The Hennessy Partnership's Living Well Street, Poppy Walk & Tom Wroe

We found the following examples of good practice:

The home had a system in place to prevent people, staff and visitors from catching and spreading infections.

People and relatives were supported to keep in contact using a range of technology.

People were supported to understand the pandemic and the need for infection prevention and control measures, such as wearing face masks . However, this was not always achieved due to the complexity of some of the people’s care needs.

All staff working at the service were vaccinated as a condition of deployment.

There was enough personal protective equipment (PPE). and we observed staff wearing it appropriately. The home had measures in place to support communication and reassurance.

Information and signage was on display to remind staff of their responsibilities regarding good infection control practices.

Staff had completed training in infection prevention control and had understanding about their roles and responsibilities and the impact of the pandemic on the people.

All visitors including healthcare professionals were subject to follow procedures, including showing evidence of vaccination and a negative lateral flow test before allowed to enter the home.

The Hennessy Partnership's Living Well Street, Poppy Walk & Tom Wroe is a care home providing personal care to 22 people aged 18 and over at the time of the inspection. The service can support up to 32 people. There are three separate services across three floors of The Hennessy Partnership's Living Well Street, Poppy Walk & Tom Wroe and two service managers. The services are known as Living Well Street, Tom Wroe and Poppy Walk. Each floor has separate bathrooms, toilets and communal areas.

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

The passenger lift from the ground floor to the first floor Living Well Street service had not worked for a considerable length of time. After the inspection, a stair lift had been installed as an interim measure.

We have made a recommendation about maintenance management.

Medication administration was observed to be safe. However, improvement was required for the safe storage and recording of medication stock levels.

We have made a recommendation about the management of medicines.

People felt safe living at the home. Risks were well managed. The provider was in the process of recruiting care staff and was utilising agency staff to help ensure safe staffing levels were maintained. Safeguarding concerns were processed appropriately.

Staff interacted with people in a caring manner. People seemed relaxed and comfortable in the company of staff. Staff and managers knew people well and showed an understanding for the people who lived at the home. Care plans recorded people’s preferences and life histories. Relatives had a mixed response regarding the ease of contacting people during the pandemic lockdown restrictions.

Relatives were mainly positive regarding the new management team. Staff were positive about the nominated individual and the way the service was organised and run. The service used an electronic care planning system as part of their support and care planning process which included risk assessments and quality checks. The electronic quality assurance records we saw demonstrated the nominated individual maintained good oversight of the service.

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 15 November 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 15 November 2019. Two 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 dignity and respect, and good governance.

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, Caring 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 improved to good. 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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Hennessy Partnership's Living Well Street, Poppy Walk & Tom Wroe on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Helme Hall is a care home providing personal care to 28 people aged 18 and over at the time of the inspection. The service can support up to 32 people. Accommodation is split in to three units, one on each floor of Helme Hall. These are separately called the Tom Wroe Unit, Living Well Street and Huddersfield Adult Memory Disorders Unit. Each floor has separate bathrooms, toilets and communal areas. There are two unit managers and two registered managers for the whole service.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement. As part of thematic review, we carried out a survey with one of the registered managers at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. Restrictive intervention practices were used where appropriate.

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

Not all equipment had been checked for safety. Staff moving and handling techniques were not always safe. There was ongoing recruitment to a number of vacant positions within the home. The recruitment of staff was safe. Medicines was safely administrated.

New staff received an induction. Feedback about the meals was positive. Staff received the input of other healthcare professionals where needed. 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. The provider was working within the principles of the MCA.

People were not always treated with dignity and respect. Staff were caring and kind. Staff knew people’s preferences, likes and dislikes. Care records were accurate, although information relating to care record reviews and activities was not routinely kept together.

People and relatives were involved in decision making. Staff were responsive to people's needs and wishes and knew people well. People were offered choices and encouraged to remain independent. People's views were sought and action taken to improve the service from these.

The registered managers were visual within the home and operated an open-door policy. People, relatives and staff knew them well.

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 7 September 2018). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 enough improvement had not been made and the provider was still in breach of regulations.

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 also 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.

Enforcement

We have identified breaches in relation to dignity and respect and good governance. For requirement actions we are able to publish at this time, 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.

Living Well Street and Tom Wroe Unit is registered to provide residential care for up to 46 people, some of whom live with dementia. Accommodation is split in to three units, one on each floor of Helme Hall. These are separately called Tom Wroe Unit, Huddersfield Adult Memory Disorders Unit (HAMDU) and Living Well Street. Each floor has separate bathrooms and toilets and communal areas. At the time of the inspection there were a total of 17 people living there. There is a manager based on each unit with an overall manager for the whole service.

Living Well Street and Tom Wroe Unit is a ‘care home’. 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.

There was a registered manager for the service. There were plans for the registered manager to move to manage a separate part of the service. At the time of the inspection the new manager of Living Well Street and Tom Wroe Unit (who had been in post for four weeks) was not the registered manager but had made an application to be the registered manager. This manager was available throughout our inspection.

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 and their relatives told us they felt safe living at this service as they were well supported and their health care needs were met. Staff had received safeguarding training and knew how to identify and report signs of abuse.

Recruitment practices were thorough to ensure staff had the suitable characteristics and background to provide care at this service. At the time of the inspection there were sufficient numbers of suitably qualified and competent staff to meet the care needs of people living at the home. However, there had been a high staff turnover prior to the inspection and the registered provider had not ensured there were enough sufficiently trained staff to support people during this time. This meant the provider had failed to plan effectively to ensure effective governance systems were in place. You can see what action we told the provider to take at the back of the full version of the report.

Audits had not identified concerns regarding the storage and administration of medicines. Medicines were not consistently stored safely. A medicine delivery had been left in an unlocked room where a person living at the home found them. Medicines were not administered consistently throughout the home. One unit recorded the application of topical creams on a body map however the two other units did not do this. This meant the provider did not have appropriate systems in place to identify concerns with the administration and storage of medicine. You can see what action we told the provider to take at the back of the full version of the report

The registered provider had recently appointed a workforce development manager and comprehensive training was completed in-house. We saw evidence of staff supervision and appraisals being completed.

People's dietary needs were well managed and there was a good choice of home-prepared food and snacks. Some of the people were supported to buy and prepare their own food. This meant staff were able to accommodate people’s individual preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. It was evident from our discussions with staff they had an in-depth knowledge of people's care and support needs.

Care plans were person-centred and focused on a therapy-led model of care. A clinical nurse (specialist care) had been employed to support the care staff to provide safe and effective care for people and ensure people received individualised support with minimal restrictions. Staff respected people's privacy and dignity as well as their equality, diversity and human rights.

Not all care plans had appropriate capacity assessments, consent or authorisation to give consent where the person was unable to do so. This meant consent to care and treatment was not always sought in line with legislation and guidance. This was brought to the attention of the manager who confirmed they would review all capacity assessments. We have made a recommendation about reviewing people’s capacity to support consent and choice.

Effective quality assurance systems had not taken place. The registered provider had failed to ensure appropriate risk assessments had taken place for fire safety and for the refurbishment of the premises. Accidents and incidents were recorded and although there were plans to ensure monitoring of these took place, appropriate monitoring had not always taken place. This meant the provider did not have appropriate oversight to ensure governance systems were adequate to ensure people’s safety. You can see what action we told the provider to take at the back of the full version of the report. Plans had been made to ensure this was done in the future.

On the day of this inspection the registered manager was not on site.

At the last inspection, the service was rated as Good. At this inspection we found the service remained Good.

People and their relatives told us they felt safe living at this service as they were well supported and their health care needs were met.

Recruitment practices were thorough to ensure staff had the suitable characteristics and background to provide care at this service.

There were sufficient numbers of suitably qualified and competent staff to meet people’s care needs. Staff received support through an ongoing programme of mandatory and specialist training as well as formal supervision.

People’s dietary needs were well managed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

It was evident from our discussions with staff they had an in-depth knowledge of people's care and support needs.

Care plans were person-centred and focused on a therapy led model of care. A team of psychologists supported the care staff to provide safe and effective care for people. Staff respected people’s privacy and dignity as well as their equality, diversity and human rights.

Quality assurance systems were found to be effective and were used to continuously improve the service. People were able to feedback regarding the service and the registered provider made changes as required.

Further information is in the detailed findings below.

During this inspection we also followed up on two warning notices for outcome 4, regulation 9 (care and welfare) and outcome 9, regulation 13 (medicines). We also followed up on four compliance actions for outcomes 5 (meeting nutritional needs), 8 (cleanliness and infection control), 13 (staffing) and 16 (Assessing and monitoring the quality of service provision) which were given at our last inspection in July 2014.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This 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?

People were cared for in an environment that was not clean and hygienic. We saw there were checklists in place for staff to sign to ensure standards of cleanliness were maintained which had not been signed.

There were not enough staff to meet people's care needs. On the middle floor of the home we saw people were left for periods of time in communal areas with no staff to supervise and support them. This was because they were busy meeting the needs of other people who lived on this floor of the home.

Is the service effective?

We looked at three people's care records and we saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs. However, in one of the records we saw a care plan in place which stated the person liked to be checked regularly throughout the night. We were unable to find evidence which showed how often people living at the home were checked through the night by staff.

Is the service caring?

People were supported by kind and attentive staff who obviously knew people well. We saw that people's bedrooms and personalised. However, when we looked in people's care records we found the care plans in place were not personalised. This meant people did not receive person-centered care.

We saw people were not supported to eat their meals in a timely manner, resulting in some food being cold when eaten.

Is the service responsive?

The care records we looked at did not contain details of people's preferences, interests and life histories. We were given an activities timetable by the home manager for the previous week and saw planned activities. However, in all of the care records we looked at we were unable to find any evidence of participation in planned activities at the home.

Is the service well-led?

Issues we found during the inspection had not been identified by the provider. For example, we found there were areas of the home which were not clean. We also found issues regarding maintenance of the premises which, when pointed out to the manager, they told us they were not aware of these.

During the inspection, we spoke with the managing director, the manager, three senior care assistants, four care assistants, the housekeeper, five people who lived at the home and two visitors who were relatives. We also looked around the premises, observed staff interactions with people who lived at the home, and looked at records.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This 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?

People were cared for in an environment that was not clean and hygienic. We found people may not be protected from the risk of infection because appropriate guidance had not been followed. We have asked the provider to make improvements.

We also found there were items of broken equipment were being stored in one of the bathrooms. These items had the potential to cause harm to a person if they were tampered with. We have asked the provider to make improvements.

There were not enough skilled and experienced staff on duty to meet the needs of the people who lived at the home. There were issues with how staff organised their time to meet the care needs of people living at the home.

One visitor who was a person's relative told us, 'The staff are pretty good however, they are all new. I've come today and I don't recognise anyone. I'm worried about my relative. They called me on the phone at night and told me it was dark everywhere and they had no light to put on. They have also told me the food is horrible and they had eaten bread and butter for their tea.'

We looked in the care records of people living at the home and saw a number of them were losing weight. We also spoke with people who told us the food at the home was awful.

Is the service effective?

We looked at seven people's care records and we saw that for three people their individual needs had been assessed and care and support was developed from an assessment of their needs. Other care records held conflicting and out of date information. One person who was admitted on the day of our inspection had no care plans in place and staff told us they did not know what the person's care needs were. This person had recently been in hospital following an epileptic seizure. Staff we spoke with were unaware of this.

Menus showed the meals provided at the home offered people a healthy nutritionally balanced diet to support their health. However people we spoke with told us they did not like the food and did not want to eat it. We also saw there were some people living at the home who required assistance from staff to eat their meals and have an adequate fluid intake. Staff did not support people appropriately in this regard. This meant people were not protected from the risks of inadequate nutrition and dehydration.

Is the service caring?

We observed some staff did not appear to know the care needs of some of the people living at the home. For example, assistance with eating and drinking. We saw there were a lot of missed opportunities for staff to engage with people.

We also saw that some staff did not appear to have an appropriate approach to caring for older people or people who were living with dementia.

Both of the visitors we spoke with told us they were concerned about their relative and they were not sure the home was keeping them updated regarding their relatives care.

The care assistants we spoke with told us they felt they did not have enough time to meet the needs of people living at the home. They also told us that at times they felt things were disorganised and they were doing things differently from day to day.

When we looked around the home we saw people's bedrooms were not clean and items of people's clothing had not been treated with care by staff. We spoke with one person's relative who showed us five items of clothing including underwear which did not belong to their relative yet were in their wardrobe. This showed peoples personal possessions were not treated with respect.

Is the service responsive?

We saw in three of the care records we looked at that people's needs had been assessed before they moved into the home. However, one person's pre admission assessment was incomplete with nothing further to inform staff on the needs of the person. Three of the records we looked at showed people's preferences, interests and life histories had not been recorded. This meant the care, treatment and support provided at the home did not meet people's individual needs.

People did not have access to appropriate activities. We observed people sitting for long periods on both days in the same chairs in the same room with little or no engagement from staff. One person told us 'I'm bored out of my head. There is nothing going on for us here. You could just cry.'

We saw people who were living with dementia become agitated throughout both days of our inspection as they were continuously told to sit down by staff or guided back to the chair they had got up from.

Is the service well-led?

The manager had recently left the home and there was a supporting manager in place. We looked at many areas of audit and quality assurance documentation which had not been completed for a significant period of time. We spoke with the managing director who told us they had not been made aware of the issues at the home by the then manager or area manager who had been based at the home.

We found people were not protected against the risks of inappropriate or unsafe care because, although the provider had a system to assess and monitor the quality of service people received, this had not been utilised for a significant period of time and therefore was not effective. We have asked the provider to make improvements.

Throughout the two days of our inspection the managing director was in attendance. They agreed with all of our findings and told us they were very concerned but were committed to improving the service.

The operations manager contacted us following the inspection to express their commitment to making improvements at Helme Hall.

During our visit to the service we spent time speaking with people who lived at the home, staff working there, the manager and a senior member of management. We looked around the home, observed care, reviewed care files, medication systems and looked at staffing arrangements.

We looked at care files for three people who lived at the home. We saw care plans were in place but found they lacked some detail.

We also identified some areas of care where people had not received the support they needed.

We saw the home used a system of pre prepared meals which, on the day of our visit, were badly prepared and presented. However a senior manager told us they had previously left instruction for the fish and chips meal not to be used and for people to enjoy that meal bought in from a local fish and chip shop. The senior manager assured us that the standard of all other meals from this supplier was very good. They also made arrangements for people who had not enjoyed their meal to be served an alternative.

We found the home unclean in several areas and no immediate action was taken to remedy this.

We found that the systems put in place for managing medicines were good, but some errors had occurred.

We found some issues with the safety of the premises.

We found there were not enough staff to meet people's needs. We saw that care staff treated people with kindness but did not always respond to their needs in a timely manner.

We spoke with six people who lived at the home. Some, due to complex care needs, were not able to tell us their opinions.

One person told us they had enjoyed the cheese and wine party the previous evening. They said they found staff to be kind and caring.

Another person told us their concerns about the home not having a cook from the day after our visit. They said "I don't like the idea cleaners doing the cooking, it's not hygienic." This person also said "Activities nil, I don't like just sitting, everybody just watches the television."

Staff demonstrated a good knowledge of the people who lived at the home. Some told us they would like more training, particularly in caring for people living with dementia. Some staff also expresses their concerns about staffing levels.

The new manager had started work at the service in the week of our visit and was therefore not yet familiar with the home. We spoke with a member of senior management who told us they were aware of some of the issues we had identified and were already working to resolve them.

People told us they were happy living at the home and they were looked after well by the staff.

People told us their views were taken into consideration when planning their care and staff respected their wishes and this included their likes and dislikes.

We observed positive interaction between care workers and people using the service and staff spoke with people in a respectful manner.

Comments from people who used the service included;

'The staff are very nice.'

'We are all well looked after here. Staff are good and especially the male carers.'

People told us they had never needed to complain but knew who to speak with if they were not happy.