Haunton Hall

Haunton Hall is a residential care home providing personal and nursing care to 41 people the time of our inspection. The service can support up to 90 older people some of whom may have a diagnosis of dementia.

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

There had been significant improvements made since the last inspection. However, some care plans did not always accurately reflect people’s needs and some people’s records had not been consistently completed. However, staff knew people’s needs well and people told us they received safe and effective care. We made a recommendation to the provider about this.

There had been some changes across the management structure which meant there was no current registered manager in place. The provider was in the process of recruiting the appropriate persons to take on the role.

There were sufficient numbers of staff to meet people’s needs. Some staff felt some additional staffing was needed in units which supported people with dementia. The operations director was aware of this and had already begun recruiting new staff.

Medicine management had vastly improved, and staff took measures to mitigate the risk of the spread of infection. There were processes in place for people and staff to follow if they had safeguarding concerns. The management team had worked to identify where things had previously gone wrong and had taken actions to learn lessons and improve the quality of care people received.

Staff had received relevant and appropriate training and the training statistics for staff completing all training had improved. People were supported to eat and drink enough to maintain a healthy, and balanced diet. The management team worked alongside external health professionals to ensure people’s health needs were met in the most effective way.

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 governance systems in place had improved but required reviewing, strengthening, and embedding. The management team had mechanisms in place to gauge feedback about the care people received and staff were engaged in the day to day running 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 25 July 2022). We issued the provider with a warning notice which included a date for compliance. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 25 July 2022. Breaches of legal requirements 15 (Premises and Equipment) of the Health and Social Care Act 2008 and regulation 17 (good governance) 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 Safe, Effective 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 changed from requires improvement 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 COVID-19 and other infection outbreaks effectively.

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

Follow up

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

Haunton Hall is a care home providing personal and nursing care to up to 90 people. The service provides support to older people, some who may be living with dementia. At the time of our inspection there were 44 people using the service. The home was undergoing an extensive refurbishment of a number of floors and wings in the home.

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

Some audits had not been routinely completed, and those which were, did not always identify issues found on inspection. The home had been without a registered manager for a year, which had impacted on the day to day running of the service, and there was limited oversight from the provider.

Some care plans lacked detail about people’s care and treatment, such as diabetes. The systems in place to monitor medicine management were not robust which meant errors in stock control had occurred.

Infection prevention control measures were not always effective.

There was an interim manager in place who had begun to address the shortfalls identified at the service. Most people had been consulted about their care and improvement plans were in place. Staff knew people’s needs well and took actions to keep people safe and manage risks.

The numbers and skills of staff matched the needs of people using the service. Staff worked well with other agencies and organisations to ensure people’s needs were met.

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

The last rating for this service was good (published 20 December 2017).

Why we inspected

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

We received concerns in relation to the care and support people received. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

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 full 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 Haunton Hall on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to Regulation 15: Premises and Equipment and Regulation 17: Good Governance at this inspection.

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

We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.

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 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.

When we completed our previous inspection on 4 January 2017 we found concerns relating to how people received medicines that were on an ‘as required’ basis. This was because there was no information available to ensure all staff knew when these were needed. Prompt action was not always taken to ensure medicines were administered in a form that people could take. Capacity assessments had not always been completed where needed and it had not always been identified that some people were subject to restrictions. The fire safety systems also needed further improvements and evidence that action had been taken was not available. The provider was rated as requires improvement overall. At this inspection we found improvements had been made, however further improvements are needed to recognise where applications to lawfully restrict people’s liberty need to be made.

On this inspection we found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about their care and staff knew how to respond if people no longer had capacity to make some specific decisions. However, where people were assessed as having capacity, authorisations to deprive them of their liberty had been applied for. Restrictions on liberty can only apply where people lack capacity to make certain decisions. We have made a recommendation about staff training on this subject.

Medicines were now managed to ensure people were protected from the risks associated to them. The number of staff on duty had been reviewed to enable people to receive support when they needed this. Recruitment procedures were in place to check that staff were suitable to work with people.

Risks to people were managed in a safe way and staff knew how to recognise and report potential abuse. Safeguarding procedures were in place and where concerns were identified these had been reported to ensure people’s safety. Accidents were reviewed and improvements were made to prevent further incidents and keep people safe. Infection control procedures were in place and the home was clean.

People felt the staff had the right skills to provide the care they wanted. People had access to health professionals and where advice was given, this was followed. People enjoyed the food and were offered a choice of what to eat and drink. Adapted cutlery and crockery was provided to support people to retain their independence. There were large pictorial signs in the home to help people to recognise different areas and rooms. The communal areas enabled people to have a choice of where to sit and there were hand rails fitted in corridors.

Staff knew people well and people were happy with the care they received. People’s privacy and dignity was promoted and they were treated in a caring way. People were encouraged to make choices about their day and remain independent.

People had care records that included information about how they wanted to be supported and this was reviewed to reflect any changing needs. The registered manager had considered people’s diverse needs when they planned to move into the home. Where people were living with dementia they had been supported to make choices and different methods of communication had been explored to help people tell the staff how they felt. People were offered the opportunity to participate in activities and pastimes they enjoyed.

Quality assurance systems were in place to identify where improvements could be made and the provider worked with other organisations to share idea; to develop the service and used feedback from people and relatives to bring about changes. The registered manager understood their responsibility around registration with us and we had received notifications when significant events had occurred within the home. The provider was displaying their previous rating in line with our requirements.

The service provides support and nursing care for up to 90 older people, some of who may be living with dementia. At the time of the inspection there were 43 people who used the service as the provider was carrying out a refurbishment programme to some parts of the building. The service had four separate units; two nursing units, a general residential unit and a residential unit for people living with dementia.

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.

The staffing provided had been reviewed however, when staff were not available, some people were not able to summon support from staff to maintain their safety.

Improvements had been made with how medicines were managed. However, where people were prescribed medicines on an ‘as required’ basis, information was not available to ensure all staff knew when these were needed. Prompt action was not always taken to ensure medicines were administered in a form that people could take. Further improvements were needed.

Staff sought people’s consent before they provided care and support. However, where some people may lack capacity, assessments had not always been completed to ensure decisions were only made by others when they lacked capacity to make decisions themselves. Where people had restrictions placed upon them in the dementia unit to ensure their safety, applications to ensure these were lawful had been made. However, it had not been identified that other people were subject to restrictions. Further improvements were needed.

Quality systems to monitor and improve the quality of care were carried out and identified where some improvements were needed. However the fire safety systems needed further improvements and evidence that action had been taken was not available.

Risks to people were identified and staff knew how to provide support to reduce the risk of preventable harm. Staff understood their responsibilities to protect people from harm and knew how to raise any concerns. Staff received training and support and when they were new to the service; they worked alongside experienced staff and spent time with them so they knew how to provide the care they wanted.

People had opportunities to be involved with a variety of activities and could choose what to be involved with and were treated with kindness, compassion and respect. People liked the staff who supported them and had developed good relationships with them. People maintained relationships with their families and friends who were invited to join in activities with them.

Health care professionals visited the service to provide additional healthcare services to people. Where people needed to have their food and drink monitored, systems were in place to ensure health support was sought promptly to ensure people were well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People knew how to complain about their care and complaints were managed in accordance with the provider’s complaints policy. People were confident they could raise any concerns and were complimentary about the registered manager and staff. They told us the registered manager was always available and was approachable.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service provides support and nursing care for up to 90 older people, some of who may be living with dementia. At the time of the inspection there were 48 people who used the service as the provider was carrying out a refurbishment programme to some parts of the building. The service had four separate units; two nursing units, a general residential unit and a residential unit for people living with dementia.

There was a registered manager in 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were not always managed safely as we saw some people did not receive their medicines if they were asleep. Systems were not in place to ensure people were offered these at a different time and medical advice about their welfare was not sought. Effective systems were not in place to ensure medicines were administered in a consistent and safe manner. Improvements were needed in this area.

There were not always enough staff available to deliver people’s planned care. People did not always receive the support they needed to keep safe and they had to wait for support with personal care. Quality monitoring checks were carried out although these had not identified where people may be at risk from the current staffing provided, or where care records did not include important information. Improvements were needed in this area.

Where people no longer had capacity to make decisions or consent to care, assessments were not completed accurately and had failed to consider that people may still be able to make some decisions for themselves. Applications had not been made for some people to ensure any restriction placed upon people was lawful. Improvements were needed in this area.

People made decisions about their care where they had capacity and staff helped them to understand the information they needed to make informed decisions.

People could choose what they wanted to eat and specialist diets were catered for. Meals were chosen the day before the meal was served but there was no information available for people to remind themselves of the meal options. Simple alternative meals could be provided upon request although if people changed their minds about their food choice, additional food was not prepared to support people to make a meaningful choice at each meal.

Staff received training and support that generally provided them with the knowledge and skills required to work at the service. People living with dementia were not always supported with their specialist needs as staff did not always recognise how to provide this care. Additional activities were not provided to enhance the care of people living with dementia.

Health care professionals visited the service regularly to provide additional healthcare services to people. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

There was a homely and relaxed atmosphere and people were generally treated with care and compassion. People told us the staff were kind and treated them with dignity and respect. However, some interactions were not dignified as staff did not speak to people when they supported them with personal care or helped them to move.

A range of activities were organised for people during the week and people spoke positively about the opportunities provided. Links had been developed with local volunteer groups who visited people and had helped with the garden areas.

People were confident they could raise any concerns with the registered manager or staff and were complimentary about the registered manager and staff. They told us the registered manager was always available and was approachable.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask:-

Is the service safe?

Where risks had been identified, risk assessments were in place with plans of action to inform staff how risks could be minimised.

Sufficient numbers of suitably qualified staff were available to meet people's needs.

Is the service effective?

Care plans were in place which informed staff how to meet people's needs. People or their relatives told us that they had been involved in the care planning process but this was not always evident in care records seen.

People's views were regularly sought and audits were undertaken to ensure the service was monitored and improved upon for the people using it.

Is the service caring?

We observed positive interactions and conversations between staff and people who used the service throughout the inspection. People told us that they were happy with the care they received and told us that they liked the staff and thought they did a good job.

Is the service responsive?

People's health and care needs were addressed promptly and referrals made to relevant health professionals as required.

People's preferences and wishes were listened to and acted upon to promote person centred care.

Is the service well-led?

Systems were in place to audit and monitor the quality of the service.

We saw that the management team in place were robust and that staff worked well as a team. Staff told us that they received the support needed to undertake their job and told us that the registered manager was approachable and available to them when needed.