All inspections: Hallcroft Care Home - Care Quality Commission

We carried out an unannounced inspection of the service on 9 and 10 August 2015.

Hallcroft Care Home provides accommodation for people who require nursing or personal care. On the day of our inspection 21 people were using the service. There was a manager in place, but, at the time of the inspection they had not applied to become registered with the Care Quality Commission. At the time of publishing this report an application for the manager to become registered had been received.

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.

During our previous inspection on 18, 19 and 20 February 2015 we identified five breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2010. These were in relation to people’s care and welfare, assessing and monitoring of the quality of service provision, consent to care and treatment, supporting workers and maintaining people’s records. During this inspection we found improvements had been made but further improvements were still needed.

People told us they felt safe at the home and people were supported by staff who understood how to identify and report allegations of abuse. Improvements had been made in the assessment of the risks to people’s safety, and accidents and incidents were appropriately investigated. Procedures were in place to evacuate people safely in an emergency. People told us there had been improvements in the time it took staff to respond when they pressed their nursing call bells, but further improvement was needed. Improvements had been made to the staffing team. There had been a significant decrease in the number of agency staff used at the home. Medicines were managed, administered and stored safely. However some gaps were identified on people’s medicine administration records regarding the application of creams.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The manager had applied the principles of the MCA and DoLS appropriately although further applications for DoLS were required.

The majority of people told us the ability of staff to provide care that met their needs had improved. Induction procedures had been implemented for agency staff; however these had not always been appropriately completed. The majority of staff had received supervision of their work, although some staff had not. People told us they felt able to make their own choices and we observed staff respect people’s wishes. Some people spoke positively about the food provided whereas others felt improvement was needed. The lunchtime experience for people did not meet their needs; condiments and menus were missing and parts of the dining room floor were dirty. People had access to external healthcare professionals, although communication between staff and people regarding these appointments required improving.

People told us staff treated with them kindness and respect. Staff spoke respectfully with people and showed a genuine interest in what they had to say. The staff understood people’s personal histories and used that information when interacting with them. People were provided with information on how they could access independent advice about decisions regarding their care. People’s dignity was promoted and maintained. People’s friends and relative were able to visit them when they wanted to.

Improvements had been made to people’s care planning documentation. People had better access to activities and there was now an activities coordinator in place to assist people to do the things they want to do. People were supported to form meaningful relationships with others and to avoid social isolation. Staff had a good understanding of people’s preferences and used that information when interacting with them. People were provided with a complaints procedure, however this was not in an accessible place or provided in a format that could be easily understood.

There was a new management team in place; however the home manager was not registered with the CQC at the time of the inspection. Staff understood the aims and values of the service and people felt able to discuss concerns they had with the manager. Processes were in place to manage the risks faced by people and the service as a whole. Staff morale had improved since the last inspection and they felt the management team listened to them and valued their opinion. Robust auditing processes were in now in place although these had not been in place long enough for us to judge whether they could sustain the improvements made at the home.

We carried out an unannounced inspection of the service on 18, 19 and 20 February 2015.

Hallcroft Care Home provides accommodation for people who require nursing or personal care. On the day of our inspection 27 people were using the service. There was a manager in place, but they had not applied to become registered with the Care Quality Commission.

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.

During our inspection on 12 August 2014 we identified four breaches of the Regulations of the Health and Social Care Act 2008. These were in relation to people’s care and welfare, assessing and monitoring of the quality of service provision, consent to care and treatment and maintaining people’s records. During this inspection we found improvements had not been made and we identified a further breach of the Regulations. This was in relation to a lack of support in place for staff at the home.

You can see what action we told the provider to take at the back of the full version of the report.

People were provided with information in the home which explained who they could contact if they felt they or others had been the victim of abuse.

People’s needs were not always appropriately assessed and recorded within their care plan. The information recorded did not always reflect people’s current level of need, which placed their safety at risk. People’s safety was also placed at risk because personal emergency evacuation plans (PEEP), used to advise staff how to evacuate people in an emergency, were not in place.

People were not supported by an appropriate number of staff in order to keep them safe and to meet their individual needs. People had to wait a long period of time for staff to respond when they pressed their nursing call bell for help.

People’s records relating to their medicines were not always appropriately completed. Where people lacked the mental capacity to consent to care and treatment, staff had not always followed the principles of the Mental Capacity Act 2005 (MCA).

We identified a number of people whose liberty was unlawfully restricted as they were unable to leave the premises if they wanted to, as the exit was controlled by a key pad system.

People raised concerns with us regarding the effectiveness of the agency staff who worked at the home. Not all agency staff received an induction prior to commencing their role at the home. The staff we spoke with told us they did not feel supported by the management team. Staff performance and ability to carry out their role was not regularly assessed. The home had three nurses who were new to the home and they had limited knowledge of people’s needs.

People were able to see external health professionals; however referrals made by the manager did not always occur in a timely manner.

People said they did not always get the food they had requested, although others spoke positively about the food. People’s weights were taken regularly although food and fluid intake charts, used to monitor how much food and drink people consumed were not completed appropriately.

There were some positive interactions between people and some of the staff although we saw little engagement with people if care and support was not being offered. People were not always treated with dignity and respect and staff did not respond quickly enough to people who were showing signs of distress. Some people were visibly upset by the actions or in some cases, inaction of the staff.

Information was available for people if they wished to be supported by an Independent Mental Capacity Act Advocate (IMCA).

People were not supported to pursue interests that were important to them. People did not always receive care and support that had been agreed with them at the time their care plan was formed. People did not receive showers and baths when they wanted them. People were not protected from the risks of social isolation and many people spent long periods of the day alone in their bedroom. People did not feel that complaints they made were responded to appropriately.

People were not supported by a staff team that was well led by their manager. Some staff felt they were blamed by the managers for the failures at the home. There was no structured process in place which identified risks to the service and how to improve the service that people received. This home did not have a set of values, goals and aims that were explained to staff and people who used the service. Feedback received from people and their relatives had not been used to improve the home.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with nine of the 31 people who were using the service and five relatives and asked them for their views. We also spoke with five care workers, the activities coordinator, a bank nurse and the registered manager. We looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building. A regional manager came to attend the feedback at the end of the inspection and provided some further information.

The registered manager was working their notice and due to leave this employment on 20 August 2014. The provider told us that after our visit they had put a peripatetic manager in to manage the home whilst a new manager is recruited. It is a condition of the provider’s registration with us that the service must have a registered manager in post. We will monitor the situation to ensure this condition is complied with.

We carried out this inspection to answer five key questions; is the service safe, effective, caring, responsive and well-led. Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found-

Is the service safe?

We saw safe practices were followed in the storage and administration of people’s medication.

We found the provider did not identify, assess and manage risks. There were no audits completed to recognise good and poor practices and identify any risks that people may face. A staff member said, “We could be better led, we could do with more direction telling us what to do.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager told us they were going to make an application for one person but had not yet done so. The manager told us proper policies and procedures were in place. The manager said they were the only person who knew how to make an application so the provider would need to ensure other staff were able to do so if needed once the manager left their post.

Is the service effective?

We found the provider did not have effective systems to involve people in planning their care, and obtaining people’s consent for this to be provided. A staff member said, “We are not asking people to sign their care plans.” Some staff were unaware of how to protect people who might not be able to make informed decisions on their own about the care they receive.

There were few activities provided for people to take part in. A person who used the service said, “I would like more things to do during the day.”

We saw monitoring charts were not fully completed and there was no check carried out to make sure that they were. A staff member said, “Records we use are not up to date or accurate at the moment.”

Is the service caring?

We found examples where staff were friendly and caring in their approach. A person who used the service said, “The staff are nice to me, they smile, laugh and we have a joke.” Another person said, “I like to chatter (with staff), some of them will but not all of them. Some staff are very caring.”

Is the service responsive?

We found staff responded appropriately when people had the capacity to make decisions about their care and welfare. A person who used the service said, “There aren’t any restrictions on me, apart from the fact I can’t run and jump anymore!”

We found care and support was not planned and delivered in a way that ensured people’s safety and welfare and staff did not always respond to people’s needs, or were not effective in meeting these. A person who used the service said, “I can wait a long time to go to bed or get up.” The person said this was not by their choice. A relative said, “I have found him (their relation) wet and unshaven. I wish I could look after him myself.”

Is the service well-led?

We found people’s care and support was not planned and delivered in a way that ensured their safety and welfare. A recently admitted person did not have some essential care plans prepared. We also found care plans were not updated to describe how staff should respond to people’s identified and changing needs.

We found the provider did not regularly assess and monitor the quality of the service. A senior staff member said, “We try to carry out audits, but can’t keep on top of things.”

We spoke with nine people who used the service. They said they were mainly happy with the care they received. One person told us, '[The staff] are lovely. There's a couple I can't get on with, but on the whole they're a good bunch.' Another person told us, 'I'm happy enough with the care. They try their best.' A third person told us, 'I think the care is good. They're always busy, but they try and help me.'

We were concerned that consent to care and treatment was not always sought from people who used the service. We were concerned that people's needs were not always assessed and care and treatment was not always planned and delivered in line with their individual care plan.

We found a number of concerns regarding medication. We found that medication was not always stored within acceptable temperature ranges. We also found gaps on the medication administration record (MAR) charts.

We found there was a lack of audits in place to monitor the quality of the service actually being delivered. We found areas of concern in relation to other outcomes of the essential standards of quality and safety. Some of these areas of concern had not been identified by the registered manager or provider.

We found overall there had been significant improvements in the delivery of care to people.

People we spoke with told us they were treated with dignity, consideration and respect. One person said, 'The girls (staff) are kind and caring, they never grumble at you. If I'm hungry I ask for a sandwich, it's not a problem.'

We found that the delivery of care was much better and that people's health care needs were met, but we were concerned that some moving and handling assessments were not up to date and safe. The provider took immediate action to look into this and make sure people were safe.

People received food and fluids when they wanted them and this meant their health and wellbeing was promoted.

We found that people were protected from harm and abuse and that action was taken to prevent harm from happening. People said they felt safe at the home.

We did not find there were enough staff on duty to keep people safe and make sure their needs were met effectively. One relative told us, "I don't think there is enough staff on duty, they (staff) are always so busy, and often when we visit we don't see much of the staff.'

We found that staff had the training and support they needed to deliver good quality care to people living at the home.

The systems in place to check that the quality of care was good enough were not robust enough and some risks had not been identified and acted on in spite of staff and relatives raising these.

Some of the people who live at Hallcroft care home would find it difficult to help us understand their views about the quality of the care being provided to them. We used a special tool, called a short observational framework inspection (SOFI) which was designed to help us understand how people who have dementia experience the care being provided to support them. We observed four people who lived at the service in the dementia care unit over two hours including the lunchtime period. We looked at how staff interacted with people and how care was being provided to support people with their needs. We looked for clear and observable signs which would show us how people felt about the care they were receiving. We also spoke with another person living at the service and two relatives to ask them for their views on the care being provided at the home.

A person living at the service told us they got on well with the staff and felt respected by them. The person told us, "I like to spend time alone and this is respected, people don't come into my room uninvited." However, other evidence did not support this view. We observed that staff did not always consider that saying certain things or doing specific tasks in communal areas compromised people's dignity.

A person we spoke with told us that their care was discussed and agreed with them. The person told us they were happy with the care being provided. However, other evidence did not support this view. We were concerned about how we observed some staff move and handle people. We saw a person being hoisted in the main lounge and although this was done safely, the staff did not offer enough reassurance to keep the person calm whilst they were in the air. This meant the person was not protected against inappropriate care.

In the downstairs lounge we saw that staff offered drinks to people and also prepared drinks for people on demand. We also observed that they encouraged people to eat and they offered people meal choices. However, we also observed a person who was identified as nutritionally at risk ask for food and tell staff they were hungry. The staff told the person lunch would be served in half an hour rather than taking the opportunity to provide a high calorie snack to boost their nutritional intake.

A relative told us that they felt their loved one was safe with the staff and they said they felt confident that the staff were caring for the person well. We were however concerned about the restrictions on a person in the dementia care unit which had not been assessed to determine whether they constituted a restriction to the person's liberty. This meant the person's rights were not upheld.

Our observations showed that there were enough staff available to meet people's needs.

We saw some staff were kind, attentive and skilled at understanding and meeting the needs of people who had dementia. We found others were less skilled. These issues had not been picked up as until recently staff had not received the training, supervision and support they needed to make sure they were doing their jobs to a sufficiently high standard.

Although there had been recent improvements in the service we found that the systems the provider had in place were not effective in assessing and monitoring the quality of the service. As it was not effective the system failed to identify risks to the health, safety and welfare of people living at the service.

We carried out this responsive inspection because we had concerns that this service had not been visited since 25 January 2010.

We spoke with four of the 26 people living at the service when we visited on 10 February 2012. We also spoke with people who had regular contact with the home to ask for their comments and observations. We spent a period of time, sitting with a group of people in a communal area. We were able to observe people's experiences of living at the home and their interactions with each other and with the staff.

Our observations showed that people had a positive experience at the home, the atmosphere was calm and friendly and the staff were attentive to the needs of the people living there.

We were told, 'I like living here, I couldn't live alone anymore.' And, I chose to live here, I was lonely at home.'

We were also told, 'They [the staff] look after me very well, they're lovely.' And, 'I spend my time doing what I want, to do.'

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Hallcroft Care Home

All Inspections

9 & 10 August 2015

During a routine inspection

18 to 20 February 2015

During a routine inspection

12 August 2014

During a routine inspection

12 August 2013

During a routine inspection

14 February 2013

During an inspection looking at part of the service

18 June 2012

During a routine inspection

10 February 2012

During an inspection in response to concerns

Reports under our old system of regulation