Hurstead House Care Home

Hursthead House is a residential care home providing nursing and personal care for up to 22 people. Accommodation was provided in one single adapted building.

We found the following examples of good practice

¿ There was clear signage displayed about the covid outbreak and families were kept updated about their relatives health.

¿ National guidance was followed on the use of personal protective equipment (PPE) and the service had sufficient stock.

¿ Temperature checks were undertaken prior to entry. National lockdown measures on visiting were in place at the time of the inspection. We noted that although the service had visitor risk assessments, they were not being completed. Following the inspection we received confirmation that these had been implemented.

¿ There was good ventilation with windows open in the home and the provider had invested in an air purifying machine.

¿ The service had appointed an infection control and prevention lead and had increased staffing levels for domestics.

¿ Staff and residents were taking part in regular covid 19 testing and the vaccination programme.

¿ The registered manager was following current admissions guidance.

Further information is in the detailed findings below.

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

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.

We made a recommendation around improving how all staff respond to an emergency such as a fire.

We also made a recommendation for more personalised end of life wishes be recorded.

Safeguarding policies, procedures and staff training helped protect people from harm. All necessary checks on staff and the environment were undertaken to keep people safe. Risk assessments helped protect the health and welfare of people who used the service. The administration of medicines was safe.

People were supported to live healthy lives because they had access to professionals, a well-trained staff team and a choice of a nutritious diet. The service worked with other organisations to provide effective and consistent care. 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 treated as individuals which helped protect their dignity. People’s equality and diversity was respected by a caring staff team and where they wanted they were supported pursue their religion.

We saw that the service responded to the needs of people by providing meaningful activities, having regularly reviewed plans of care and any concerns acted upon. Staff training enabled them to care for people at the end of their lives.

The deputy manager conducted audits and attended meetings to discuss best practice topics with other organisations to improve the service. People who used the service and staff said managers were available and approachable. People who used the service and staff were able to air their views about how the service was run.

Rating at last inspection.

The last rating for this service was requires improvement (published 22 August 2018) and there was a breach of Regulation 17 HSCA RA Regulations 2014. Good governance. The oversight of the service did not always detect or react to issues which may affect the safety or wellbeing of people who used the service. 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 further improvements had been made and the provider was no longer in breach of regulations.

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.

This inspection took place on 22 and 23 August 2018 and the first day was unannounced. The home is registered with CQC to provide nursing and personal care for up to 30 older people. At the time of our inspection there were 25 people living at the home. Accommodation is provided over two floors, with a passenger lift providing access to the first floor.

There were two registered managers in place, one of whom was also the registered provider. 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.

The home was last inspected on 30 October, 1 and 2 November 2017 when it was rated as Inadequate. This meant the service was in ‘special measures.’ At that time, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These related to safe care and treatment; safeguarding people from abuse; premises and equipment, and the overall governance of the home. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe?’, ‘is the service effective?’ ‘is the service caring?’ ‘is the service responsive?’ and ‘is the service well led?’ to at least good. At this inspection we found some improvement in these areas. The service is no longer rated “inadequate” and has moved out of special measures.

However, we found further improvements were required. We identified a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the governance arrangements for the service had not identified concerns regarding the safe management of the home. Issues included reviews of risk assessments which did not consider changes in need; faulty and dirty equipment in a shower room; the lack of hot running water and hand washing facilities in the laundry, and a smoke detector which had been temporarily rendered ineffective.

We also recommended that the service considers managerial arrangements to respond to risk and ensure the premises are safe and suitably maintained for the people who live and work at Hurstead House.

The service reported a low incidence of safeguarding concerns which reflected the safety of the people who used the service, and staff we spoke with demonstrated a good understanding of the signs of abuse, telling us they were encouraged to report any concerns.

Staff rotas reflected a good level of staff and robust recruitment policies ensured that staff recruited to work at Hurstead House had the right qualities to work with vulnerable people.

People's health was monitored by trained nurses and they had access to other healthcare professionals to meet their individual needs. People received their medicines safely.

Staff knew the people who lived at Hurstead House well, and had access to ongoing training to improve their knowledge. Some refresher training had not been completed by all staff, but had been scheduled for later in the year. This would provide staff with the opportunity to review and update their knowledge.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs. When we asked, people told us they enjoyed the food provided. One person told us, “The food is very good, tasty and plentiful”.

During our inspection we found the service reflected a caring ethos. We observed good examples of caring interventions, and all staff were consistently courteous and polite. We witnessed good interaction between staff and people who lived at Hurstead House, and saw that friendship groups were encouraged and supported. Visitors told us they were always made welcome.

Care records contained information about how they liked their care to be delivered, and people told us that the staff knew what they liked and disliked. There was a good range of activities and people were stimulated throughout the day.

People told us the registered managers were approachable and would listen and respond to any issues raised. The home regularly sought feedback, and used this to improve the quality of the service.

Hurstead House Nursing Home is situated in a suburban area of Rochdale close to local amenities and transport links. Nursing and personal care can be provided for up to 30 people in accommodation on the ground and first floor.

We last inspected Hurstead House Nursing Home in November 2014 and rated the service as Good. This inspection was carried out to ensure these standards were still being maintained, however we found standards had declined in several areas.

During the inspection we identified breaches of regulations with regards to safe care and treatment, safeguarding people from abuse, premises and equipment and good governance. You can see what action we have asked the service to take at the back of this report.

We found the home did not always assess and mitigate risks well. Flammable objects such as lighters were allowed to be held in bedrooms where oxygen was in use. Comprehensive risk assessments had not been carried out to mitigate these risks.

An electrical installation check was carried out at the home in May 2017 and several recommendations had been made which required both urgent and immediate action to ensure the electrics were safe. However at the time of the inspection this work had not yet been completed. These issues presented the risk of a fire at the home.

There were other environmental risks seen around the home such as a steep stair case leading to the attic which was left unlocked which presented a risk of people accessing it and falling. An upstairs sluice room was seen unlocked during each day of our inspection where cleaning products were stored, despite it being fitted with a key coded lock. A store room used to store the supplement, ‘Thick and easy’ was also left unlocked during the day. This presented the risk of people consuming these products in an unsafe manner, particularly people living with dementia who may not understand the presented risks.

We reviewed how medication was handled and overall, found this was given to people safely. However, we found there were no records kept for the application of topical creams, such as barrier creams to maintain good skin health. We also did not see any instructions for care staff about where the topical creams were to be applied. This meant we couldn’t be certain that the people using the service were receiving prescribed creams as required. We have made a recommendation about this within the detailed findings of the report.

We looked at systems in place with regards to infection control. The home was observed to be clean and tidy, with no malodours present. We did however observe some poor practice where a member of staff wiped a person’s nose with a tissue and then assisted a person to eat their lunch whilst holding the tissue in their hand. One bathroom/toilet was not fitted with a soap dispenser so that people could wash their hands if they had been to the toilet. This presented the risk of the spread of infections within the home.

We checked to see if the home were working within the requirement of the MCA (Mental Capacity Act) and were making appropriate DOLS (Deprivation of Liberty Safeguards) referrals to the local authority. We found DoLS applications were not always made in a timely manner where people lacked the capacity to make their own choices and decisions. The registered manager said if these people were to ask to leave the home then they would have to stop them due to it being unsafe for them. This presented the risk of people being detained without lawful authority.

Staff were not always discreet when taking people to the toilet and overheard staff saying this loudly in front of others living at the home. People also told us they often had to wait for assistance to be taken to the toilet. This could impact on people’s dignity.

The feedback we received from people living at the home and relatives was that there were not enough activities taking place. Our observations were reflective of this and we did not see any taking part during the inspection. People also said they would like to go out more, although weren’t given the opportunity to do this.

We had concerns about the governance systems at the home to monitor the quality of service being provided to people. This was because the homes own internal quality assurance systems had failed to identify the concerns we had raised during the inspection.

The overall rating for this service is 'Inadequate' and the service is therefore in 'Special Measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, we will be inspecting again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate in any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

During an inspection of the home in June 2014 we found the provider did not have an effective system to regularly assess and monitor the quality of service that people received. The provider also did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Following the inspection in June 2014 we served a Warning Notice to ensure that improvements were made quickly in order to protect people.

During this inspection we found the Warning Notice had been complied with. The provider had introduced systems to monitor the effectiveness of the service provided. Systems were also now in place to assess and manage risks to the health, safety and welfare of people who used the service and others.

Below is a summary of what we found. The summary is based on speaking with seven people who used the service and four relatives. We also spoke with the provider who was present on the day of the inspection, a professional visitor to the home, seven members of staff and looked at records.

Is the service safe?

All the people we spoke with told us they felt safe at Hurstead House.

Most care files we looked contained the necessary records to inform staff of the care people needed. An assessment had also been made of whether people were able to make their own decisions in relation to their care and treatment. However, in particular, people admitted on respite did not have a care plan in place.

People were not protected against the risk of acquiring infections. This was because the home was not kept clean and hygienic.

People were protected because an assessment had been undertaken of their capacity to make their own decisions. Relevant staff knew what actions to take if they considered a person needed to be deprived of their liberty in order to keep them safe.

Is the service caring?

People we spoke with were complimentary about the care provided. Comments they made to us included, "The care in really good", "This is one of the best homes I've been in for personal care" and "My relative is well cared for. There are other problems but the care is good".

It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs.

Is the service effective?

Not enough staff were in place to effectively meet people's needs. This was because the lack of domestic staff meant care and nursing staff were sometimes unable to spend quality time with people.

During our observations we saw people were sat for long periods without any stimulation or activities provided to meet their needs

Arrangements to clearly lead and support the staff team were not in place. This meant people did not always receive the care and support they needed.

Is the service responsive to people's needs?

Staff had responded appropriately to a range of medical needs and we saw that medical professionals such as the G.P and district nurse were regularly involved in people's care.

A relative told us, "The staff have always acted on any comments I have made".

Is the service well led?

We were aware there had been no registered manager at the home since 1 April 2014. In this report the name of the registered manager appears who was not in post and not managing the regulatory 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.

Systems to monitor and review the quality of care and facilities, as well as opportunities for people to give their views about their experiences were not in place. This information would help to identify where improvements could be made within the home.

Staff and visitors told us they found it difficult to speak to the owner of the service in the absence of a registered manager. They commented, "When asked he says 'talk to the manager' and walks off' and "I don't think he takes enough responsibility".