Halsey House

Halsey House is a residential care home providing personal and nursing care to up to 89 people, some of who may be living with dementia. The dementia unit is a separate unit from the main building, which holds provision for people requiring nursing and residential care. At the time of our inspection there were 55 people using the service.

The care home is built over 3 floors. Many bedrooms have an ensuite shower and toilet. There are shared living areas on each floor. In addition, there is an enclosed garden which is wheelchair accessible and is available to people, their relatives and visitors.

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

Following the last inspection a review of the quality assurance systems had been conducted. However, these systems were not robust enough and had not addressed shortfalls identified within the records found at this inspection.

Since the last inspection the provider had completed a review of risk assessments and updated these to ensure they contained information to guide and direct staff in the delivery of person-centred care.

A process was in place to support the safe recruitment of staff. Staff completed an induction which equipped them to complete their role effectively.

Staffing levels were improving, and recruitment continued to take place at the service. Agency staff were used where required to maintain safe staffing levels.

People and their relatives told us they found the staff to be caring and passionate. Comments included, “The home is very honouring of those in the military. Staff provide care which is dignified and respectful of military service men, women and their families these actions bring a unique lift to the atmosphere. There is a warmth and caring feeling as soon as you walk in.” Other comments included, “There is real kindness amongst all staff here."

People, their relatives and staff provided positive feedback about the registered manager who they felt was approachable and addressed concerns raised in a timely manner.

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.

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 May 2020) and there were 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 we found improvements had been made and the provider was no longer in breach of some regulations. However, not enough improvements had been made in other areas and the provider was still in breach of the associated regulation.

The last rating for this service was requires improvement (published 05 May 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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.

We carried out an unannounced comprehensive inspection of this service on 13 March 2020 and 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 safe care and treatment and the management and governance of the service.

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.

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 remained 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 Halsey House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified repeat breaches in relation to the quality assurance processes in place at this inspection.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Halsey House provides accommodation, nursing and personal care for a maximum of 89 people, some of whom may be living with dementia. The dementia unit is a separate unit from the main building, which holds provision for people requiring nursing and residential care. At the time of the inspection there were 66 people living at the service.

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

Overall, we saw improvements in the care and support provided at the service, since our last inspection. However, we continued to identify some concerns in relation people’s medicines management, the recording of aspects of people’s care, and the management of certain environmental risks to ensure people’s safety. Leadership and governance arrangements within the service were evolving, and aspects of the improvements made were yet to be fully embedded. Whilst audits were being completed, we continued to find some shortfalls which had not been found by the service. There remained breaches of regulations impacting on aspects of the quality of service provided to people.

We received mixed feedback regarding staffing levels and food quality, however we received positive feedback regarding the levels of activities people were able to access, and their ability to maintain their hobbies, interests and social networks. Staff treated people with kindness and were polite, and we received positive feedback from people and their relatives about the care provided.

Management plans were in place for people needing support at the end of their life. The service told us they had good working relationships with health and social care organisations to ensure people received joined up care.

The interim manager encouraged staff, people and their relatives to give feedback on the service and areas for improvement, through questionnaires and regular meetings. Overall, staff morale had improved since the last inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive ways possible; policies and systems in the service were followed to support good practice. Improvements had been made to the assessment of people’s capacity since the last inspection.

We have made recommendations relating to the effective deployment of staff and monitoring people’s fluid levels.

Rating at last inspection and update

The last rating for this service was Requires Improvement, with Inadequate for well-led (published 27 November 2019). There were three breaches of the regulations. Following the last inspection, we placed conditions on the provider's registration. This meant the provider was required to send us monthly action plans to show what action they were taking in response to the concerns we found. These conditions will remain in place as the provider still needs to continue to make improvements.

Why we inspected:

This was a comprehensive inspection, completed in line with our inspection schedule.

Enforcement

We have identified repeated breaches of regulation in relation to safe care and treatment and good governance arrangements. Please see the actions we have told the provider to take at the end of this report.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner. The provider will continue to submit monthly action plans in line with the conditions in place on their registration.

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

About the service

Halsey House provides accommodation, nursing and personal care for a maximum of 89 older people, some of whom may be living with dementia. The dementia unit is a separate unit from the main building, which holds provision for people requiring nursing and residential care. At the time of the inspection there were 75 people living in the home.

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

Quality assurance systems were not always effective in identifying shortfalls and improving the service. Contemporaneous records were not always accurate and up to date. The provider had failed to identify notifiable incidents.

Environmental risks to people were not always assessed, identified and mitigated. Medicines were not always administered as prescribed and recording was not always consistent. Care plans did not always accurately reflect current risks to people. Incidents were not always reported to the management team and to relevant safeguarding authorities when there was alleged abuse between people using the service. There was inconsistent recording to show how people were supported to eat and drink enough.

There were times that people went without the care they required. Care plans were not always reviewed effectively and updated in line with people’s needs. They did not always contain sufficient guidance for staff on some areas of people’s needs, such as behavioural, emotional and mental health support. There was not always sufficient provision of activities for people who preferred to stay in their rooms, were cared for in bed or who lived with dementia.

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. However, there were areas where improved recording was needed and ensuring mental capacity assessments were carried out in all necessary cases.

Staff received training relevant to their roles and felt supported by the management team.

Staff adapted their communication and engaged in a caring way towards people, respecting their dignity and privacy. People felt they were listened to.

There were end of life care plans in place.

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 inspection carried out was a focussed inspection on the key areas of safe and well-led. We did not inspect the remaining three areas. The overall rating for this service was Requires Improvement (published November 2018) and there were three 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.

The previous comprehensive inspection was carried out in September 2016 (published March 2017) and the home was rated Good.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to safe care and treatment, governance, and notifiable events at this inspection.

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

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 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.

Hasley House is a care home with nursing. People in care homes receive accommodation and nursing as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service can accommodate up to 89 people. At the time of our inspection there were 79 people using the service.

At the time of our inspection 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.

During our inspection we found the service had not always ensured people were safe and protected from hazards in line with their assessed needs. Following a serious incident, the service had reviewed their processes and had taken actions to safeguard people in their care. However significant shortfalls contributed to avoidable harm and this resulted in a breach of Regulation 12 of the Health and Social Care Act: Safe care and treatment.

People were safeguarded from abuse as far as reasonably possible because staff received the necessary training to help them recognise abuse. They had access to policies and procedures so they knew what actions to take. The service reported concerns to the safeguarding team but since the last inspection failed, on two occasions, to report these to the CQC. This resulted in a breach of Regulation 18: Notification of Incidents – CQC (Registration) Regulations 2009 (Part 4)

Care plans included a health profile which described people’s physical, mental health and well-being and helped staff provide holistic care.

The environment provided people with comfortable accommodation which was flexible around their individual needs. The service promoted people’s independence and right to positive risk taking and control over their lives.

We observed people received kind, considerate care by staff mostly familiar with their needs. Recently the service had been using regular agency staff to cover staff vacancies or to support existing staff whilst new staff were being inducted. Ongoing staff recruitment meant vacant posts were being filled and there was a gradual reduction in the use of agency staff.

People’s needs were being reassessed to help ensure that the service could continue to meet their needs safely and in line with current staffing levels.

The service had a registered manager. They said they felt well supported but it was clear that the last year had been difficult in terms of staff recruitment and having effective deployment of staff to meet people’s needs. The deputy manager had recently left which had left the registered manager short within the management team. A deputy and assistant deputy manager had been recruited in the last two months which had helped to improve the overall quality of the service people were receiving.

Recent audits had helped to clearly identify where the service needed to make improvements and audits identified timescales and who should carry out any necessary actions.

Medication audits were in place and the service identified where things needed to improve. Action plans were in place to help ensure people received their medicines safety and medicines were available as required.

The cleanliness and maintenance of the service was good and the environment was suited to people’s individual needs.

We did not look at staff recruitment. At the last inspection to this service staff recruitment was good. We did however look at agency records to ensure agency staff had the right credential, skills and recruitment checks in place. We also looked at their onsite induction which was adequate.

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.

Halsey House was a well led service, with strong values and a vision to involve people as much as possible and continually improve people’s experience. The service adopted various initiatives such as Namaste Care (a sensory program designed to improve the quality of life for people with advanced dementia.) We saw evidence that these initiatives had a positive impact on people and significantly improved their lives and wellbeing.

The service had achieved repeated accreditation to the “Six Steps to Success” (a nationally recognised end of life care programme). Halsey House had also adopted the principle of Advance Care Planning from the Gold Standards Framework (an accredited, systematic evidence based approach to optimise care for people approaching the end of life). In addition, the service had integrated Namaste care into its palliative and end of life care approach. It was evident that these approaches also had a positive impact on people by enabling people to live well until the end of their lives.

People lived in a safe environment because staff knew how to recognise signs of possible abuse and knew the correct procedures for reporting concerns. Staffing levels were sufficient to meet people’s needs and appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively. The premises were well maintained and any safety issues were rectified promptly. Medicines were managed and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work and all new members of staff completed an induction. Staff were supported well by the manager and the provider.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The manager and staff understood the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance.

People had enough to eat and drink and enjoyed their meals. When needed, people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people’s dignity. Visitors were welcome and people who lived in the home were encouraged and supported to be as independent as possible. People were also able to follow a wide section of pastimes or hobbies of their choosing.

Assessments were completed prior to admission, to ensure people’s needs could be met. People were involved in planning their care and received care and support that was person centred and individual to their needs. Risk assessments detailed what action was required or needed to be carried out to remove or minimise any identified risks.

People and their families and friends were able to voice their concerns or make a complaint if needed and were listened to with appropriate responses and action taken where possible. Communication between the management team, staff, people living in the home and visitors was also frequent and effective.

There were a number of systems in place in order to ensure the quality of the service provided was regularly monitored and regular audits were carried out by the provider in order to identify any areas that needed improvement.

Halsey House was a well-led service, with positive and inclusive leadership at all levels. There were strong connections with the local community and the service had very good working relationships with various stakeholders. People said they would recommend it to others.

We found that staff obtained people's consent before care and treatment was provided. We found examples where people hadn't agreed to something and their wishes had been respected and their decision upheld. Where someone's capacity to consent was in doubt over a significant decision staff knew what action to take and were aware of their responsibilities under the Mental Capacity Act.

Care plans were well organised. We found risk assessments that were generic in nature supported by risk assessments specific to the individual. These individual risk assessments resulted in care plans personal to the individual. For example, we saw detailed plans in place to support one person who on occasion presented challenging behaviour.

Staff we spoke with were clear about safeguarding and training had been booked for those where it had become due. The provider's policies were considerably out of date and were being revised at the time of our inspection.

Staff recruitment processes were robust and systems were in place to ensure that the service being provided was monitored on an ongoing basis to ensure the quality of the service provision.

Systems were in place to record when medicines were received into the service, when they were given to people and when they were disposed of. Those seen were completed appropriately and provided an audit trail of medicines in use. This showed us that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Staff told us that there was a good provision of training opportunities in the home. We saw that all the staff who worked in the dementia unit had received additional training in dementia awareness. This demonstrated to us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Information about making a complaint was present in the service user guide. This showed us that there was an effective complaints system available for the people using this service.