All inspections: Haresbrook Park Care Home

When we visited Haresbrook Park Care Home, we spoke with the registered manager, the unit leader, two care staff, three people who used the service, a relative and a GP. Speaking with these people helped answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

We saw there were robust systems in place to assess and check appropriate and safe care was being delivered. These included daily and monthly internal audits. These audits included monitoring checks on medicine administration, recording and storage, infection control and prevention and care planning.

The provider had appropriate security arrangements in place to protect people who lived at the service. We found the entrance door was secure and visitors could only enter the building with the knowledge of the staff. People told us they felt safe and secure in the home and had the freedom to go outside if they wished.

Is the service effective?

We looked at three care plans. People's individual needs were established before they began to use the service. We saw people's files contained comprehensive assessments carried out prior to admission.

We saw people's care was planned and delivered in line with their individual needs. Each person had a care plan in place which provided personalised information. The care plans were divided into sections to include physical health, mental health, hygiene, food and drink, spiritual needs, social life and risk assessments. The indexing of the care plans allowed staff to locate information easily.

It was clear from what we saw and from speaking with staff that they understood people's care and support needs and they knew them well.

Is the service caring?

Care plans had been regularly reviewed to ensure there was up-to-date information on the person's needs and how these were to be met. We saw some care plans indicated specific actions had to be taken if people's health declined in a particular way. For example we saw that one person's physical health had declined which required long term bed rest. Risk assessments regarding tissue viability had been conducted, pressure-relieving interventions put in place and the outcome recorded.

People were very comfortable, well dressed and clean which demonstrated staff took time to assist people with their personal care needs.

The atmosphere throughout the home was relaxed and we saw staff took time to talk to people. Staff spoke with people respectfully, giving good eye contact and the opportunity to respond.

Is the service responsive?

Care plans recorded what each person could do independently and identified areas where the person required support. When people moved into the home detailed assessments took place which ensured people's independence was maintained.

We saw when people required care from another health care professional this was efficiently arranged. A GP told us "The care delivered here is very good and I have no concerns. I also feel confident that any problems my patients may develop will be promptly brought to my attention."

Is the service well led?

We found the service had an effective quality assurance system in place and any identified actions had led to improvements in the service people received.

Staff were monitored and supervised in their role to ensure they knew how to provide a high standard of care. The manager told us a range of policies and procedures had been written and developed to support staff in their role. Staff confirmed they could access this information when needed.

Audits were carried out on the environment and services provided. This was to identify, monitor and manage risks to people who used, worked in or visited the service. Examples of these included environmental, medication and support plan audits.

Staff told us regular staff meetings were held and they felt very comfortable raising issues with the management of the home. Staff said they were confident they would be listened to and action taken if needed.

We observed the daily manager's briefing which ensured all key staff had a common understanding of matters affecting the management of the service that day.

The action taken by the provider meant that they have an effective system of records in place.

Many people who lived at the home had different levels of dementia, so not everyone was able to tell us about life at the home. At this inspection, we spoke with four people who lived at the home and two relatives. We also spoke with six staff and the deputy manager. The home manager was on leave but they spoke with us after this inspection.

At our previous inspection on 9 April 2013, we identified that the provider did not meet the expected standards in some outcome areas. Therefore we set compliance actions, which required the provider to make the improvements to ensure the quality and safety of care for people who lived at the home.

At this inspection, we reviewed progress in the improvements needed. We found that the provider had taken action to ensure that people's needs were met by responsive staff with compassion in a safe and effective manner.

We observed examples that showed us that people who lived at the home were treated with respect and as individuals. We saw that progress had started to plan and deliver activities. This made sure people had the opportunities to lead as full a life as possible.

People and the relatives that we spoke with made positive comments about the way staff treated them and the care people received. One person told us: 'I've been here years, I find it lovely here, very safe indeed. I help out, I look after the garden. I do a lot of walking, I'm allowed out on my own; I go down the lane and over the fields'. Another person said: 'The staff are very polite and helpful, they treat me respectfully. They always seem to be there when you want them. I feel quite safe here'.

People told us that there were enough staff to meet their needs and they did not have to wait for staff to help them. One relative said: 'The staff are very kind and helpful but I think there should be more of them. They seem very shorthanded sometimes but it doesn't seem to affect her care'.

The manager was able to demonstrate that the systems they used to monitor the quality of the service were effective. For example, we saw improvements had been made since our last inspection. The manager was also aware that the general quality and accuracy of care records needed to improve further.

Many people who lived at the home had varying levels of dementia, so not everyone was able to tell us about life at the home. At this inspection, we spoke with three people who lived at the home and four representatives of other people.

People and representatives that we spoke with made positive comments about the care people received. One relative told us: 'Staff look after him well' and the staff 'are very caring'. Another relative said:' Cope with X (persons name) as best as they are able to'.

We identified that some improvements had started to take place since our last inspection in July 2012. These included revised care plans that provided staff with information and review processes to meet people's needs and keep them safe.

We also observed that people did not receive their medicines whilst they were eating their breakfast and therefore their dignity was respected. However, we saw care practices that did not always respect or treat people as individuals when meeting people's needs.

The arrangements in place did not provide enough assurance that staffing levels were right. Some people that lived at the home told us that they frequently had to wait for support because staff were busy.

During our inspection we found that work was in progress to check the standards of care people received whilst they lived at the home. Further assurance was required to show how the provider was going to maintain ongoing compliance with the essential standards.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an expert by experience that is a person who has experience of using services and who can provide that perspective.

Forty nine people were living in the home when we visited. Some of the people were not able to talk directly with us because of their dementia and communication needs so we used different methods to see whether they received the care and support they needed. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People's privacy was respected. We observed each person had their own room and if they shared privacy screens were provided. One person who lived in the home said staff knocked on the door if they wanted to come in.

We observed lunch being served to people who lived in the home and saw that staff offered people choices of where they would like to eat their meals. People were not always treated with respect and dignity whilst eating their meals.

Some of the people who lived in the home who we spoke with told us that they were happy with the meals provided at Haresbrook Park. They said, 'The foods not bad, there's always a choice' and '.you get enough food, they will get you a sandwich if you want one.'

We observed that people who lived in the home moved freely around choosing where to sit and what they wanted to do. We saw one person going for a morning walk and another person choosing to sit in their room. One person told us, 'They're plenty of activities' and 'sometimes we go to the airport to see the planes.'

We did this visit to check what improvements the service had made in the areas checked when we did our previous inspection in August 2011. These were health and welfare, nutrition and medicines. During this inspection we found that there had been considerable improvements in all these areas.

A new manager had started work at the home since our previous visit and was working with the local authority to address the training needs of staff working at the home. This included dementia care training to help the staff in develop the approach to dementia care at Haresbrook Park.

During our inspection we observed life at the home and spoke to a visitor, a health

professional and a number of care workers. We were not able to have full conversations with the people who live there because most had difficulty

communicating due to the effects of dementia but we spent a lot of our time observing life for people there.

We found that the home felt calmer and that the general atmosphere was more relaxed than when we last visited. Staff we spoke with told us that the organisation of the home had been improved by the new manager and that they felt more supported in their work. One of the care workers told us, 'It is a million times better working here now. I look forward to coming in in the morning.'

We saw that people living at the home were spoken to by the care workers in a calm and polite way. We saw some good examples of people being spoken with in a way that respected them as individual adults. People appeared relaxed and at ease with the staff. One person who had been restless and ill at ease during our last visit greeted us in a more relaxed way and was more settled.

At lunchtime we saw that people had more help to eat their meals although some people still waited for periods of time with their food going cold in front of them. The home had introduced more flexible arrangements for providing food for people who may be too restless to sit at a dining table for their meals. Finger food and snacks were provided throughout the day and staff were expected to make sure meals were saved or alternatives provided for people who walked away from their meal. We did however see two people who were trying to eat lasagne with their fingers.

The manager had improved the arrangements for dealing with people's medication. Storage and stock control had improved and people's medication was being regularly reviewed. The manager told us that in some cases people's medication had been reduced or changed as a result of this. We also saw examples of this in the care records.

We did this visit to check what improvements the service had made in the areas checked when we did a review in March 2011. These were health and welfare, nutrition and medicines. Following our March review Worcestershire Council's Care Services Quality Team (CSQT) had been working with the service and providing training with the aim of supporting the service to make improvements. Staff from the CSQT team had recently made safeguarding referrals for three people because they found shortfalls in care during their visits. The concerns were in the same areas that we had concerns in March. During this review in August 2011 we found significant shortfalls in how some aspects of care were being dealt with.

During our visit we observed life at the home and spoke to two visitors, a health professional and a number of care workers at the home. We were not able to have full conversations with people who live at the home because most have difficulty communicating due to the effects of dementia but we spent a lot of our time observing life for people there.

From our conversations we learned that visitors find staff friendly and helpful. They feel staff work hard and do their best but do not always have enough time. When we spoke with staff they told us that they do not have time to do everything that people need. They also spoke about not knowing enough about people living at the home and that they feel especially challenged by the needs of people whose dementia causes them to have periods of agitation and aggression. Some staff sometimes felt frightened by this.

We saw that there were some people at the home who were restless and agitated for periods of time. We saw that staff avoided one person who spent their time pacing around the building. The only occasions we saw staff speak to him they were asking him to move because he was in the way of more frail people in the home.

We saw evidence during our visit of some people not having much attention from the staff. In the sitting rooms we saw that people were left on their own for periods of time and that at mealtimes people did not have the help they needed to eat their meals. This meant that people were left for periods of time with their food going cold in front of them. We observed that some staff had little awareness of how to deal with people distressed by their dementia. For example we saw a care worker say to a person who was calling out in distress 'No, stop it. You are alright.' and leave them without any reassurance.

We looked at the medicines for three people and in each case we found recording errors or that the home had run out of items of people's medicines. In each case the out of stock medicine was important to the individual health and wellbeing of the person. We were told that a delivery was due the next day or the day after but were not told that more urgent action would be taken until we told a director of the company about this.

We made safeguarding referrals for the people whose specific care needs we were concerned about. We are co-coordinating our work with Worcestershire Council's safeguarding team and their Care Services Quality Team.

During our visit a director of the company, some members of staff and a person who lives at Haresbrook Park were interviewing for a new manager for the home. At the end of the visit the director told us that they had appointed one of the applicants and that the person would start work in September. We took this positive development into account when we decided what action we would take.

We arranged a meeting with a director of the company which owns Haresbrook Park. At this meeting, the director and the newly appointed manager gave us their full assurance that they were working hard to make improvements to the quality of care provided at Haresbrook Park.

We did this visit to check what improvements the service had made in the areas checked when we did a review in March 2011. These were health and welfare, nutrition and medicines. Following our March review Worcestershire Council's Care Services Quality Team (CSQT) had been working with the service and providing training with the aim of supporting the service to make improvements. Staff from the CSQT team had recently made safeguarding referrals for three people because they found shortfalls in care during their visits. The concerns were in the same areas that we had concerns in March.

During this review in August 2011 we found significant shortfalls in how some aspects of care were being dealt with. We made safeguarding referrals for three people because we found that medicines prescribed for them were out of stock and for a person whose pressure area care we were concerned about.

During our visit we observed life at the home and spoke to two visitors, a health professional and a number of care workers at the home. We were not able to have full conversations with people who live at the home because most have difficulty communicating due to the effects of dementia but we spent a lot of our time observing life for people there.

From our conversations we learned that visitors find staff friendly and helpful. They feel staff work hard and do their best but do not always have enough time. When we spoke with staff they told us that they do not have time to do everything that people need. They also spoke about not knowing enough about people living at the home and that they feel especially challenged by the needs of people whose dementia causes them to have periods of agitation and aggression. Some staff sometimes felt frightened by this.

We saw that there were some people at the home who were restless and agitated for periods of time. We saw that staff avoided one person who spent their time pacing around the building. The only occasions we saw staff speak to him they were asking him to move because he was in the way of more frail people in the home.

We saw evidence during our visit of some people not having much attention from the staff. In the sitting rooms we saw that people were left on their own for periods of time and that at mealtimes people did not have the help they needed to eat their meals. This meant that people were left for periods of time with their food going cold in front of them. We observed that some staff had little awareness of how to deal with people distressed by their dementia. For example we saw a care worker say to a person who was calling out in distress 'No, stop it. You are alright.' and leave them without any reassurance.

We looked at the medicines for three people and in each case we found recording errors or that the home had run out of items of people's medicines. In each case the out of stock medicine was important to the individual health and wellbeing of the person. We were told that a delivery was due the next day or the day after but were not told that more urgent action would be taken until we told a director of the company about this.

During our visit a director of the company, some members of staff and a person who lives at Haresbrook Park were interviewing for a new manager for the home. At the end of the visit the director told us that they had appointed one of the applicants and that the person would start work in September. We took this into account when we decided what action we would take.

In addition to the compliance actions made in this report we have arranged a meeting with the responsible individual for the service, a director of the company which owns the home. We made safeguarding referrals for the people whose specific care needs we were concerned about. We are co-ordinating our work with Worcestershire Council's safeguarding team and their Care Services Quality Team.

People have had mixed experiences of the care and support provided at Haresbrook Park. We spoke with a relative who told us they were very pleased with the care given to their parent and had seen an improvement in their well-being when they moved there. Another family however had experienced poor communication from staff and been very concerned about how the health of their relative had been dealt with. During our visit we observed some positive care but also noted some areas where improvements are needed.

We found that the care records were not being used as a daily working tool by care workers and that some information that staff had was not included in the records. This could lead to some staff not having all the information they need.

While staff were clearly caring, we saw that the dignity of people at the home was not always upheld. For example people who need a lot of help with eating were routinely referred to by staff as 'the feeders'. We also saw that some people were given drinks of tea in plastic beakers which is undignified and marks people out as being 'different'. We also saw a person being fed a sandwich by a care worker who was standing up next to him. This showed a lack of understanding of good practice when helping people with dementia as well as being undignified for the person. This added to the impression we gained that the care staff have limited time to spend with people during mealtimes.

The home has an experienced and committed chef who has worked to improve the quality and choice of food served but has not been offered opportunities of further training specific to the nutritional needs of older people or those with dementia.

We found that there were in house systems for monitoring that medication was being managed correctly. However, we found a number of errors when we did a random check of some items of medication which indicated that people may not have received their prescribed medication correctly. We also saw records which indicated that items such as creams and eye drops may not always be administered according to the instructions.

Since we did our visit the providers representative has given assurances that robust actions have been taken to make immediate improvements.

Archived: Haresbrook Park Care Home

All Inspections

21 May 2014

During a routine inspection

During a check to make sure that the improvements required had been made

30 July 2013

During a routine inspection

9 April 2013

During a routine inspection

20 July 2012

During a themed inspection looking at Dignity and Nutrition

20 January 2012

During an inspection looking at part of the service

4 August 2011

During an inspection looking at part of the service

14 July 2011

During an inspection looking at part of the service

31 March 2011

During an inspection in response to concerns