Archived: Halcyon House

Halcyon House is a care home located in a residential area of Formby. The home provides accommodation, residential and nursing care for up to 31 older people. The home is owned and managed by Abbeyfield North Mersey Society Ltd, which is a charitable organisation. The building is single storey with a large garden and patio area with seating in the centre. During the inspection, there were 29 people living in the home.

At the last inspection in January 2017, we identified that the provider was in breach of regulations in relation to the management of medicines, fire safety, staffing, safe recruitment, consent, staff support systems, care planning and the governance of the service. Following the inspection we issued a warning notice in relation to Regulation 17; Good governance. The provider also submitted an action plan which told us what action they planned to take to ensure the breaches of regulations were met. During this inspection we looked to see if improvements had been made.

A registered manager was 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 registered manager was on leave during the inspection but did call into the home on the first day of the inspection.

During the last inspection we found that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA) and applications to deprive people of their liberty had not been made as required. During this inspection we found that when required, applications to deprive people of their liberty had now been made.

When people were unable to provide consent, mental capacity assessments were completed. We found however, that these did not always follow the principles of the MCA. The provider was still not meeting regulations regarding this.

At the last inspection we found that audits completed were not effective. During this inspection we saw that audits were completed regularly and actions taken to address any areas that required improvement. However, not all of the issues identified during the inspection had been highlighted. The provider was still in breach of regulations regarding this.

In order to enable staff access to information regarding people’s care needs, copies of relevant care plans were stored within people’s bedrooms. This meant that private information was available to people who may not need access to it and confidential information was not always stored securely.

During the last inspection we found that plans were not in place to address all identified needs and did not all contain sufficient detail to ensure all staff knew how to best support people. We also found that planned care was not always evidenced as provided. During this inspection we found that the provider was no longer in breach of regulation regarding this. Care plans we viewed were detailed and provided information specific to the individual, including their needs and preferences. We saw that planned care was evidenced as provided.

At the last inspection we found that staff were not provided with regular supervisions or an annual appraisal to support them in their roles. During this inspection, staff told us that they were well supported and had received supervision recently as well as an appraisal and records we viewed reflected this. The provider was no longer in breach of regulation regarding this.

During the last inspection we found that there was not always adequate numbers of staff on duty to meet people’s needs in a timely way. During this inspection we saw that staffing levels were maintained, but feedback regarding staffing levels was mixed. Staff told us there was always enough staff on duty, however some people living in the home told us they had to wait for support at times. We saw that call bells were answered quickly during the inspection and staff were available to support people at meal times. Although it was clear that improvements had been made since the last inspection some people living in the home felt that they had to wait too long for care when they needed it.

During the last inspection we found that people were not always protected from risks as fire doors were seen to be wedged open. During this inspection, we saw that fire doors were either closed, or held open appropriately with automatic closure devices. Internal and external contracts were in place to check the safety of the building and its equipment. The provider was no longer in breach of regulation regarding this.

At the last inspection we found that medicines were not always managed safely. During this inspection we saw that improvements had been made. Medicines were stored safely and stock balances we checked were correct. People told us they received their medicines when they needed them, however there were no protocols in place to inform staff when to administer medicines prescribed as and when required. The provider was no longer in breach of regulation regarding the management of medicines.

During the last inspection we found that safe staff recruitment procedures were not always adhered to. At this inspection we saw that staff were recruited following completion of relevant checks. This helped to ensure people were suitable to work with vulnerable people.

Staff were knowledgeable about adult safeguarding and how to report concerns and records we viewed showed that accidents were recorded and reported appropriately. The care files we looked at showed staff had completed risk assessments to assess and monitor people’s health and safety and appropriate actions were taken to minimise the risks.

People’s nutritional needs were known and met by staff, although feedback regarding meals was mixed.

People told us staff were kind and caring and treated them with respect and relatives agreed. We saw people’s dignity and privacy being protected during the inspection and heard interactions between staff and people living in the home were warm and kind.

There was a schedule of activities available for people to participate in and people told us they were happy with what was offered.

Systems were in place to gather feedback from people, including surveys and regular meetings. People had access to a complaints procedure and told us they knew how to raise any concerns. Complaints made were investigated and responded to.

Feedback regarding the running of the service was positive. People felt able to raise any issues with the registered manager and deputy manager.

There was a range of policies available to help guide staff in their role and many of these had been recently updated. Staff we spoke with were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any concerns.

Ratings from the last inspection were displayed as required.

Halcyon House is a care home located in a residential area of Formby. The home provides accommodation, personal care and / or nursing care for up to 31 older people. The home is owned and managed by Abbeyfield North Mersey Society Ltd, which is a charitable organisation. The building is single storey with a large garden and patio area with seating in the centre. During the inspection, there were 29 people living in the home.

We carried out an unannounced comprehensive inspection of this service in December 2015 and breaches of legal requirements were found in relation to person centred care and the governance of the service. The service was rated as, ‘Requires improvement.’ During this comprehensive inspection we also looked to see if improvements had been made in these areas.

A registered manager was 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. Although a registered manager was in post, they were not in work on the days the inspection took place.

At the last inspection we found that not all staff had a good understanding of the Mental Capacity Act 2005 (MCA) and only the registered manager and deputy manager had undertaken training in this area. During this inspection records showed that training had been extended and most staff had now completed this. We found however that not all care plans reflected that consent had been gained in line with the principles of the MCA.

No applications had been made for people who may have been deprived of their liberty as they were unable to consent to their care and treatment.

Staff felt well supported and could raise any concerns they had, however records showed that they had not had supervision regularly. Appraisals had been completed for all staff in 2015 and the process had been commenced in 2016 and was still underway. Staff told us they completed an induction to care and most felt that this was sufficient. Not all staff reported they had received an induction to the home and its safety procedures. Only one of the staff recruitment files we viewed evidenced that this information had been provided.

We observed a number of fire doors to be wedged open during the inspection. This meant that in the event of a fire the doors would not close and people would be at risk.

We found that medicines were not always managed safely within the home. For instance, prescribed thickening agents which were added to fluids when people had difficulty swallowing, were not always stored securely, however all other medicines were kept in a locked clinic room. There were no PRN protocols available to ensure people received their medicines when they needed them, eye drops were not always dated when opened in line with best practice and we observed a number of gaps of the recording of medicine administration. We checked the stock balance of two of medicines and found them to be inaccurate.

Staff who administered medicines had completed medicine training, however not all staff had had their competency assessed to ensure they managed medicines safely.

Most people living in the home told us there were not always enough staff on duty, especially at night. Most staff told us there was usually enough staff on duty during the day, but we were told that it could be very busy, especially after lunch. Staff we spoke with also told us that there was not enough staff on duty at night. There were no staffing analysis or dependency assessments used to help determine how many staff were required to be on duty to be able to meet people’s needs effectively.

We looked at four staff personnel files and evidence of application forms, photographic identification, appropriate references and Disclosure and Barring Service (DBS) checks were in place. We found that potential risks identified during the recruitment process, were not always assessed by the provider to ensure it was safe for staff to work with vulnerable people. Not all staff application forms provided sufficient information regarding staff member’s previous employment.

At the last inspection we found that although regular checks regarding the quality and safety of the service were being made, they had not highlighted the concerns we identified during the inspection process. During this inspection, we found that audits had still not identified all of the issues we highlighted during the inspection.

Where concerns had been identified, it was not always recorded what actions were going to be taken to address these, or by who. Other audits showed that when actions had been identified, they were not always addressed.

At the last inspection we found that there was a lack of person centred approach to care, such as activities not provided that were based on people’s preferences. During this inspection we found that improvements had been made and the provider was no longer in breach of this regulation.

Most people we spoke with were satisfied with the activities that were offered, such as jigsaws; pamper evenings, films, a mobile library and weekly chair exercises.

Care plans had been reviewed regularly, however they were not always updated when people’s needs changed. This meant that care plans were not always reflective of people’s current needs. We also found that plans were not in place to guide staff regarding all of people’s needs, such as medicine administration. Not all plans provided sufficient information to ensure that all staff could understand and meet people’s needs and planned care was not always evidenced as provided.

All people we spoke with told us they felt safe living in Halcyon House. People told us they felt safe for a variety of reasons, including that staff were available to help them. Relatives we spoke with agreed that people were safe.

Staff were able to explain how they would report any safeguarding concerns and a policy was available to guide them in this. Most staff had completed training in relation to safeguarding and we found that appropriate safeguarding referrals had been made when required.

Accidents and incidents were reported and recorded appropriately and regular internal and external checks were made to help ensure the environment and equipment remained safe and well maintained.

Staff had completed training that the provider considered mandatory. Clinical training was also available in areas such as syringe driver management and male catheterisation. People we spoke with told us staff employed by the home were well trained.

Care files reflected that referrals were made appropriately to other health professionals to ensure people’s health and wellbeing were maintained.

Feedback regarding meals was positive. The chef was knowledgeable about people’s dietary needs and told us they catered for specialist dietary requirements.

People living in the home and relatives told us that staff were kind and caring, treated them with respect and provided support in such a way as to protect their dignity.

We saw that staff knew the people they were caring for well, such as their dietary needs and preferences and how people liked to spend their days, but this detail was not always recorded in people’s plans of care. People we spoke with told us that staff supported them in such a way as to promote their independence.

Most people were aware of their care plans and had seen them or knew that a family member had.

Relatives told us they were kept informed of any changes to their loved one’s health and wellbeing and the people we spoke with agreed.

People told us they had choice as to how they spent their day, such as where to eat their meals, whether to sit in lounges, whether to join in activities or spend time in their rooms. Care files evidenced people’s choice with regards to their daily routines, whether they wanted to vote and their preferred place of care.

There was a complaints procedure in place within the home and this was also available within the service user guides provided in people’s bedrooms.

There were processes in place to gather feedback from people and their relatives, such as regular meetings and quality assurance questionnaires. Records reflected that people were able to share their views at these meetings.

We asked people their views of how the home was managed and feedback was positive. Staff told us they enjoyed working at Halcyon House and that staff all worked well together as a team and provided support to each other when necessary.

Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

Staff were encouraged to share their views regarding the service and felt they would be listened to. Staff provided examples of suggestions they had made to improve the service and told us that the registered manager had actioned them.

The registered manager had not notified the Care Quality Commission (CQC) of all events and incidents that occurred in the home in accordance with our statutory notifications. We discussed this with the registered manager following the inspection and have since received the relevant notifications.

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

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 wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they felt safe and that if they had any concerns they would raise these with staff or with the manager.

The manager was aware of their responsibilities to support people who lacked the capacity to make decisions. At the time of our visit there were no concerns with regards to people's capacity to make their own decisions.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were appropriately managed.

The provider has a system of checks in place to ensure people who used the service were provided with a safe home environment.

New staff only started working at the home when all required checks on their suitability to undertake their role had been obtained.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare. People's needs were assessed prior to them moving into the home. Care was then planned and delivered in line with people's assessed needs.

People who lived at the home felt listened to and included in day to day decision making. People were encouraged to attend meetings in order to have their say about the running of the service.

Is the service caring?

People who lived at the home told us staff were caring. People's comments included, 'The care is excellent' and 'The carers are very good.'

Staff told us they were clear about their roles and responsibilities to promote people's independence and to respect their privacy and dignity.

Is the service responsive?

The service worked well with other agencies and to make sure people received the treatment and support they needed. GPs and other health professionals were referred to promptly when people required support with their health care needs.

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and through meetings with the residents. People's feedback was then used to make improvements to the service.

Is the service well-led?

The service was managed in a way that ensured people's health, safety and welfare were protected. For example, care was delivered in line with people's assessed needs and risks to people's safety were assessed and managed.

Systems were in place for assessing and monitoring the quality of the service. These included regular seeking the views of people who lived at the home. An external quality assurance company was used to carry out annual audits of the service and report on the findings. Improvements were then made to the service in response to the findings.

We reviewed three people's care records and found they contained the information staff required to provide care in a way which met people's individual needs. At the time of our inspection people received care and support from sufficient numbers of staff.

Processes for infection control were in place. However, these had been ineffective in maintaining the cleanliness of the building and minimising the risk of infection. We were shown around the building and found the communal toilets and bathrooms required refurbishment and were not sufficiently clean.

However one person explained they had not been able to have a bath or shower as frequently as they would like. They said there had been a recent increase in staff and this meant they could now bathe more regularly. We were told the food was good.

There is a residents' committee at the service, which is regularly attended by five people who live at the home and act on behalf of all residents. People who attend this committee said 'they do listen to what we have to say' and 'some things change through the meetings.'

We spoke with two people who was visiting relatives or friends who live in the home at the time of the inspection. One person said 'the staff always keep me up to date' and 'it [the home] couldn't get any better.' They also said that although the staff can be very busy their relative doesn't have to wait long for support. Food and drink is always available and is offered regularly. Another visitor said, 'I am always made to feel welcome and can come at any time.'