Hadley Lawns Care Home

We found the following examples of good practice.

•The provider had appropriate arrangements for visiting to help prevent the spread of Covid 19. All visitors were required to complete a risk assessment and a checklist, prior to entering the building. Visitors had their temperatures taken on arrival and were screened for symptoms of acute respiratory infection before being allowed to enter the home. They were supported to wear a face covering and maintain hand hygiene during their visit.

•The provider had appropriate arrangements to test people and staff for Covid 19 and was following government guidance on testing. There was a designated team of staff that carried out all testing on people and staff at the home. This ensured that people and staff were tested for Covid 19 in a consistent way.

•The provider ensured that staff received appropriate training and support to manage Covid 19. All staff had received training on Covid 19, infection control and the use of Personal Protective Equipment (PPE). They received guidance on supporting people with dementia to understand Covid 19. Staff wellbeing was supported when they became unwell and when they returned to work.

•There were sanitiser points available throughout the building and thorough cleaning was done daily and a housekeeper was in place for each floor. Deep cleaning was carried out on a regular basis by an external contractor.

•Chairs in the lounge and dining areas had been arranged to ensure social distancing measures were in place. However due to the current outbreak of Covid 19 the dining room and communal areas were not in use

•All people admitted to the home were required to have a test before admission and appropriate systems were in place to ensure safe transfer.

•The provider ensured that people using the service could maintain links with family members and friends. People were supported to keep in touch by phone and virtual technology. The service was in the process of adapting a room with separate access to ensure safe visits for relatives in line the latest government guidelines.

• The provider was working closely with the local authority and public health to manage the current outbreak effectively.

•Specific staff were deployed to work with residents who had tested positive with Covid 19

• The provider had recently made changes to how meals were served and to donning and doffing stations in line with recommendations made by the local authority and further enhanced infection control training was planned.

• Weekly infection control audits were taking place and discussed daily during staff meetings.

• The provider had a named clinical lead who was providing regular weekly contact with the service.

Further information is in the detailed findings below.

Hadley Lawns care home provides accommodation, nursing and personal care for up to 44 older people. The ground floor supports people with residential care needs and the first floor supports people who also have nursing needs At the time of our inspection there was 38 people using the service.

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

Systems and processes were in place to keep people safe and risks associated with people's care needs had been assessed. There were enough staff to meet people's needs and recruitment processes and procedures were robust.

Medicines were managed safely. The service was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

Staff received training and supervision for them to perform in their role. People's nutrition and health were supported and promoted. 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.

Staff knew people well and care plans were detailed and provided staff with clear guidance on how to meet people's needs. Staff respected people’s privacy and dignity and encouraged people to remain independent. People and relatives could express their views about the running of the home.

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People received personalised care and support which met their needs and reflected their preferences. People benefited from a variety of activities, events and trips out that were available to reduce social isolation, give meaning and purpose and enhance their wellbeing.

The service was well led. People, staff and relatives spoke positively about the clinical services manager and the provider. There was a positive culture throughout the service which focused on providing care that was personalised. The management team used a variety of methods to assess and monitor the quality of the service. They were aware of their regulatory responsibilities associated with their role.

More information is in the full report.

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 (report published March 2017). The service remains good.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Hadley Lawns residential and nursing home provides accommodation, nursing and personal care for up to 44 older people, some of whom have dementia. The ground floor supports people with residential care needs and the first floor supports people who also have nursing needs. On the day of our visit there were 41 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with CQC 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 and associated Regulations about how the service is run.

People were positive about the service and the staff who supported them. People told us they liked the staff and that they were treated with dignity and kindness.

Staff treated people with respect and as individuals with different needs and preferences. Staff understood that people’s diversity was important and something that needed to be upheld and valued. Relatives we spoke with said they felt welcome at any time in the home; they felt involved in care planning and were confident that their comments and concerns would be acted upon. The care records contained detailed information about how to provide support, what the person liked, disliked and their preferences. People who used the service along with families and friends had completed a life history with information about what was important to people. The staff we spoke with told us this information helped them to understand the person.

The care staff demonstrated a good knowledge of people’s care needs, significant people and events in their lives, and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

Risk assessments were in place for a number of areas and were regularly updated, and staff had a good knowledge and understanding of many complex health conditions.

There were sufficient numbers of suitably qualified, skilled and experienced staff to care for the number of people with complex needs in the home.

Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Medicines were managed safely. Staff had detailed guidance to follow when administering medicines. Staff completed extensive training to ensure that the care provided to people was safe and effective.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration.

There was an open and transparent culture and encouragement for people to provide feedback. The provider took account of complaints and comments to improve the service. A complaints book, policy and procedure were in place. People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA.The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).We found that the service was working within the principles of the MCA, and conditions on authorisations to deprive people of their liberty were being met.

The management team provided good leadership and people using the service, relatives and staff told us they were approachable, visible and supportive. We saw that regular audits were carried out by the provider’s head office to monitor the quality of care.

At this inspection we found that a number of improvements had been made to the overall care and treatment provided by the home. The relief manager had reviewed and updated care provided and care plans, rearranged staffing rotas to better meet people's needs, regularly met with people and their relatives to discuss changes required in the home and introduced a broader range of appropriate activities. People and staff we spoke with told us that their experiences of the changes introduced had been positive. We were told "I'm now perfectly happy here," "staff are much happier in the home, everyone pulls together" and "it's much better here."

We found that care was not being planned and delivered in a way that met people's individual needs. We saw that people's care records did not always provide guidance for staff to meet the needs of people effectively. The provider was failing to protect people from the risks associated with incontinence, malnutrition and pressure ulcers. We have shared our concerns with the commissioners at the host local authority.

We also checked the equipment used within the home and found there were effective systems in place to ensure enough, suitable equipment was available and maintained.

People spoken with told us they felt staff members were good, one person said, "they are kind." Another person told us, "they take their time." We saw that staff interactions were friendly, caring and respectful. Dementia and dignity and respect training had been delivered to staff. Most staff had attended training required by the provider and had received recent supervisions. We saw that a new system was in place to ensure that reviews of incidents and quality auditing was carried out to assess the service provided.

We found that some people were not involved in the care delivered to them. We found that some people had no stimulation for long periods. We also found that care staff did not always treat people with a sufficient understanding of their care needs or with sufficient dignity.

Care plans reflected people's current needs. Care planning processes included consideration of people's capacity to make decisions. People told us that they felt safe with the staff who supported them.

Some staff did not receive appropriate training to work with people who use the service. We also found that the organisation was not always monitoring the quality of the service in line with its own procedures.

There has been no registered manager working at the service since April 2012. This is a breach of the provider's registration condition for Hadley Lawns Residential and Nursing Home. We are writing to the provider separately about this.