14 April 2021
During an inspection looking at part of the service
Hadley Place Residential Home is a care home providing accommodation and personal care for up to 29 older people, some of whom may live with a mental health condition or dementia. At the time of our inspection 23 people lived at the service.
People’s experience of using this service
Risks to people's health, safety and welfare were not always identified and managed. Lessons were not learned when things went wrong. Medicines were not managed safely.
There were gaps in the skills and knowledge of staff in relation to fire evacuation procedures and supporting people with complex needs and behaviours that may challenge.
People did not always receive person-centred care and care records did not fully reflect their needs. There was a lack of meaningful activities for people.
People were not consistently supported to have maximum choice and control of their lives and staff did not support them in the least restrictive ways possible and in their best interests; the policies and systems in the service did not support this practice.
Areas of the environment were poorly maintained. Some improvement works had been completed recently and other work underway, following guidance from the community infection prevention and control nurse. Appropriate standards of hygiene had not been maintained in all areas.
Staff were recruited safely. Feedback from staff was mixed about having sufficient numbers of staff on all shifts to meet people’s needs. We have made a recommendation about reviewing people’s dependency needs effectively and the staffing levels.
People and relatives said they liked the staff and described them as kind and caring. However, there were times when some people’s dignity was compromised.
People’s nutritional needs were met. Although staff worked closely with a range of health and social care professionals, there had been delays in making referrals for assessments when some people’s needs changed.
The service was not well-led and there continued to be a lack of effective governance and oversight by the provider and manager. The provider’s quality assurance systems were not effective in identifying and addressing issues. The provider had not always notified CQC when people had deprivation of liberty safeguards authorised by the placing authority. The service has a history of not sustaining improvements.
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 14 September 2020) and there were multiple 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 and significant concerns remained.
The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.
Why we inspected
The inspection was prompted in part due to concerns received about infection control, the premises and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led. However, we identified other concerns during our inspection and therefore a decision was made for us to inspect all five key questions.
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 see what action we have asked the provider to take at the end of this full report.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to person-centred care, safe care, consent, dignity and respect, the environment, staff training, governance and notifications.
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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hadley Place Residential Home on our website at www.cqc.org.uk.
Follow up
We will work alongside the provider and 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.
Special Measures:
The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.