Hadleigh Court

Hadleigh Court is a residential care home registered to provide accommodation and personal care for up to 31 older people. At the time of our inspection, 27 people were living at the service.

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

People told us they were happy living at Hadleigh Court and felt supported by staff who were kind, caring and knew them well.

People’s medicines were not always stored or managed safely and we have made a recommendation in relation to the medicine’s administration auditing process.

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. Safeguarding systems were established and the provider had clear policies and procedures in relation to safeguarding adults.

People’s needs were assessed and care plans contained key information to inform and guide staff on how best to support each person. Staff seemed to know people well and understood how to communicate effectively with people.

People and their relatives told us the service was well managed and spoke highly of the registered manager. Staff spoke positively about the leadership of the service and told us they felt listened to, appreciated and supported in their role.

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 9 August 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 9 July 2019, breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements.

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 not changed and remains requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hadleigh Court on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment at this inspection and have made a recommendation in relation to governance systems. 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.

Hadleigh Court is registered to provide accommodation and personal care for up to 31 older people. At the time of our inspection, 28 people were living at the home.

People’s experience of using this service:

People told us they felt safe, supported and were happy living at Hadleigh Court. Staff were seen to be kind, caring and attentive to people’s needs.

Quality assurance and governance systems were in place to assess, monitor, and improve the quality and safety of the services provided. However, we found the systems in place had not been undertaken robustly and therefore had been ineffective in identifying shortcomings in practice. These included concerns with records, risk management, and the management of people’s medicines.

People’s medicines were stored safely. However, we found one person had not received their medicine as prescribed and some aspects of medicines recording could be improved. This included information for ‘when required’ medicines and those requiring regular monitoring.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, it was unclear what action had been taken to mitigate those risks and keep people safe. For example, where some risks had been identified, care records did not contain enough information of any action taken, or guide staff as to the action they should take to mitigate those risks.

Other risks were well managed. Risks had been identified, in relation to people’s care needs such as mobility, skin care and action had been taken to minimise these.

Regular checks were undertaken in relation to the environment and the maintenance and safety of equipment, and fire safety systems were serviced and audited regularly.

Accidents and incidents were monitored to look for trends and identify whether changes were needed to reduce risks.

People had confidence in the registered manager and told us the home was well managed. One person said, “The home is well run, and the manager is nice”.

People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

Hadleigh Court was clean, and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).

Rating at last inspection:

Hadleigh Court was previously rated as ‘Good.’ The report was published on 11 January 2019.

Why we inspected:

We carried out an unannounced comprehensive inspection of this service on 4 and 5 December 2018. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do to improve and by when.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions, Safe and Well-led which contain those requirements. 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 changed from Good to Requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hadleigh Court on our website at www.cqc.org.uk

Hadleigh Court is a ‘care home’ without nursing, operated by Babbacombe Care Limited. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

People living at Hadleigh Court were older people, many living with long term health conditions or dementia. The service accommodated up to 31 people in one adapted building, with a lift to access the rooms on the first floor.

The service had 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.

At the last inspection of the service on 12 July 2016 the service was rated as ‘good’ in all areas.

On this inspection we have rated the service as good overall. The key question for well led has been rated as requires improvement. This was because we identified a number of people’s records and care plans had not been updated, or were not comprehensive enough to guide staff on how to support people consistently. We did not find people had suffered harm as a result, and staff knew people well. However, this could have left people at risk.

Assessments were in place to support people with other risks, for example with pressure damage, choking risks, poor nutrition, falls and moving and positioning. We saw staff understood how to support people in ways that made use of known information about the person’s history and choices. Staff knew people well, and we saw evidence of compassionate, caring and supportive relationships in place.

There were enough safely recruited staff on duty to meet people’s needs. Staff and people told us they felt they had the skills and knowledge to support people effectively and had access to senior staff for advice and support. Training plans were in place and an external training advisor visited the service every month to assist with updating staff training and management systems, policies and procedures. Systems were in place to learn from accidents or incidents and for staff supervision.

People received their medicines as prescribed. People were protected from abuse. Staff understood what constituted abuse and were aware of how to report concerns about people’s wellbeing. Where people were at risk from poor nutrition or hydration this was monitored, and the service had built supportive relationships with visiting professionals such as district nurses, community mental health teams and podiatrists.

People’s rights with regard to the Mental Capacity Act 2005 were well understood. Where Deprivation of liberty authorisations (DoLS) had been granted, conditions of the DoLS were well understood. This meant people’s rights were being supported. We did not identify any areas of discrimination.

Hadleigh Court is a long-established care home, set in a residential area of Torquay, close to local shops and facilities. The registered manager told us they were working on developing the building and workmen were painting and refreshing décor during the inspection. Work had been undertaken on communal areas, flooring and furnishings in people’s bedrooms and the garden in the last year, but some areas were still looking tired. We have recommended the registered persons seek and follow best practice guidance on the adaptation of the premises to meet the needs of people living with dementia.

During the inspection we identified concerns over the laundry room, and systems for the safe management of laundry. We have made a recommendation about this.

Activities had been updated to better meet people’s needs. This had included a member of staff being appointed ‘activities champion’. They told us about how they had provided some more person-centred activities. The home also had a minibus which was used to take people out regularly.

Visitors were able to visit the service at any time, and complaints procedure were well understood.

People told us the registered manager was approachable and responsive. Staff told us they worked well as a team and the service was continually improving and well organised. They told us the registered manager was approachable and kind and they enjoyed working at the service.

This unannounced inspection took place on 12 July 2016, and started at 6.30am to allow us to meet with the night staff and see how people were supported from the start of their day. It was a comprehensive inspection, and was unannounced. It followed on from a focussed inspection carried out in May 2016, and a comprehensive inspection of October 2015 where concerns had been identified. You can read the reports from our last inspections by selecting the ‘all reports’ link for Hadleigh Court care home on our website at www.cqc.org.uk.

On this inspection of 12 July 2016 we looked to see that the improvements that we had seen in May 2016 had been sustained. We found that the improvements were ongoing, but those seen in May 2016 had been maintained. Quality and safety had improved, and risks were being managed with improved communication both within and outside of the home. Comprehensive training was being provided and the new staff team had been boosted with additional management and leadership support.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 were being protected because systems for the management and assessment of risks had been put in place. Where risks had been identified measures were taken to reduce these wherever possible. Internal and external audits were used to identify concerns, and where issues were identified, action plans showed the progress being made to resolve them. For example, new systems had been put into place to ensure the risks of cross infection were reduced. This included more regular audits, cleaning schedules and improved equipment. Cleaners understood their roles, and could demonstrate how a safe environment was kept maintained, and we found the home was clean, warm and comfortable. Developments were under way to make the environment more ‘friendly’ for people with dementia.

Staff understood how to safeguard people from abuse. There were clear policies and procedures in place and staff had received training in how to identify abuse and what to do about it. Staff told us they were clear about what to do if they had any concerns about people’s safety or wellbeing.

There were enough staff to meet people’s needs in a timely way. Additional staff had been provided at times of high need to make sure people received the care they needed in the way that they wished. We saw staff were skilled at identifying changes in people’s needs or behaviours and taking action to reduce anxieties before they increased. Staff told us they had received the training and support they needed to carry out their role, and although there had been a significant staff turnover recently, the staff team were working well together to protect and support people. Records identified the training given to staff and when updates were needed. Staff were positive about training. They told us the manager and training provider were approachable and would access any training they needed.

Risks relating to the recruitment of staff were identified, and a full recruitment process was being followed for new staff. Communication systems were in place including handovers and regular staff meetings. Staff we met were enthusiastic about providing good care for people, and told us they were happy with the standards of care at the home. We saw them working well as a team.

People’s care files and plans reflected people’s needs or wishes about their care and how this was to be delivered. Relatives had in many cases been involved in giving information about their relation’s care needs, wishes and social and personal history. This helped staff understand people’s behaviours and choices in the context of the life they had lived.

The home was supporting people in line with the Mental Capacity Act 2005 (MCA), and protecting their rights. Assessments of people’s capacity and decisions made in their best interests were being carried out and recorded in accordance with the MCA. People had access to the community healthcare services they needed and positive relationships were being built with the local district nursing teams. Many people living at the home had complex needs for care with both physical and mental health needs. We saw that prompt referrals were being made for professional support when needed, for example to support people with distressed behaviours.

People were being protected from the risks associated with medicines. Staff had received training to administer medicines and had clear protocols in place for the administration of ‘as required medicines. The home had worked with local GP practices to review and reduce people’s medicines which had resulted in improvements in their health.

People ate a good diet, with meals reflecting their preferences. Where people needed support with eating this was provided sensitively, and where people needed additional supplementation to maintain a healthy weight referrals were made to dietician or speech and language services.

Staff were caring and people told us they were kind. We saw good relationships in place, with staff trying to understand people’s needs and respect their individuality. People’s dignity was being respected with attention paid to clothing, and grooming. Staff had guidance available on how to respond to people’s communication needs. Systems were in place to respond to any complaints.

Records, policies and procedures had improved. People’s care plans reflected their needs, wishes and aspirations regarding their care in more detail, and policies and procedures had been updated. The home had returned to using a paper based recording system, as a trial of a computerised system had not been effective in improving the quality or accuracy of the care plans. The plans that we saw were up to date and were being used by staff. We saw that they were reflective of the care being delivered.

People had opportunities to take part in activities, including twice weekly outings. People were encouraged to have a say in the activities provided, and tailor them to meet their interests where possible. We saw staff interacting with people and discussing activities that had been undertaken.

Quality assurance systems and feedback had led to improvements for people. For example changes had been made to improve the environment and people were enjoying more trips out. Feedback from people living at the service or visiting was positive about the changes being made.

This inspection took place on the 3 May 2016. It was an unannounced focussed inspection to follow up on a warning notice issued following an inspection on the 8 and 13 October 2015. On the inspection in October 2015 we identified concerns over a number of breaches of legislation.

We issued the provider and then registered manager with a warning notice in relation to Regulation 17 (1) and (2) (a) (b) (c) and (d) of the Health and Social Care Act (Regulated Activity) Regulations 2014 (Good Governance). The provider and registered manager needed to comply with the warning notices by 15 January 2016.

The provider sent us an action plan telling us what actions they had taken to improve, and worked with the local authority’s safeguarding and quality teams to improve standards at the home. The registered manager in post at the time of the inspection in 2015 had left the home and additional time was allowed to enable the service to make the changes they needed to improve.

This focussed inspection was carried out to ensure the provider had met the detail of the warning notices for Regulation 17 (Good Governance). Other areas for improvement identified during the inspection of 8 and 13 October 2015 remain part of the home’s ongoing action plan, and will be looked at on the next comprehensive inspection, when we will also check to see improvements made at this time have been sustained.

We found sufficient action had been taken to meet the requirements of the warning notice.

There was a newly appointed registered manager in post. A registered manager is a person who has registered with the CQC 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 safety had improved. Systems for the management and assessment of risks had been strengthened and where risks had been identified measures were put into place to reduce these wherever possible. We saw that people’s well-being had improved as a result of the reduction and proper management of risks, for example the number of falls had declined. Internal and external audits had been put into place, and where issues were identified, action plans identified progress being made to resolve them. New systems had been put into place to ensure the risks of cross infection were reduced. This included more regular audits, cleaning schedules and improved equipment.

Improvements had been made to the leadership and management of the home. Staff received increased guidance in their role and routines were being made more flexible to meet people’s differing needs and wishes. Communication systems had improved, including handovers and regular staff meetings.

Records, policies and procedures had improved. People’s care plans reflected their needs, wishes and aspirations regarding their care in more detail, and policies and procedures had been updated. Staff recruitment processes and records had been strengthened to help protect people and provide greater assurance of their character and work performance. References had been obtained and disclosure and barring service (police) checks had been undertaken before any new staff started to work with people. Systems had been put in place to assess any risks in relation to staff recruitment and gaps in people’s employment history had been explored.

Quality assurance systems and feedback had led to improvements for people. For example changes had been made to improve the environment and people were enjoying more trips out. Feedback from people living at the service or visiting was positive about the changes being made.

This report only covers our findings in relation to compliance with the warning notice for Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Hadleigh Court care home on our website at www.cqc.org.uk.

The ratings identified on the inspection of 8 and 13 October 2015 have not been changed as a result of this inspection but will be updated at the next comprehensive inspection. A comprehensive inspection will take place to inspect all five questions relating to this service. These questions ask if a service is safe, effective, caring, responsive and well led. At the next inspection we will also check to ensure improvements made for this inspection have been sustained.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective? Is the service well led?

Below is a summary of what we found. The summary was based on our observations during the inspection, speaking to people using the service, staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with dignity and respect by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that the managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The home had clear policies and procedures in relation to the Mental Capacity Act. Deprivation of Liberty Safeguard applications had been submitted in a timely fashion proving that the manager was protecting the vulnerable people who lived there from harm. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people were safeguarded as required and decisions were taken in the person's best interest.

The Deputy Manager set the staff rotas, we saw they took people's care needs into account when making decisions about numbers, qualifications, skills and experience required in the staff on duty. This helped to ensure that people's care needs were always met.

Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that unsafe practice was identified and people were protected.

Is the service effective?

People's healthcare needs were assessed with them and they were involved in writing their care plans. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said they had been involved in writing them and they reflected their current needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People commented, 'The staff are so friendly, patient and caring'.

People who used the service, their relatives, friends and other professionals involved with the service completed annual satisfaction surveys. Where shortfalls or concerns were raised these had been addressed.

Randomly selected cards from relatives said "Thank you so much for all you are doing for my Mum. You treated her with respect, dignity and humour. God bless every one of you'. Another card said 'There are not enough words to express our thanks and gratitude for all you did for Dad. Not only did you do him proud but our Mum as well. Your kindness will never be forgotten".

People's preferences, interests, aspirations and diverse needs had been clearly recorded in their care plans and care support had been provided in accordance with people's wishes.

Is the service responsive?

People regularly completed a range of daily activities within the home. There was a full time activities organiser, day trips in the mini bus and external entertainers employed. Everyone within the home was able to choose their level of involvement.

People knew how to make a complaint if they were unhappy. No one we spoke to felt the need to make a complaint as they were very happy with the service they received. We looked at how complaints had been dealt with and found that the responses had been open, thorough and timely. People could therefore be assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

The service worked well with other agencies and services to make sure that people received their care in a joined up way.

The service had a quality assurance system. Records seen by us showed that identified shortfalls had been addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities.

People told us that they were treated respectfully by care workers and that they were offered choices in relation to their daily care and their activities at the home.

People who lived the home, their relatives and visiting health professionals were positive about the care delivered at Hadleigh Court. Comments included 'The service here is very good, very flexible.'

People's needs had been assessed and their care had been planned and delivered in line with those assessments. Care plans had been regularly reviewed and updated.

We observed organised activities which took place at the home. People told us that they enjoyed a range of different activities such as quizzes, games, music and gentle exercise classes.

We saw evidence that Disclosure Barring Service (DBS) checks and reference checks had been completed on care workers at the home prior to employment.

We looked at the quality assurance systems in place to monitor the quality of care delivered. We saw that the provider monitored the service and responded to feedback effectively.

People told us they were happy at the home. One person said 'I feel safer now I am here and I have company all the time'.

We found that people's needs were met in a respectful and discreet manner. Care workers were able to tell us how they respected people's preferences even though their dementia might mean that the person was no longer aware of their previous preferences.

We saw that care plans contained details of people's physical needs and directions for care workers on how to meet these needs. We saw these needs had been met.

People told us they felt safe at the home and care workers were aware of the procedures to be followed if they suspected abuse was occurring.

People were very complimentary about the stable group of care workers. One person said 'They are all as good as gold.'

We found that there were enough care workers on duty to meet the needs of the people who lived at the home.

The home was well managed. People, staff and visitors all spoke highly of the manager and provider. Records reflected the management of the home. They were well maintained and securely stored.