Hadrian House

We found the following examples of good practice:

• Appropriate measures were in place at the entrance and inside the home to prevent visitors from spreading infection. All visitors were required to wear appropriate personal protective equipment (PPE) and follow good hand hygiene practices.

• There were sufficient stocks of PPE. Staff had received appropriate training in infection prevention and control.

• The environment was very clean, with enhanced cleaning taking place of frequently touched surfaces.

• Social distancing rules were being complied with. Some minor changes had been made to the layout of furniture to encourage and support social distancing.

• The provider was following national guidance for anyone moving into the home and admissions were carried out safely.

• People were supported to keep in touch with their family members via video or telephone calls. The provider had developed ways to safely support visits in line with the latest guidance.

Hadrian House is registered to provide accommodation for up to 63 people with residential care needs. 52 people were using the service at the time of the inspection. Some of the people were living with a dementia type illness.

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

People and family members told us the service was safe. Risks were well managed and the provider learned from previous accidents and incidents to reduce future risks. The registered manager and staff understood their responsibilities about safeguarding. Arrangements were in place for the safe administration of medicines.

There were enough staff on duty to meet the needs of people. The provider had an effective recruitment and selection procedure, and carried out relevant vetting checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

People’s needs were assessed before they started using the service. Staff treated people with dignity and respect. They helped to maintain people’s independence by encouraging them to care for themselves where possible.

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 supported this practice.

The provider had a complaints procedure and people were aware of how to make a complaint. An effective quality assurance process was in place. People, family members and staff were regularly consulted about the quality of the service.

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 15 February 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.

Hadrian House provides personal care for up to 63 older people, including people with dementia related conditions. Nursing care is not provided at the home. At the time of our inspection there were 54 people living at the home.

The service had a 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.

The service had established systems for preventing abuse and responding to any safeguarding concerns. Risks to people’s safety and welfare were assessed and appropriately managed. People and their relatives told us they felt care was provided safely.

The home was clean, comfortable and free from hazards. Safety checks were conducted and the accommodation was well-maintained. There were plans to further enhance parts of the building, with an emphasis on creating a more dementia-friendly environment.

New staff were checked and vetted to ensure their suitability in working with vulnerable people. Sufficient staff were employed to provide continuity of care and we found that staffing was now much better organised. The staff team received regular training and supervision that enabled them to carry out their roles effectively.

People were supported to receive their medicines as prescribed. The service worked in a co-ordinated way with external professionals to support people’s health and well-being. Improvements had been made around mealtime arrangements, the food provided and the help that people required with eating and drinking.

The service worked within the principles of mental capacity law to make sure people’s rights were protected. Relatives were involved in decision-making and, where needed, independent advocacy was arranged. People and their representatives were given information and support and were encouraged to be involved in care planning.

Staff understood the needs and preferences of the people they cared for. We observed they were kind, caring and had a good rapport with people and their families. People confirmed that staff respected their privacy and dignity.

Personalised care plans had been devised that guided staff on meeting people’s identified needs. Social stimulation had greatly improved and people now had access to a range of activities and events.

Measures were in place for obtaining people’s opinions about the service and feedback was acted on. Any complaints made were properly investigated and responded to.

Staff received appropriate leadership and support. Structured methods were used to monitor the service’s standards. The registered manager believed in working inclusively and was open to people, their families and staff influencing the quality of the service.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found -

Is the service safe?

People's care and treatment took account of their personal safety to ensure they were not put at risk of being harmed. A person living at the home told us, 'The staff are so friendly, I feel safe here'.

There were enough staff on duty to care for people safely. Staffing was regularly reviewed in line with the numbers of people living at the home and the level of care they needed.

Is the service effective?

People and their relatives told us they were happy with the care and support provided. Their comments included, 'It's great here, fantastic, I love it all the time', and, 'I am very happy here, I came to try it for a few days then put myself here'. Our observations confirmed people were cared for effectively by staff who had a good understanding of their needs.

We found there were not suitable arrangements to train staff and supervise and appraise their performance. This meant the provider could not demonstrate that staff were properly supported in their professional development. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service caring?

Care planning was focused on the needs and welfare of the individual. People told us they were well cared for and said staff treated them kindly. We saw staff were patient and caring when providing support and people were able to do things at their own pace.

Is the service responsive?

Assessments of needs were updated at regular intervals and care was adapted and delivered according to people's changing needs.

There was a clear process for making complaints that people knew about and felt confident to use. Complaints about the service were responded to promptly and were fully investigated.

Is the service well-led?

The manager and staff understood the ethos of the service and their roles and responsibilities. People and their relatives were consulted about the running of the home and whether they were satisfied with the service they received. Quality assurance processes were also in place to keep check on standards and make improvements to the service.

In this report the name of a registered manager appears who was not in post and not managing the regulated activity at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

People living in the home (and, where appropriate, their relatives or other representatives) had been asked to give their consent to their care and treatment, as set out in their care plans, and this was recorded. Where people lacked the mental capacity to make informed decisions about their care, this had been formally assessed, and appropriate decisions about their care had been made, in their best interests.

Improvements had been made to how the service responded to safeguarding incidents. We found that incidents were now being reported appropriately, and in a timely way.

Staffing hours had been reviewed, and staffing levels were linked more closely to people's dependency needs. Changes had been made in the way staff were deployed in the home, with the result that staff were better able to meet people's needs. One staff member told us, 'Staffing has improved recently. We never go short. We use agency staff, if necessary.' Another staff member said, 'There's been a big change for the better in staffing.'

Improvements had been made to the accuracy and appropriateness of the records kept about people's care. Records were kept more securely and were easier to access. The computerised record keeping system was found to be more reliable.

People living in the home were happy with the quality of their care and spoke highly of the staff's attitude and commitment. One person told us, 'I love it, here. I'm always well cared for.' Another person said, 'The care is excellent. I've never regretted coming here.' A third spoke of the kindness, helpfulness and pleasant manner of the staff.

Visiting relatives and health professionals also spoke highly of the quality of care given in the home.

People's nutritional needs and preferences were properly assessed and met. People told us they had a lot of choice with their meals, and enjoyed their food.

A recent safeguarding issue had not been reported to the appropriate local authority safeguarding unit, raising questions as to the effectiveness of the home's safeguarding practices.

People were being given their prescribed medicines safely, and at the appropriate intervals.

Staff resources were not always being deployed to meet the demand at peak times of the day, such as meal times, medication rounds, bedtimes and early mornings.

People's care records were not able to be accessed at all necessary times, and different recording systems meant that records were not always clear and up to date.