During this inspection we spoke with seven people who used the service, one relative, and six members of staff. 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.
Is the service safe?
The people who used the service told us they felt safe in the home and trusted the staff. One person told us, 'If I was not happy with something I'd go to the care staff or the manager.' Another person said, 'If there was a problem I'd talk to one of the girls (the care workers) and if nothing was done I'd tell the manager or social services.'
At our first visit to the home on 16 April 2014 the area manager told us that following recent safeguarding concerns being raised, staff had had further safeguarding training. We spoke with two care workers and both were clear about their responsibilities in this area. One care worker told us, 'I wouldn't hesitate (to report a safeguarding concern).'
We looked at the management of medication in the home. People told us they received their medication on time and when they needed it. One person said, 'The staff bring me my medication twice in the morning and then during lunch and tea. It's nice that I can rely on them to do this.'
At our second visit to the home on 29 April 2014 we followed up an incident reported to us by the home regarding some missing medication. The home had taken appropriate action when the error was discovered.
The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).
Is the service effective?
The people who used the service told us they liked living at Hadrian House. One person said, 'It's a pleasant place and easy to get to know people here. If I need help I just ask the staff.' Another commented, 'If I want to see a doctor one of the staff takes me to the surgery.'
At our first visit to the home we looked at falls management as concerns had been raised about this with us and the local authority. The area manager told us she had introduced a weekly and monthly falls audit. We looked at the records for March and the beginning of April 2014. These showed that falls had been analysed and action taken to minimise risk.
We looked at the care of people who were prone to falling. They had detailed care plans and risk assessments in place to advise staff on how to care from them safely. One person had been referred to an occupational therapist who had advised staff on how to prevent them falling. Other people's care plans and risk assessments showed similar interventions had been used to minimise the likelihood of falls.
At our second visit we looked at pressure area care. Prior to this visit a local authority social worker had twice found a person left in an armchair without a pressure cushion in place. This was despite this person having their own pressure cushion and a care plan saying it should be used at all times when the person was seated.
We discussed with the area manager who said that on both occasions staff had forgotten to bring the cushion through to the lounge. The area manager said this was unacceptable and she had taken steps to ensure it would not be forgotten again. These included labelling pressure cushions with their owner's names, and reviewing all care plans and risk assessments to ensure information about pressure care was highlighted.
Is the service caring?
People told us they were pleased with the staff at Hadrian House. One person said 'The staff have got a good attitude and are nice and friendly.' Another commented, 'I am happy with the staff particularly when they go out of their way to talk to me.'
One person described the relationship they had with a particular staff member. They told us, 'X (a care worker) is so thoughtful. She always brings me something back from her holiday. And when she's on the evening she comes and sits on the edge of my bed and talks to me. I love it when she does that, it makes me feel really special.'
Prior to our inspection concerns were raised with CQC and the local authority about the quality of care at night. This had resulted in the local authority carrying out a night visit in March 2014 to check how people were being cared for. The local authority concluded that care at night was not always of the required standard.
At our first visit to the home we discussed this with the area manager who said action had been taken to address the problem. This included changes to the staff team, further staff training, and monitoring handovers and night-time records to help ensure care at night was effective and safe.
Is the service responsive?
We toured the premises and saw that although the home had a range of lounges (six in total), most people were using the main lounge near the entrance to the building. This made the room busy with almost every chair occupied, visitors and staff coming and going, and the television on at one end of the room. One person who used the service told us, 'Sometimes I can't hear myself think in here it's so noisy.' But another person said they liked the main lounge because there was 'a lot going on'.
We looked at the other lounges. All were empty apart from the smoking lounge which one person was using. One of the lounges, known as the 'reminiscence room', had been transformed into a 1950s parlour with period furniture, decoration, and household items. A lot of work had gone into this room and there was plenty for people to see and do, but it was a long way from the main lounge and not being used.
We discussed this with the area manager and the acting manager. They suggested moving the 'reminiscence room' to a large office adjoining the main lounge to make it more accessible, and providing organised activities such as crafts and games in some of the lounges to tempt people to use them and ease the pressure on the main lounge. They said they would discuss these suggestions with the provider with a view to implementing them.
Is the service well-led?
The home had been through a time of change. The registered manager was no longer in post, although her name appears on this report as the provider has not yet applied to deregister her. At our first visit to the home an area manager was in charge, while a newly appointed acting manager was being inducted. We met the new acting manager when we returned to the home for our second visit.
We discussed how the people who used the service and their relatives were involved in the running of the home. The area manager told us monthly residents meetings and quarterly relatives meetings were in progress. We saw posters for these in the foyer. The provider also published quarterly newsletters to keep people up to date with events at Hadrian House and its other homes.