The Hailey Residential Care Home

The Hailey Residential Care Home is a care home providing accommodation and personal care to up to 40 people who require support with their mental health. At the time of our inspection there were 36 people using the service, 17 of whom received the regulated activity of personal care.

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

Risks to people’s health, safety and welfare were not consistently managed. Risk assessments, to provide staff with guidance on how to minimise risks, were not completed in some cases.

People received their medicines as prescribed. However, we identified an area for improvement around the recording of application of prescribed creams.

Recruitment processes had not been consistently followed and we identified this as an area for improvement.

Checks on the safety and quality of the service were not consistently effective or robust. When feedback had been received from people or staff, this had not been analysed. There was not an effective system to ensure feedback was followed up to ensure improvements were made.

People were supported by enough regular staff who knew them well. People were supported to go out for activities and appointments. Staff understood how to protect people from the risks of abuse and knew how to report any concerns.

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.

People spoke positively about the service, and it was clear staff knew people well. Staff felt valued and supported by the registered manager.

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 (published 4 December 2018).

Why we inspected

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

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

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hailey Residential Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to risk management and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Hailey can accommodate up to 40 people who require support with their mental health. On the day of our inspection, there were 32 people living at the service. Each person had their own bedroom. Everybody shared a communal lounge, a large kitchen/diner, a laundry and utility room, a smoking room and large rear garden and a courtyard.

At our last inspection we rated the service overall as Good. At this inspection we found continuing evidence to support the overall rating of Good with no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is therefore written in a shorter format because our overall rating of the service has not changed since our last inspection.

Medicines were managed safely and people received their medicines when they needed to. People were supported to maintain good health and attended appointments and check-ups. People were supported in a safe environment and risks had been identified and managed in a way that enabled and encouraged people to live as independently as possible.

Staff understood how to protect people from the risk of abuse. They had received safeguarding training and were aware of how to recognise and report safeguarding concerns. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so that staff knew what to do in an emergency.

Staff recruitment processes were thorough with sufficient numbers of staff on duty to meet people’s assessed needs. Staff received regular training and supervision which enabled them to support people effectively.

People were supported to make decisions and choices about all aspects of their lives. People took part in activities that they had chosen. Staff understood people's support needs and there were detailed care plans, risk assessments and guidance in place to help staff support them in a personalised way.

People were supported to raise any concerns they may have. Staff respected people's right to complain if they were unhappy and supported them to resolve any concerns and issues.

Staff were caring, kind and respectful of people’s privacy and dignity. Interactions between people and the staff were positive and people were comfortable and at ease.

The registered manager and the registered provider had good management oversight. Staff said they were listened to and their suggestions were discussed and implemented. Quality assurance audits were carried out to identify any shortfalls within the service and highlight any improvements that needed to be made. The service had good links with other health and care professionals and staff were proactive in working in partnership to achieve the best outcomes for people.

Further information is in the detailed findings below.

The service is located on the seafront at Herne Bay with views across the sea. There were 35 people living at the service at the time of the inspection. The care and support needs of the people varied greatly.

People were independent and able to make their own decisions about how they lived their lives. They were able to let staff know what they wanted and were able to go out on their own if they wanted to.

There was registered manager working at the service. 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 of the Health and Social Care Act and associated Regulations about how the service is run.

The registered manager had been in charge at the service for a long time. They knew people and staff well and had good oversight of everything that happened at the service. The registered manager led by example and promoted the ethos of the service which was to support people to achieve their full potential and to be as independent as possible. The registered manager made sure there were regular checks of the safety and quality of the service. They listened to people’s views and opinions and acted on them.

People received personalised care and support in a way that suited them best. A lot of the people and staff working at The Hailey had been there for many years. Positive relationships had developed. Staff knew how to support people with their day to day needs and how to develop people’s independence and skills. This continuity of care and support resulted in building people’s confidence to enable them to make more choices and decisions themselves and become more independent..

Before people decided to move into the service their support needs were assessed by the registered manager to make sure they would be able to offer them the care that they needed. The care and support needs of each person were different and each person’s care plan was personal to them. People or their relative/representative had been involved in planning peoples’ care. Most of the care plans recorded the information needed to make sure staff had guidance and information to care and support people in the safest way and in the way that suited them best. People had regular reviews of their care and support when they were able to discuss any concerns or aspirations and goals they wanted to achieve. The care plans did need to be further developed to include this information so people and staff could identify what had gone well and where more support was needed.

People were satisfied with the care and support they received. Potential risks to people were identified and guidance on how to safely manage the risks was available. People received the support interventions they needed to keep them as safe as possible.

Planned and spontaneous activities took place regularly. People had choices about how they wanted to live their lives. People were involved in activities which they enjoyed. Contact with people’s family and friends who were important to them was supported by staff. People’s individual religious preferences were respected and staff supported people to attend church services and meetings.

There were sufficient numbers of staff to meet people’s needs. There were robust staff recruitment procedures to ensure staff were suitable for their job roles. Staff had the knowledge and skills to meet people’s needs, and attended regular training courses. There was a training programme, including induction training in place to ensure that all staff received the basic and specialist training they needed to ensure they had the skills and competencies to care and support the people.

People received care and support from an experienced, dedicated team of staff that put people first and were able to spend time with people in a meaningful way. Staff received regular one to one meetings with the registered manager and an annual appraisal to discuss their training and development needs. Staff were supported by the registered manager and felt able to raise any concerns they had or suggestions to improve the service.

Staff understood how to protect people from the risk of abuse. Staff had received training on how to keep people safe. They were aware of how to recognise and report safeguarding concerns both within the service and outside agencies such as the local authority safeguarding team. Staff were confident to whistle-blow to the registered manager if they had any concerns, and were confident that appropriate action would then be taken.

People had an allocated keyworker who was involved in their assessments and reviews. A key worker was a member of staff who takes a key role in co-ordinating a person’s care and support and promotes continuity. Throughout the inspection people were treated with kindness and respect. Everyone told us their privacy was respected and they were able to make choices about their day to day lives.

The registered manager and staff understood how the Mental Capacity Act (MCA) 2005 was applied to ensure decisions made for people without capacity were only made in their best interests. CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. No DoLs applications had been made to the relevant supervisory body in line with guidance as no-one required one.

People said that they enjoyed their food and it was always of a good standard. They said there was plenty of choice and the portions at meal times were good. They told us they had involvement in the menu to ensure they had their favourite foods.

People received their medicines safely and when they needed them. If people were unwell or their health was deteriorating the staff contacted their doctors or specialist services. People’s medicines were reviewed regularly by their doctor to make sure they were still suitable.

The complaints procedure was available and assessable. People were confident to raise issues and felt comfortable in complaining. They told us they were listened to by the registered manager and staff and action was taken to resolve any issues. People had opportunities to provide feedback about the service provided both informally and formally. Feedback received had all been very positive.

Staff were aware of the visions and values of the service by providing person centred care and treating people with dignity and respect. Staff and people told us that the service was well led and that the registered manager was supportive and approachable. There was a culture of openness and transparency within The Hailey.

The provider ensured that the maintenance of services, Fire drills were held regularly to ensure staff were familiar with actions in the event of an emergency, however some people did not have a personal emergency evacuation plan (PEEPS). This was an area for improvement.

Regular audits and checks were undertaken at the service to make sure it was safe and running effectively, however these were not always formally recorded and action plans did not always show detailed action to be taken to achieve the improvements. The registered manager was aware they had to submit notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

We saw that care plans had been written and regularly reviewed based on people's individual assessments of their needs and contained detailed information. We saw evidence of monitoring and regular evaluations of the support that was provided, together with involvement and liaison with relatives and various health professionals, to ensure they were kept informed of changes in people's conditions when necessary.

We found that there were systems in place to ensure that medicines were managed safely, and people told us they received their prescribed medicines on time. People told us that there were enough staff at the home to meet their needs. We saw that staff had time to talk to people at the home, and to support them in activities such as local outings.

The staff members told us that they felt well supported by the management team and their colleagues. We noted that the manager had implemented regular audits across various areas of the service, to ensure that any issues of concern could be quickly addressed. People told us that the staff asked them regularly if they were happy with the care they had received.

We spoke with two people living at the home. Both people told us they enjoyed the activities inside and outside of the home. They told us they felt well supported and listened to by staff. We observed staff interacting with people in a friendly and caring manner.

We found that there were care plans, health files and person centred plans in place for all people that used the service and that these were regularly reviewed and changes made as necessary. We found that people were encouraged to be as independent as possible and to make their own decisions. Where this was not possible we found that best interest meetings and mental capacity assessments had taken place.

People were protected from risk of abuse or harm by there being safeguarding policies and procedures in place and by staff knowing how and when to use them.

Evidence we saw showed us that people were supported by a caring, experienced staff team. The staff team were well supported and trained.

There was a regular cycle of quality audits undertaken to ensure that the home was kept under review. Records showed us that people using the service, families and professionals involved in people's care were consulted.