Hall Green Care Home

Hall Green Care Home is a residential care home providing the regulated activity of accommodation with personal care for up to 62 people. The service provides support to people living with dementia. At the time of our inspection there were 39 people using the service. The home is separated across three floors, each with separate adapted facilities. The top floor provided short stay interim beds- Enhanced Assessment Beds (EAB) for people discharged from hospital, who may require further assessment of their care and support needs before returning to their own home or another form of care placement.

People’s experience of using this service and what we

People’s safety was monitored and managed effectively. They were supported by appropriate numbers of suitably trained and safely recruited staff. People were supported to take their medicines safely. Their home was clean and free of clutter. People told us they felt safe. One person told us; “I do feel safe, they come and check on me at night too.”

People received good quality care, which was monitored by effective governance processes. Their relatives and staff who supported them spoke highly of the registered manager and deputy manager. One staff member told us; “I love my job; the managers have been so supportive.” Staff were kept up to date with national policy which helped them improve the care provided.

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 25 October 2019).

Why we inspected

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

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 has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hall Green Care Home 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.

Hall Green is a care home providing personal care for up to 62 people. The service was provided over three floors. People on the first floor and second floor lived there permanently at Hall Green. There was an assessment unit on the third floor, where people were temporarily admitted from hospital or the community to assess their needs. At the time of the inspection 39 people were living there.

Peoples experience of using the service and what we found

People were kept safe by staff who knew how to report concerns and manage risks to keep people safe. Staff were safely recruited and there were enough staff to support people.

At the last inspection the support people had with their medicine was not always safe. At this inspection medicine management has improved so people receive their medication safely.

People were supported by staff who were caring. People were involved in decisions around their care and were treated with respect and dignity.

Staff knew people well and supported them in line with their preference and choices.

People and staff felt supported by the management team.

There were systems in place to monitor the service, but further improvements were required for the systems to be fully effective.

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.

Rating at last inspection and update

The last rating for this service was requires improvement (published-04 July 2019) and the provider was in breach of regulations. 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.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Safe, Effective and Well led which contain those requirements. The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. 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 Hall Green on our website at www.cqc.org.uk.

Hall Green care home is a residential care home that provides personal care for up to 62 people, aged 65 or over, most of whom are living with dementia. The service was provided over three floors. People on the first and second floors lived permanently at Hall Green. There was an assessment unit on the third floor, where people were temporarily admitted from hospital or from the community to assess their needs. This took place over a four to twelve week period, prior to making more permanent arrangements to meet their care needs. 51 people lived at the home at the time of the inspection.

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

We have found evidence that the provider needs to make improvements. People were at risk because medicines were not always managed safely and in accordance with best practice guidelines. People did not get always get their medicines as prescribed or when they needed them which put their health at increased risk. We asked the registered manager to take some immediate steps to reduce these risks, which they did, and to make further improvements.

Some of the providers quality monitoring systems were not fully effective. This was because they did not take effective action to make the required improvements to address risks identified.

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 have made a recommendation about improving records of best interest decision making.

People did not have access to safe outside space because the gardens were poorly maintained. This reduced people’s ability to move around outside independently.

Please see the Safe, Effective and Well led sections of this full report. You can see what action we have asked the provider to take at the end of this full 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.

People were supported by caring and compassionate staff who treated them with dignity and respect.

People and relatives felt the service was safe. Staff demonstrated an awareness of each person's safety and how to minimise risks for them. There were enough staff who worked flexibly to ensure people received care and support in a timely way.

People were supported by staff who received regular training and supervision to provide them with the skills and knowledge to meet people's needs. Staff worked in partnership with local professionals to provide effective care, support and treatment.

People received personalised care responsive to their needs. Recent improvements had been made in the variety of activities for people. Further improvements were needed to make activities more personalised for the needs of people living with dementia.

People's concerns were listened and responded to. Accidents, incidents and complaints were used as opportunities to improve the service.

People, relatives and professionals gave us positive feedback about leadership and the quality of people's care. They said the registered manager was approachable, organised, and acted on feedback.

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. (Report published on 04 May 2016).

Why we inspected: This was a planned inspection based on the previous rating. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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 manager was registered with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Medicines were given appropriately and the recording of their distribution was clear and concise. Medicines were kept and disposed of as they should be.

A suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs. People told us that they were kept safe.

People were able to raise any concerns they had and felt confident they would be acted upon, they understood the complaints procedure that had been given to them.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005. Staff interacted with people in a positive manner.

People were supported to take sufficient food and drinks and their health needs were met.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People took part in activities and staff interacted positively with them, spending time to stop and talk. Cultural needs were observed and people felt that staff understood their needs.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of the registered manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

Quality assurance audits were undertaken regularly and the provider gave the registered manager support.

Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

The local authority and other external health care agencies had concerns regarding the care and welfare of some people who lived there. Concerns raised included, the number of falls people experienced, inadequate record keeping and dementia care. As a result the local authority suspended the funding of new placements. The local authority then determined a gradual improvement had been made and the suspension had been partially lifted to allow the provider to admit one new person per week to the home. However, during the week of our inspection new issues had been raised regarding a high number of people who had allegedly suffered from urinary tract infections and some aspects of infection prevention . External health care professionals had started to investigate those issues to determine whether or not there was a concern. Due to this the local authority was again reassessing if a suspension of new placements was required.

This was our first inspection of this home under the ownership of the present provider. The home environment comprised of three floors where people lived and were cared for. At the time of our inspection 60 people lived at Hall Green. (This included 18 people who required rehabilitative care and support). This provision was available for a short duration as ultimately people could return back to their homes within the community or transfer to an alternative care facility.

During our inspection we spoke with ten people who lived there, five relatives, nine staff and the manager. The majority of people who lived there and their relatives were positive about the home and the services provided. One relative said, 'They are well looked after. I have no concerns'. One person who lived there said, 'I like living here'. Comments from other people included, 'I'm happy' and, 'I like it here' However, a number of people and relatives told us to us that some aspects needed some improvement which included activity provision, the cleanliness and staffing levels.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. All people and relatives that we asked told us that they had not seen anything of concern. One person told us, 'The staff have never done anything to me that I do not like'.

Staff we spoke with knew of Deprivation of Liberty Safeguard (DoLS) processes. DoLS is a legal framework that may need to be applied to people in care settings who lack capacity and may need to be deprived of their liberty in their own best interests to protect them from harm and/or injury. At least two DoLS applications had been approved by the local authority and were being reviewed. This showed that systems were in place to keep people safe.

We found that people's mobility needs had been assessed and were generally met. However, the management of day to day risks and safety should be improved upon. Those include systems to prevent falls, dehydration and malnutrition.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

People's health and care needs were assessed but they were not always included in detail in their care plans. For example, care plans did not highlight what action staff should take to reduce people who suffered from agitation. This meant that care plans were not able to consistently support staff to meet people's needs.

Systems in place did not give assurance that when staff identified that people had red skin adequate action or care planning was effective to prevent skin breakdown.

Systems regarding menu planning and the main mealtime experience process were not effective. Although a number of people told us that the meals were good, other people told us that they were not. Some people told us that meals lacked variety.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to care planning and meal time experiences to ensure that the service is effective.

Is the service caring?

Overall we determined that staff showed people respect and promoted their dignity. We saw that staff showed patience when supporting people. A relative said, 'The staff are good'. The majority of people we spoke with told us that the staff were caring and kind.

We found that day to day activity provision was lacking. A number of people told us that they were bored. One person said, "There is not much to do". A relative told us, "There are not enough activities. People are always asleep in their chairs".

People who lived there and their relatives had not been given the opportunity to complete satisfaction surveys. The registered manager told us that they were in the processes of addressing this. By listening to the views of the people who live there and their relatives the provider would know where improvement was needed.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring that the service provided was caring.

Is the service responsive?

The provider had acknowledged that fall prevention systems should be improved and was to have a new alarm system installed. This demonstrated some responsiveness.

During this inspection we found non-compliance in a number of areas. Most non-compliance had already been raised with the provider by external care agencies. The provider had made some changes but improvement was slow/or there had been no improvement. This did not give assurance that the service had been adequately responsive.

People and their relatives told us that they were concerned about odour and the cleanliness in some parts of the premises and some soft furnishings. Our observations confirmed those concerns. A relative said, "The chairs and carpet are filthy. It is disgusting". We saw that the issues had been raised in senior manager visit reports from at least January 2014 yet there was no replacement of the carpets and soft furnishings. This did not give assurance that the provider had been adequately responsive.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make to ensure that the service is responsive.

Is the service well-led?

The provider told us that improvements had been made since external care agencies had raised issues. However, our observations showed that staff did not always perform to the standard that was required when using the hoist or by paying adequate attention to people's needs at mealtimes.

The provider had basic quality assurance systems. However, records seen by us showed that they were not all completed adequately and some care plans relating to dementia care, skin damage and those to evidence sufficient food and fluid intake were not adequate. This showed that staff not undertaken tasks as they should and did not give assurance that the service was well led.

We have asked the provider to tell us what they are going to do to meet the requirements of the law and the improvements they will make in relation to the management of staff and quality assurance processes to demonstrate a well led service.