Henwick Grange

Henwick Grange is a residential care home providing personal and nursing care to up to 56 people. The service provides support to younger and older people with a range of needs, including people with physical disabilities and people living with dementia. At the time of our inspection there were 34 people using the service.

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

Since our last inspection improvements had been made to ensure risks to people’s safety were effectively managed. Daily checks and audits were in place to ensure people received their medicines as prescribed. This included daily checks to confirm people’s pain medication patches remained in place and the administration site was being rotated. People’s risks had been identified and there was clear guidance in place for staff to follow to reduce the risks. This included in relation to people’s skin needs.

Improvements of the governance systems ensured better oversight of performance and quality. A range of audits were used to effectively monitor the service. Areas for improvement were identified and responded to so the service was continuously learning and developing.

Systems and processes were in place to safeguard people and protect them from the risk of harm or abuse. People were supported by staff who had been trained and recruited safely. Accidents and incidents were reviewed to identify themes and the actions needed to prevent them from happening again. Any learning from incidents were shared with the staff team.

People’s needs were assessed before moving into the home so their care could be planned to meet their individual needs. People’s dietary and nutritional needs were met in accordance with their needs and preferences. Staff recognised changes in people’s health and sought professional advice appropriately.

Staff knew people well and treated them with respect. People and those important to them were involved in planning their care.

People and their relatives were encouraged to provide feedback in the form of meetings and surveys. Information was used to drive through improvements.

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.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 April 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about personal care, manual handling and the management of the service. We also wanted assurances the provider had followed their action plan and to confirm they now met legal requirements. As a result, we undertook a focused inspection to review the key questions safe, effective, caring and well-led which contain those requirements.

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 changed from requires improvement to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Henwick Grange 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.

Henwick Grange is a nursing home providing personal and nursing care to 56 people aged 65 and over. At the time of the inspection the service was supporting 20 people.

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

Clinical oversight was ineffective. There was a lack of management oversight of the service being provided. Systems, processes and checks had failed to identify the shortfalls we identified during our inspection visit.

Risks to people’s safety was not always well managed which placed people at risk of harm. Care plans were not always being followed including some aspects of medicine administration.

Risks to people's skin care management and instructions from health care professionals were not always followed.

Staff were recruited safely. Checks made prior to employment had been carried out to ensure staff were of good character.

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 requires improvement (published November 2020).

Why we inspected

This focused inspection was prompted in part due to concerns received about safe care and treatment for people. A decision was made for us to inspect. We only looked at the key questions of safe and well-led.

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 coronavirus and other infection outbreaks effectively.

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 continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe administration of people's medicines, risks to people's pressure area care and clinical governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Henwick Grange is a nursing home providing personal and nursing care to 56 people aged 65 and over. At the time of the inspection the service was supporting 42 people at the time of our inspection.

Rating at last inspection -

The last rating for this service was requires improvement (published 08 January 2020). At that inspection two breaches in regulation were identified to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 12 Safe Care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

This focused inspection was prompted in part due to concerns received about safe care and treatment for people. A decision was made for us to inspect and examine those risks and to check on progress of a Warning Notice in relation to Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 we issued, following the previous inspection.

The manager had made significant improvements at the home. Feedback from professionals about their leadership was positive . They confirmed the management team worked in a transparent and open way and were focused on continual improvement and active working partnerships that met people's needs. The manager worked with other professionals and agencies to ensure people's needs were met and to help develop best practice.

Quality assurance and monitoring systems were now in place to help drive improvements at the service. People knew how to raise concerns and felt confident the management team would address and rectify any problems.

Since our last inspection the home has undergone a refurbishment programme to improve the environment. Fire safety concerns have been addressed and passed by the Hereford and Worcestershire Fire Service as compliant.

People's needs were assessed before they moved to the service to ensure those needs could be met. Staff received training and supervision to support them in carrying out their role effectively.

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 coronavirus and other infection outbreaks effectively.

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.

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

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

The provider's quality checking arrangements were not consistently strong enough and effective in ensuring there was a sufficient oversight of the home. The potential risks to people's safety and welfare were not effectively identified and reduced by the management teams own checking procedures. The provider had not taken action to ensure all fire safety requirements had been met.

The provider had not taken steps to assess and review the risks to people’s safety and welfare. They had not taken action to consistently ensure risks from fire were reduced and people could safely escape in the event of a fire.

The provider needed to improve infection prevention and control practices to better protect people from the risks of cross infections. There were inconsistencies in staff practices when cleaning and storing items within communal areas which evidences staff did not apply their training to effectively reduce risks of infections.

People received their medicines as intended from trained staff, but written guidance available was not always sufficiently detailed on the use of 'when required' (PRN) medicines.

The provider were making improvements to the home environment which needed to continue so they could assure themselves people’s needs were met safely and effectively with their wellbeing enhanced.

Staff did not always protect people's personal information, by ensuring this was accessible by authorised persons only.

Some relatives of people who lived at the home did not consistently feel people’s needs were responded to in a personalised way. The manager was not able to provide evidence of how they assured themselves people’s needs were consistently met when people used their call alarms.

The provider had not consistently ensured there were arrangements for people to express their views and make suggestions about the management of the home.

People were supported by staff who had received training and knew how to report witnessed incidents of potential abuse. The provider had procedures, so they could assure themselves potential new staff were suitable to support people who lived at the home.

Assessments were undertaken so risks attached to people’s health and physical needs were identified alongside any equipment required so these could be met safely.

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.

People were supported with dignity and respect and end of life care was centred around each person being comfortable and pain free.

People were provided with choices of meals and drinks to meet both their dietary requirements and effectively reduce the risk of dehydration. Staff worked with health and social care professionals to gain advice and support to meet people’s individual needs in the right way for each person.

The management team had identified further improvements could be made to the things for people to do for fun and interest to further enhance people’s wellbeing. Information in different formats to meet people’s needs was made available.

The provider’s complaints procedures were followed, and the manager ensured ongoing complaints were receiving attention to resolve these.

Staff were complimentary about the manager who had come into post in August 2019. They felt the manager was supportive and were confident their views and suggestions would be listened to with action taken. The manager showed throughout the inspection they were active in promoting duty of candour in their role and showed they were motivated in driving through the improvements required.

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 30 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about care standards, staffing and general management. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to potential risks to people’s safety and monitoring and oversight of the service.

You can see what action we have asked the provider to take at the end of this full report. For requirement actions of enforcement which we are able to publish at the time of the report being published.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection took place on 22 June and was unannounced.

The home provides accommodation for a maximum of 56 people requiring personal care. There were 36 people living at the home when we visited. A registered manager was in post when we inspected the service. 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 and associated Regulations about how the service is run.

People told us they felt safe around care staff and did not have any concerns for their safety. Relatives told us they had no concerns and that care staff understood how to keep their relatives safe. People were supported by staff that understood people’s health needs and the risks to people’s health that people lived with. Information was given to staff to help them to support people appropriately. People received help to take their medicines and people medicines were safely administered and stored. The registered manager made regular checks to ensure people received the correct support.

People were cared for by staff who had access to regular supervision and training. People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Whilst people’s ability to make decisions was recorded and processes were followed to ensure people were not restricted unnecessarily.

People were offered a choice of food and drink and people requiring support were offered this at mealtimes. Staff kept families up to date about their relative’s care and encouraged them to visit whenever they chose to. People felt respected by staff that understood how to protect their dignity and maintain their respect. Staff demonstrated this knowledge by supporting people in a way that reinforced to people that they were being cared for in a respectful manner.

People were supported to take part in a wide variety activities they liked or had an interest in. People’s personal preferences were incorporated into their care. People and their families felt able to contribute their thoughts about their care. People understood they could complain if they chose to and felt assured their complaint would be responded to.

People liked the registered manager who they found approachable and willing to listen to them and discuss their care needs. Staff were positive about the registered manager and felt part of a team. People’s care was regularly checked and reviewed by the registered manager. However, some of the systems for ensuring people received the care they needed were still in the process of being updated and we could not be assured that the processes were fully embedded. We saw that whilst staff had received training and guidance on the MCA, staff did not understand who was affected by a Deprivation of Liberty. However, the registered manager took immediate action when this was brought to her attention.

Further information is in the detailed findings below.

The people we spoke with told us they were happy with the home and the staff. One person told us: 'The staff are very good, very kind.' One of the visitors told us: 'All of the staff are fantastic.' Another visitor said: 'We are really happy, the staff are lovely.'

We watched staff as they cared for people. They provided care and support that met people's needs.

We found that staff knew about the needs of the people they were caring for. We looked at care records for five people and found that these contained guidance for staff on how to meet their needs. We saw that people's needs were reviewed regularly.

We found that the equipment that was used in the home was maintained appropriately and that staff had been trained in its use.

We saw that staff were supported to be trained to an appropriate standard and we looked at records which showed that the provider was regularly monitoring the quality of its service.

The manager of the home was not registered with CQC at the time of our inspection. We discussed the requirement to register with the manager and have escalated this to the registered provider.