Hadrian Park

Hadrian Park is a residential care home that provides accommodation and personal care for up to 74 older people and people living with dementia. At the time of the inspection there were 73 people using the service.

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

People told us they were happy living at Hadrian Park. The provider ensured people lived in a safe environment. Health and safety checks were regularly conducted. Staff were trained to support people in the event of an emergency. Medicines were managed safely. Individual and environmental risks were identified and managed.

People were protected from the risk of abuse. Staff had completed safeguarding training. Information gathered from safeguarding concerns, accidents and incidents was analysed to identify trends or patterns with actions put in place to minimise risk of further incidents.

Staff had completed training in infection control and followed protocols to reduce the risk of infection. A robust recruitment process was in place. Enough staff were deployed to meet people’s needs. The registered manager regularly reviewed staffing levels to ensure people’s needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The provider had a clear vision and values which staff demonstrated. The registered manager promoted an open and inclusive culture. Staff told us the provider and management team were supported in both the work and home environments. The home had introduced a number of ideas to improve both people and staff’s well-being.

The provider and registered manager understood their duty of candour. Staff were knowledgeable about their roles and worked well together. The home had developed strong partnerships with health and social care professionals to ensure people received joined up care.

The provider had comprehensive quality assurance systems to monitor the quality and safety of the home. The home regularly sought feedback from people, their relatives and staff.

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 February 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. 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 remains good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Visitors were required to complete a health questionnaire before visiting the home. Temperature checks were completed on arrival and personal protective equipment (PPE) was available for all visitors. Lateral flow testing was also done, and results obtained prior to visits taking place. Plans were in place for visiting to commence again in line with government guidance and there was a purpose built visiting pod within the home to make visits as safe as possible.

Alternatives such as telephone and video calls with relatives were arranged for families who could not visit. The registered manager had kept in regular contact with family members to provide reassurance when they were not able to visit. An online question and answer session to address any general concerns had also been held.

Staff were working hard to ensure people did not feel isolated and more one-to-one activities were taking place. Staff had created a range of activity booklets containing things such as puzzles and colouring activities to try to reduce boredom when people were isolating.

Staff changed into their uniform before the start of their shift and changed again before going home. The option had been given to staff to launder their uniforms at the home if they wished to. We observed staff wearing PPE correctly throughout the home. Staff who needed to shield were supported to do so. Special provision and changes to working patterns had been made to accommodate staff who were more vulnerable, for example staff members who were pregnant had been able to transfer to office work.

There was a plentiful supply of PPE and a number of PPE stations around the home so staff could change their PPE prior to entering individual rooms. Clinical waste bins were in place for the safe disposal of used PPE. There were laminated posters all around the home reminding staff of the correct PPE procedures and staff had received support and training from a specialist infection prevention and control (IPC) nurse. Explanations and reassurance had been given to people about why staff were wearing masks and some people were so comfortable with the practice they sometimes chose to wear them too.

The home was very clean and tidy. Enhanced cleaning schedules were in place and this was the responsibility of all staff. These included regular cleaning of high touch areas such as handrails and door handles on both day and night shifts to reduce the risk of cross infection. Suitable arrangements were also in place to manage contaminated laundry. There were two infection control champions on the staff team who helped and supported staff with safe working practices.

There was a detailed infection prevention and control policy in place and regular checks were completed.

We last inspected the service in January 2017 and at that time identified breaches in two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were related to safe medicines management and good governance.

We took action by requesting the provider send us an action plan stating how and when they would achieve compliance. During this inspection we found there had been improvements made in line with the provider’s action plan. As a consequence of these improvements the service was no longer in breach of the regulations detailed above.

Hadrian Park 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.

Hadrian Park can accommodate up to 74 people in a two-storey purpose built building. At the time of this inspection there were 55 people using the service.

The service was divided into three units, Lilly, Chester and Poppy. The Lilly unit provided residential care on the ground floor whilst the Chester unit, also on the ground floor provided care for people living with dementia. Upstairs the Poppy unit provided accommodation for people who needed a higher level of support. The first floor was accessed by stairs or a passenger lift. There were four dining areas and a variety of communal living areas.

The service had a manager in place. They had submitted an application to become registered manager and that process was underway 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.

At the last inspection we identified that people’s medicines were not always managed safely. At this inspection we found that improvements had been made in the records for oral medicines, however improvements were still needed for the records of topical preparations and the guidance for when required medicines. We have made a recommendation about this.

Safe recruitment procedures were in place and appropriate pre-employment checks were undertaken.

There was a sufficient number of staff on duty to care for people safely. People’s dependency levels were calculated regularly and used to determine the number of staff needed for each shift.

Care records contained detailed risk assessments. People had individual personal emergency evacuation plans in place. Accidents and incidents were recorded and analysed to look for patterns or trends. Regular maintenance checks and repairs were carried out and all areas of the service were clean and tidy.

The majority of staff were up to date with training and additional training courses linked to the needs of the people using the service had been completed by staff. Some training was not included on the matrix and this made keeping track of training more difficult.

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.

Requests for DoLS authorisations were being submitted appropriately. Capacity assessments were being undertaken and best interest decisions were being recorded.

Staff felt well supported and regular supervision sessions and annual appraisals were planned.

People were supported to maintain their health and wellbeing and had access to health professionals when needed.

People were happy with the food they received. There was a varied menu containing well balanced nutritious options. Snacks and drinks were available throughout the home for people to access as and when the wanted. People’s weights were monitored regularly and expert advice sought from dieticians if there was any cause for concern.

People and their relatives were happy with the way care was delivered and happy with the staff approach. Staff interacted positively with people who used the service and had a good knowledge of the people they cared for. Relatives were made to feel welcome and were involved in the care planning process.

Staff provided care in a way that protected people’s privacy and dignity and promoted independence. Advocacy support from external agencies was available should anyone require it.

People were receiving care that was tailored to their individual needs. Care plans contained detailed information, including life history, to help staff support people in a personalised way.

There was a small team of staff who were responsible for co-ordinating activities and there was a varied timetable of events each day.

There was a complaints procedure in place and people knew how to make a complaint if necessary.

People had end of life care plans in place and all staff had undertaken training in end of life care.

Equality and Diversity was part of the provider’s mandatory training requirements and people were cared for without discrimination and in a way that respected their differences.

A more effective system of audits was taking place. Although they had not identified every issue we found the manager made changes to audits immediately in light of feedback give throughout the inspection to ensure they were even more robust going forward.

Records contained accurate and up to date information relating to people’s care needs.

Staff meetings took place every two months and staff felt able to discuss any issues with the manager. Regular staff surveys were also conducted and action plans drawn up to address any issues raised. Staff spoke highly about the new manager and felt significant improvements had been made.

Feedback was sought from people using the service and relatives in a variety of ways. Meetings were held, telephone surveys conducted and a suggestion box was also in place.

The service had close links with healthcare professionals who gave positive feedback regarding the knowledge and cooperation of management and staff.

Following our inspection we served a warning notice against the registered provider in respect of the breach in regulation 17, good governance and stated that they must take necessary action to comply with this regulation by November 2016.

We also issued a requirement notice in respect of the breach in regulation 12, safe care and treatment. The registered provider sent us an action plan detailing how and when they would take action in order to meet this requirement notice.

We undertook a focused inspection on the 20 February 2017 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 this topic. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Hadrian Park on our website at www.cqc.org.uk

Hadrian Park is a purpose built care home in Billingham. The home is registered to provide care and accommodation for up to 73 older people and people with dementia. At the time of our visit there were 66 people living at Hadrian Park.

The property was divided into three units across a ground and first floor, accessed by stairs and a lift. The Lilly unit provided residential care on the ground floor whilst the Chester unit, also on the ground floor provided care for people living with dementia. Upstairs the Poppy unit provided accommodation for those people who had greater levels of dependency.

The home 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.

At the last inspection we found that accurate and complete records of people’s medicines were not being kept and some medicines were not always administered as prescribed by the doctor.

At this inspection we found there were still a number of issues with medicine management and records.

At the last inspection we found that accidents and incidents were being recorded but an analysis of the data to look for patterns and trends was not being undertaken.

At this inspection we found this had improved. We saw a monthly accidents and incidents analysis was done for each unit. A weekly analysis was also done for each individual and an accident and incident report produced.

At the last inspection we found that systems in place to monitor and improve the quality of the service were not effective. Issues found during the inspection had not been picked up by management audits. We also found that accurate and up to date care records were not always being kept.

At this inspection we found there were still a number of issues with the audit process. Medicine audits were not being carried out as described by the registered manager and the audits that were done had failed to identify the issues we found. Inaccurate recording on audits meant that statistics gathered from them was not correct.

We found that improvements had been made to the standard of care records and those we looked at were detailed and up to date.

At this inspection we found that some improvements had been made but people were still at risk due to medicines not being managed safely and there was an on-going breach of Regulation 12.

We also found that, although some improvement had been made to care records, people were still at risk because effective quality assurance of the service was not taking place and there was an on-going breach in Regulation 17.

Hadrian Park is a purpose built care home in Billingham. The home is registered to provide care and accommodation for up to 73 older people and people with dementia. The home does not provide nursing care. At the time of our visit there were 64 people living at Hadrian Park. The property has been divided into three units across a ground and first floor, accessed by stairs and a lift. The Lilly unit provided residential care on the ground floor whilst the Chester unit, also on the ground floor provided care for people living with dementia. Upstairs the Poppy unit provided accommodation for those people who had greater levels of dependency. The home was clean, nicely decorated and had a well organised lay out with a variety of communal space.

On the first day of inspection 1 June 2016, the home had a registered manager in place. On the 7 and 21 July we were informed that the registered manager had handed in their notice and the deputy manager was acting 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.

We last inspected the service in November 2015 and found the provider to be in breach of four regulations regarding safe care and treatment, good governance, staffing and need for consent.

At this inspection we found that, despite some changes being made, people were still at risk due to medicines not being managed safely and there was an ongoing breach in relation to safe care and treatment. We also found that people were still at risk because effective quality assurance of the service was not taking place and there was an ongoing breach.

We found that improvements had been made in some areas. Staff had received training on challenging behaviour and a number of new training courses had been implemented to improve staff knowledge and skills. The registered provider was therefore no longer in breach of this regulation.

We saw evidence of consent and best interest decisions on people’s records, although there was still some work to be done in this area significant improvements had been made and the registered provider was no longer in breach of this regulation.

We found that medicines were not always administered as prescribed by the doctor. Creams and ointments in particular were not administered as regularly as directed. We found errors on some medicines administration records (MAR) and the fridge that was used to store medicines in on one of the units was faulty and not maintaining the correct temperature for safe storage.

There were systems and processes in place to protect people from the risk of harm. We saw that individual risk assessments were in place and that they covered the key risks specific to the person. These did not always contain sufficient information and we identified some risks that had no associated risk assessment.

Staff had received safeguarding training and demonstrated knowledge of the procedure to follow.

We found that safe recruitment and selection procedures were in place and appropriate pre-employment checks had been undertaken.

Accidents and incidents were being recorded but an analysis of the data to look for patterns and trends was not being undertaken.

We were shown how the service calculated their staffing levels using a dependency tool. We were able to see from this and from checking staff rotas that the service was adequately staffed according to the level identified by this method. Staff felt that there were not always sufficient staff to provide the correct level of care for people and in response to this feedback we were shown new rotas indicating an extra member of staff was to be on duty during the day.

Staff had received appropriate training and had the skills and knowledge to provide support to the people they cared for.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

We saw that there were policies in place in relation to the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). Staff had received training and demonstrated an understanding of the requirements of the Act and we saw that the service had been applying the DoLS appropriately. We saw evidence that capacity assessments and best interest decisions were being undertaken and correctly recorded.

We saw that people were provided with a choice of food and drinks to help ensure their nutritional needs were met. We were told by people using the service and relatives that the food was not always of good quality. People were being seen by a dietician when this was deemed necessary and their diets were fortified when a need for this was identified. The records kept by kitchen staff were not reflecting the most up to date information relating to peoples dietary requirements.

We saw that people’s wellbeing was supported by the appropriate access to health care professionals such as dentists and opticians.

The care plans we looked at needed to include more detail and personal information on preferences in respect of care delivery to be fully person centred. The care plans were held on an electronic system and contained all necessary information relating to the day to day care needs.

Staff were observed to be caring and respected people’s privacy and dignity. People who used the service said they were happy with the care they received.

A range of activities were available to people, although some of the people we spoke to told us they preferred not to engage in them. We saw staff interacting well during activities and the service was actively recruiting for a new activities co-ordinator to improve and increase the activities available to people.

A programme of regular staff supervision had begun. Staff confirmed they were having these meetings but not all staff had found them useful.

There was a complaints procedure in place and this was clearly displayed in communal areas. We saw evidence that complaints had been dealt with appropriately but the outcome of investigations was not always documented.

Although there were systems in place to monitor and improve the quality of the service provided they were not effective. A number of issues we highlighted during our inspection had not been picked up by the audit process.

There were a number of comments made by staff regarding the morale within the staff team and the management team were aware that this was an issue. A staff surgery was being held on 21 July 2016 with a member of the registered provider’s human resources team and a ‘Going the Extra Mile’ (GEM) awards scheme had recently been introduced to recognise and reward staff achievement.

We found the provider was breaching two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the proper and safe management of medicines and monitoring and improving the quality and safety of the services provided. You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in post. The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health safety and welfare of people.

During the inspection, the team worked together to answer five key questions which are outlined below.

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

Is the service safe?

People told us they felt safe and secure living in the home. Staff were knowledgeable about the procedures they needed to follow to ensure that people were safe. Staff took quick action when needed to ensure that the risk of harm to people was minimised.

We saw that the home was very clean and well-maintained. All the people we spoke with told us this was always the case. All staff took action to ensure that infection prevention and control procedures were followed.

People had access to the equipment which they needed at all times. Equipment was clean and fit for purpose. Referrals for equipment were carried out when needed.

Recruitment procedures were rigorous and thorough. Staff records contained all of the information required by the Health and Social Care Act. 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 older people including people living with a dementia.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care home. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand where an application should be made, and how to submit one.

Is the service effective?

People had individualised care plans which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

People had access to a range of health care professionals some of which visited the home. People told us staff escorted them to healthcare appointments if needed. When people were admitted to hospital, staff kept in regular contact.

People spoke highly of the staff and the care which they received. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

There was a flexible but robust activities schedule in place which catered for everyone's needs. Activities were provided individually and in a group. People were encouraged to maintain links with their local community by attending local events.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people whilst helping them to remain independent.

Care plans were individualised and included people's preferences, interests, aspirations and diverse needs. Our observations of the care provided showed that staff were very knowledgeable about people's needs and wishes.

Is the service responsive?

Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

The home was responsive to people's needs, wishes and preferences. We saw that changes were made when needed, such as menus and activities. Fundraising activities had been taking place to raise money for a minibus which would help to increase people's access to the community and to access holidays within the region.

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. People and their relatives told us they were kept informed of changes which affected them.

A robust system to assure the quality of the service provided at the home was in place. The way the service was run had been reviewed regularly. Prompt action had been taken to improve the service or put right any shortfalls they had found.

Regular audits were carried out which were used to identify changes and improvements to minimise any risks to people and staff.

People told us they had completed a customer satisfaction survey. They confirmed they had been listened to and as a result of the survey changes to the menu had been made.

Regular meetings were in place for people and their relatives which were well attended. Further to this there was a weekly drop-in session in place to discuss any queries or concerns. Relatives told us they found the management team very approachable.

What people said

People who were able to express their views told us they were satisfied with the care and support they received. One person told us, 'The staff are nice to me.' Another said, 'The staff are very helpful.'

Everyone we spoke to told us they enjoyed living at the home and they were happy with the care provided. People told us, 'I like it here. The atmosphere is very relaxed' and 'Staff are very good, I can't praise them enough. I am very happy.'

Relatives also spoke positively of the staff and the care provided to their relatives. Two relatives told us, 'The staff are responsive to people's needs.' One relative told us, 'I have happy with the care my relative has received. They have been putting on weight and are encouraged to keep active.

Staff told us they enjoyed working with older people. Staff spoke highly of their team and of their manager. One staff member told us, 'The manager is brilliant.' 'Another told us, 'The manager is easy to talk to and very supportive of our work.'

People and relatives told us that they were extremely happy with the care. One person said, 'The staff are very, very good.' One relative said, 'It is like a five star hotel here. You could not get a better set of staff anywhere else.' Another relative we spoke with told us, 'I can sleep at night knowing that my mum is safe and happy. It takes a lot of concern away. I think the staff are tremendous.'

People had been supported to make decisions about their health checks and treatment options. We saw that people were provided with care and support from a range of health professionals, such as their GP and community nurses.

We saw that people were protected against the risks of abuse. Staff we spoke with were very knowledgeable about the signs of abuse and knew the procedures to follow if they suspected abuse was taking place.

Staff had received appropriate training to dispense medication and followed procedures carefully.

The provider took action to ensure the quality of the service. We saw that there was enough staff to care and support people. We found evidence to show that the views of people and their relatives were taken into account.

We found that most care records were held electronically on computer and that these were kept up to date and fit for purpose. We found that additional paper records, such as weekly weight charts and fluid charts, were being kept to protect people's safety and wellbeing.

However we found that although records contained detailed up to date information, the delivery of care did not always meet people's individual needs and ensure the safety of the person who used the service. We found that one person had nine falls within a two month period. This person had been referred to the falls team in December 2012 by the district nurse; however the home had not followed this up. We observed that one person was not assisted by staff to eat their lunch as stated in their care plan. We found that care had not always been delivered in line with care plans and referrals to the falls team had not been followed up.

We have written to the provider separately, regarding referrals to the falls team, and requested further information be provided to us within 7 days.

In this report the name of the registered manager appears who was not in post and not managing the regulated activities 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.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect and involved people in their care.

We saw that people had their needs assessed and that care plans were in place. However we found that people's needs had not always been met.

We found processes for the administration and management of medicines were not always being followed.

Staff were receiving appropriate training and arrangements were in place to ensure they had regular supervision and appraisals.

We found that care records were not always accurate and up to date.