Hafod Nursing Home

About the service

Hafod Nursing Home is a care home providing personal and nursing care for up to 29 people. The service cares for younger people and some people over the age of 65 and living with dementia. The service accommodates people across two floors in two adjoining buildings. At the time of the inspection 25 people were living there.

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

The home environment was poorly maintained and some areas of the home were unsafe. We found multiple areas within and outside the home where ceilings, walls, paintwork and flooring was damaged. There were also issues with fire doors and window restrictors. Due to the fire safety concerns identified at the service, a referral was made to West Midlands Fire Service to conduct a fire safety visit.

The provider’s governance systems had failed to identify the concerns we found. Whilst regular checks and audits were in place, the provider was not effective at driving improvement.

The provider had failed to maintain robust oversight of the maintenance of the service. As a result, the condition of the building and state of repairs had continued to deteriorate.

The home environment had not fully supported people’s autonomy and independence. There was limited wheelchair access to the garden area and improvements to the home environment was required to meet the assessed needs of people living with dementia.

Care plans and risk assessments were in place and had been reviewed regularly.

People we spoke with told us they felt safe from the risk of abuse. Family members told us they felt their relatives were safe living at the home and spoke positively about all the staff that supported their relatives. Staff understood their responsibilities to keep people safe and safeguarding concerns were referred to the local authority.

Medicines were managed safely. Incidents and accidents were monitored for future learning.

There were enough staff on duty to meet people's needs and recruitment processes were in place to safely recruit staff. We found there was good communication with healthcare agencies. We saw kind interactions with people.

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.

Staff felt supported by the registered manager. Staff had received supervision to help them in their roles and training had been completed or in the process of being arranged for them.

The registered manager understood their regulatory responsibilities.

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 05 February 2020) and there were breaches of regulations. The enforcement action taken included issuing a warning notice. The provider submitted an action plan to tell us what they would do to comply with the warning notice. At this inspection we found the provider had complied with part of the warning notice. However, not enough improvement had been made to the governance processes and the provider was still in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

At our previous inspection we found breaches of legal requirements. The provider completed an action plan after the last inspection to show what they would do and by when to improve to meet the breaches of regulation 11 need for consent and regulation 17 good governance.

We undertook this focused inspection to check the provider had followed their action plan, met the warning notice and to confirm they now meet legal requirements.

This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements. We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. 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 has remained requires improvement. This is based on the findings at this inspection.

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.

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 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 with upkeep and maintenance of the building, an unsafe home environment and governance at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hafod Nursing Home on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Hafod Nursing Home is a care home providing personal and nursing care to 22 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

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

People’s views were mixed about staffing levels. Our observations were staff were available to meet peoples’ needs and they did not have to wait to receive their care. staff used personal protective equipment when required. Although there was a system in place to ensure individual slings were used for manual handling, not all staff were following this system. People told us they felt safe and staff knew how to recognise signs of abuse and how to report them. People received their medicines safely. Some care records had not been updated in a timely manner to mitigate against risk. Accidents and incidents were recorded and appropriate action taken.

People were not supported to have maximum choice and control of their live and staff did not always support them in the least restrictive way possible and in their best interests; and the policies and systems in the service did not support this practice. Staff had received training, but this wasn’t always effective and some training to update skills, was not available to all staff. The environment was being re-decorated to improve the environment and people were positive about this change.

The provider's systems did not always support the service to be fully caring. People received care and support that respected their dignity and privacy. People and relatives were positive about the caring nature of staff. Relatives were made to feel welcome in the home at any time.

People told us they were not always involved in reviews of their care but we saw evidence relatives were. Improvements were needed so person centred activities were on offer for people to engage in. Complaints were responded to in a timely manner and people’s end of life wishes were recorded and respected.

The service did not have a registered manager in post. A clinical lead had been recently appointed and staff were positive about the improvements they had made. The systems in place to monitor the quality and safety of the service were in place but were not consistent. People were unclear about who was in charge but felt able to raise concerns if needed.

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 July 2018) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

You can see what action we have asked the provider to take at the end of this full report.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to regulation 11 consent to care and regulation 17 good governance at this inspection.

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.

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

Hafod Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hafod Nursing Home accommodates up to 29 people. At the time of the inspection there were 26 people using the service.

The registered manager had recently left their post prior to the inspection. The provider told us a new manager would be registering with us. 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.

People’s medicines were not always administered in line with guidance. Risks to people were not clearly understood by staff and guidance was no always followed.

People did not always have their rights protected and the principles of the Mental Capacity Act 2005 were not always followed.

The systems in place to monitor people’s care delivery were not consistently effective and we could not be assured the systems were sustainable.

People were not always supported by suitably deployed staff. Staff were sometimes unable to provide dignified care due to being task orientated. Staff training was not up to date and competency was not always checked.

The building was not always designed to meet people’s needs; in particular people with dementia. Some decoration, adaptations and furnishings also required updating. Infection control required improvements to ensure furnishings were replaced promptly.

People’s care plans were not always up to date and held conflicting information. Care plans did not have much personalised information. People were not always receiving support to be stimulated with activities and to follow their interests.

If people required their health conditions monitoring following guidance being provided, this was not always being done. Records of care delivered were not always completed as required as stated in people’s care plans. People were not always receiving consistent care and support.

People had their needs assessed but further improvements were needed to how this informed people’s care plans. People were supported by knowledgeable staff, however further improvements were required in supporting people living with dementia. Improvements were needed to the environment to ensure it was suitable for people living with dementia.

People were safeguarded from potential abuse. People were supported in a way that met their wishes and effectively at the end of their life.

People received support from staff that were caring and people were involved in decisions and had their choices respected by staff. People understood how to make a complaint.

Notifications were submitted as required and the provider understood their responsibilities for notifying us of specific incidents which had occurred at the service. We found people, their relatives and staff felt supported by the provider.

Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010 Consent to care and treatment

The provider must ensure where any restrictions apply that the appropriate assessments have been carried out to ensure any restrictions are in the person best interest.

During this latest inspection we could see that all issues relating to these breaches had been addressed and rectified.

HAFOD Nursing Home is a registered care home providing accommodation and nursing care for up to 29 people. At the time of our inspection there were 27 people living at the home.

There was a registered manager in post. 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.

The provider failed to protect people’s confidential data and records.

Management systems to audit, assess and monitor the quality of the service provided were ineffective to ensure that people were benefitting from a service that was continually developing.

People were safe and secure. Relatives believed their family members were kept safe. Risks to people had been assessed and managed appropriately.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual needs. People safely received their medicines as prescribed to them.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat and meal times were flexible to meet people’s needs.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there was positive communication and interaction between staff and the people living at the location. Staff were aware of the signs that would indicate a person was unhappy and knew what action to take to support people effectively.

People’s right to privacy were upheld by staff that treated them with dignity and respect. People’s choices and independence was respected and promoted and staff responded appropriately to people’s support needs.

People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

People told us and we saw that staff respected their privacy and dignity and that they were given choices about their care. One person told us, 'I have been here for two years and I like it, staff are very kind'.

People's care and health needs were planned and met in a personalised way. All staff spoken with told us they had the information they needed to care for people safely.

Staffs were clear about the action to take should they become aware of an allegation of abuse in the home. All five people spoken with told us they felt secure and knew who to tell if they had concerns and were confident that these would be acted upon.

Staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

There were systems in place to monitor, investigate and respond to complaints received. One relative told us that when they made a complaint the provider ensured that the complaint was resolved. This meant the provider took the appropriate action to resolve issues that were brought to their attention.