Haydock House

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We assessed 7 quality statements in the well-led key question and found continued areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was inadequate. Our rating for the key question remains inadequate. The service was not well led. We identified a continued breach of the legal regulations. The provider failed to demonstrate there was an inclusive and positive culture of continuous improvement. There had been delays in reporting of events which occurred in the service to other agencies, including the CQC. The governance systems were not effective in identifying improvements to the service. Audits completed failed to identify all the issues we shared in this assessment. No effective systems were in place to ensure that people were supported by competent, trained staff who had access to clear and effective guidance and direction. Staff and management were not always aware of people’s needs and wishes due to a lack of assessment and effective care planning. Individual care plans and risk assessments failed to identify any risk and how a person’s needs were to be met. People were not actively involved in the developing the service. These concerns demonstrated a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Records showed that leaders did not always ensure that risks in relation to delivery of care were assessed and action taken. The environment presented a health and safety risk to people living within in the service. During the day of the assessment there was no hot water in one bathroom, one staff member told us, “One person complained it was too hot, so they turned it off.”

People did not receive person centred care and support to achieve good outcomes. Incident and accident logs were not always written in a respectful manner. For example, a record for one person stated, “Don't give them [person] an audience, walk away and don't try to reason with then when they are agitated.” Audits in relation to the environment were not effective as outcomes of safety checks failed to be addressed where identified. The environment presented a health and safety risk to people living within in the service. During the day of the assessment there was no hot water in one bathroom, one staff member told us, “One person complained it was too hot, so they turned it off.”’ Observations throughout the assessment identified concerns regarding staff members level of understanding in relation to equity, diversity and human rights. Some people were restricted and provided with limited activities and engagement. Interactions between staff and people who lived in the service were minimal.

Staff did not always have clear direction due to the lack of effective assessment of risk and care planning for people. The management within the service were not always visible, one staff member told us, “Managers are ok when they are here.” The service had experienced several changes of manager over a short period of time. There was no clear management structure within the home. External support was being commissioned; this included consultants specialising in social care, however, these roles were not structured and there were no clear guidelines as to what was expected from their services. Staff spoken with were not aware of their roles and responsibilities. Information regarding people’s care needs were not always communicated to staff. Leaders did not lead by example. CQC observed several staff members responding to an individual who was distressed by laughing.

There was no registered manager in place, the deputy manager has stepped up to interim manager until a registered manager has been recruited. There was an inconsistent management team within the service, a lot of support was being provided remotely with no clear guidance. The provider was having difficulties in recruiting staff. There was no activity co-ordinator in place and agency staff were being utilised to bridge the gaps until permanent staff could be recruited. Staff had not had the relevant training to support people safely. No staff had training in relation to supporting people with a mental health condition. Not all staff had been trained in relation to the use of restrictive practice, this placed people at risk of being restrained by staff who were not trained to do so.

Staff did not know how to access the whistleblowing policy. People who lived at the service told us they had raised complaints, but nothing happens. Staff told us they have not received regular supervision for their role. One staff member told us, “I have not had supervision for a while due to change in managers.”

People were not actively involved in sharing feedback to allow for improvements. There were no records of any complaints or compliments. Team meeting minutes were amended during the assessment therefore we could not be assured these were accurate and captured staff feedback. Staff members had not received regular supervision for their role. There was no evidence of any lessons learnt following on from accidents and incidents.

Staff told us they were happy with the support they received from management when they were available. There had been a high turnover of managers which had caused problems as staff had not received supervision, guidance or direction. There had been problems with the culture within the home due to inconsistencies with management. However, staff felt there was an improvement, one staff member told us, “The team are now working better together.” Another staff member told us, “We are almost there now.”

There was no evidence staff who did not have English as their first language were provided any additional support in promoting effective delivery of the service to people. Staff had received training in relation to equality, diversity, and human rights. However, the lack of effective person centred care planning, management of risk, direction and guidance failed to promote equality, diversity and individual’s human rights.

There was no clear information available to inform staff of their roles and responsibilities. Written communication about people's needs and wishes and staff responsibilities was inadequate as it failed to give clear information as to what people's needs were and how they were to be met. The management team were not aware of people’s needs. One staff member told us a person was in hospital due to a deterioration in their mental health however, the person was in hospital due to their physical health. Staff were not aware why some people were on enhanced observations.

The provider had systems in place to monitor some aspects of the service. However, regular audits were not fully completed to help identify areas of improvement. Where actions plans were in place they had not always been followed and actions were not completed within the timescales identified. Risk assessments to guide staff on how to support people safely were either not completed or not effective. There was no evidence of any actions being taken following on from concerns identified within internal audits. Action plans were not being followed or adhered too, dates for actions to be completed were not effective, actions identified as urgent were still not completed during this assessment. Walkarounds were being completed by the manager however, these were not effective as they failed to identify areas of improvement needed. There was no policy or procedures in place in relation to observations despite some people receiving support from 2 staff to deliver care and support. Safeguarding referrals and statutory notifications to CQC were not being submitted as required. There was lack of understanding by managers in relation to when notifications needed to be submitted and the level of information required. There was no clear management structure within the service, there were numerous people commissioned externally to provide support however, these roles were not clear. Staff did not know their roles and responsibilities to ensure the service was run safely with people at the heart of support provided. Staffing rotas put restrictions on people accessing community activities due to limited staff providing support in the evenings. This put people at risk of not receiving the support they required. There was a business contingency plan in place to provide guidance on what to do in an emergency situation.

People were not supported to access the community, one person told us, “I have been waiting all day.” We observed a person waiting to access the community in the communal area for a long period of time. The lack of effective planning of people's care and support impacted on the activities planned with other agencies.

There was no clear structure for people who required staff support to meet their needs. For example, community access was provided on the needs of the service rather than the needs of the individual. One staff member told us, “They [person] can’t go out staff need breaks.” The provider engaged with the Local Authority and health professionals due to concerns raised during the previous inspection. However, there was lack of recognition for external support for those people who were experiencing distress.

Partners were concerned regarding the care and support people were receiving. Feedback obtained showed recommended identified actions, to help manage repeated incidents were not being completed and known risk to people were not being minimised wherever possible. People's care and support records did not evidence that their choice, control and preference had been considered. The two commissioning authorities and the host authority continued to raise concerns regarding the service people were in receipt of. A visiting professional told us, “When I came, they [person] were blue and struggling to breath, no one had done anything about this, it took me to go and find staff for help.” Numerous safeguarding referrals had been submitted and were being investigated by the host local authority.

The provider did not always act on recommendations from the local authority and health professionals to support people safely. A lack of effective processes for the oversight, care planning and management of risk resulted in people not always receiving the care and support they required.

Staff were provided with a list of training however, little opportunity was available to enable them to complete the training. One staff member told us, “I don’t get paid to do the training at home and I don’t have time in work to complete it.” Records showed that staff supervision was not carried out regularly to allow staff to provide and receive guidance, direction and feedback on care being provided.

The oversight of training was not effective, not all staff had received the training they required to meet people’s needs safely. Governance meetings were taking place monthly however, no improvements or actions were taken following on from concerns identified. People's care plans were not updated following incidents or where changes in people's support was identified. For example, we found one person who required support from 2 staff members, their care plan stated one staff member.