflected the individual needs and wishes of people.

A satisfactory system was in place for checking the quality of care and the facilities that the service provided.

People were protected against the risk of unsafe or inappropriate care and treatment because records required to protect their safety and wellbeing were accurate and up to date.