Handford House Care Home

We found the following examples of good practice.

We observed staff following good infection prevention and control practices including appropriate use of personal protective equipment (PPE) in line with government guidance to reduce the risk of infection.

Handford House Care Home was clean throughout. Increased cleaning was taking place across all aspects of the home. This included ensuring all high touch points were regularly sanitised.

Windows and doors were observed to be open to support with ventilation whilst a comfortable temperature was maintained.

Polices, and procedures were in place to assist the registered manager and staff to manage any risks associated with the COVID-19 pandemic.

People living at Handford House Care Home and the staff were undertaking COVID-19 testing in line with Government guidance. Appropriate action had been taken if anyone contracted the virus including staff who were supported to self-isolate. Staff absence was being effectively managed where shift cover was required.

During times when visiting had been restricted, due to either Public Health England guidance or an outbreak in the home, people were supported to stay in contact with family and friends through regular video calls and telephone calls as well as visits in person where people were considered to be having end of life care.

People had clear care plans in place in relation to COVID-19, this ensured risks could be mitigated and people could be supported in a personalised way.

The service provides residential and nursing care in a purpose built building for up to 52 older people, some of whom are living with dementia. There were 51 people living in the service when we inspected on 19 and 20 April 2018. This was an unannounced comprehensive inspection.

We last inspected this service in April 2017 and rated the service as ‘requires improvement’ in all key questions. We found the home was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During that inspection, we found that, there were insufficient numbers of staff on duty; staff were not always deployed effectively in order that they could meet people's needs effectively. Staff were not always well supported, and they did not receive any formal supervision or appraisal.

We also found that, although all medicines were administered by staff who were trained to do so, some aspects of the medicines management needed improvement. People's care records did not demonstrate their involvement in decision making. Mental capacity assessments were not completed and best interest meetings had not always taken place for people who lacked capacity to make decisions for themselves.

Care plans were not all up to date; the information within them was not always current. We could not be confident that people always received the care and support they needed. People received support from staff that were mainly kind and caring. However, people were not always treated with dignity and respect because staff were task focussed and care took place in a manner that was not centred on people as individuals and was at times hurried.

There was a quality assurance audit in place however the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process. This meant that the systems in place to assess and monitor the quality of care provided were not effective.

Following that last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of care a support people received to at least good.

During this inspection on 19 and 20 April 2018, we found that improvements had been made to meet the requirements to help ensure that people received a good service and were no longer in breach of regulations.

Handford House Care Home has had a newly registered manager since our last inspection in April 2017. 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 took up their post in June 2017 shortly after the previous manager had left. The new manager completed their registration process with us in September 2017. The people who used the service, their relatives and staff told us that they thought the new registered manager had made many positive changes to the quality of the service people received.

The people we spoke with and relatives also said they believed people were safe and well cared for. There were systems in place that provided guidance for staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. There were processes in place to ensure the safety of the people who used the service. These included risk assessments, which identified how risks to people were minimised.

There were sufficient numbers of trained and well supported staff to keep people safe and to meet their needs. Where people required assistance to take their medicines there were arrangements in place to provide this support safely, following best practice guidelines.

Both the registered manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager knew how to make a referral if required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services.

There were arrangements in place to make sure the service was kept clean and hygienic.

We saw many examples of positive and caring interactions between the staff and people living in the service. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff protected people’s privacy and dignity.

People received care that was personalised and responsive to their assessed needs. The service listened to people’s experiences, concerns and complaints. Staff took steps to investigate complaints and to make any changes needed.

People’s relatives and the staff told us that the registered manager had made positive changes in the service and that they were open and had good leadership skills. There were systems in place to monitor the quality of service offered people.

Further information is in the detailed findings below.

This inspection took place on 26 April and 2 May 2017 and was unannounced on both days.

A registered manager was in post at the time of our inspection. 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.

There was a change of provider at the home during April 2016 when the current provider Healthcare Homes Ltd took over the running of the home.

There were insufficient numbers of staff on duty. Staff were not always deployed effectively in order that they could meet people’s needs effectively. Staff were not always well supported. They did not receive any formal supervision or appraisal.

All medicines were administered by staff who were trained to do so but some aspects of medicines management needed improvement.

Care records did not demonstrate people's involvement in decision making. Mental capacity assessments were not completed and best interest meetings had not always taken place for people who lacked capacity.

Care plans were not all up to date; the information within them was not always current. We could not be confident that people always received the care and support they needed.

People received support from staff that were mainly kind and caring. However, people were not always treated with dignity and respect because staff were task focussed and care took place in a manner that was not centred on people as individuals and was at times hurried.

There was a quality assurance audit in place however the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

Staff had an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Staff undertook safeguarding training providing them with knowledge to protect people from the risk of harm.

Risk assessments in relation to people, such as mobility, skin integrity and choking were in place and identified control measures to minimise risk.

Referrals were made to external healthcare professionals and we saw involvement from district nurses, chiropody, dentists and GPs.

We found the home was in breach of five regulations 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.

This is a summary of what we found;

Is the service safe?

We found that the service was safe. When we arrived our identification was checked and we were asked to sign the visitor's book. Later, when we needed to re-enter the building, a different staff member challenged us for our identification. This showed that the staff took the security of the building and the safety of the people who lived there seriously.

We saw that staff wore their identity badges so that visitors and non-authorised people could be identified.

When we spoke with people they told us they felt safe living in the service and that they would speak with the staff if they had concerns.

Staff were trained to identify and act on any suspicion of abuse and our records showed that the service had acted quickly to safeguard people if they considered people were at risk.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), which was updated every year. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety checks were carried out in the service regularly and action was taken if equipment was found to be faulty or unsafe. This included regular visual checks and servicing of equipment such as hoists, the fire alarm panel and wheelchairs. Regular fire safety and legionella tests and checks were carried out, which showed that people were protected from unsafe or poorly maintained equipment.

We saw that there were sufficient staff on duty to protect people’s health, safety and wellbeing. The staff rota and dependency level assessments showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them. One person said, "I don’t have to wait long for help." Another person told us that, “We are always properly looked after.”

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "It’s brilliant here, especially when the sun comes out and we can get into the garden."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said that staff were, "Alright." Another person told us, "I couldn’t find anything to complain about."

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to. The activity team worked flexibly, coming in at different times of the day to enable people to participate in activities of their choice.

We saw evidence that the service was flexible and made changes as required to ensure people were kept safe. For example staffing levels were based on the assessed needs of the people. If necessary, because of unforeseen circumstances, staffing levels would be increased to ensure people’s needs were met.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including the doctor, district nurse and dietician.

The people who used the service, their relatives and other professionals involved with Handford House who had completed the satisfaction questionnaires said that they felt that the service responded well to concerns raised with them. Where shortfalls or concerns were raised they were dealt with quickly.

Is the service well led?

Annual surveys were sent to the people who used the service and their relatives. The questions included; how do you rate the standard of care delivery in the home and how do you rate the standard of how telephones enquiries are handled? Forty-five questionnaires were returned and 87% of the questions were answered positively. Of those sent to the professional bodies, 12 were returned and 96% of them were positive.

The service had an effective quality assurance system in place and the records we examined showed that identified shortfalls were addressed promptly. This would ensure that the quality of the service was maintained.

The staff we spoke with told us that the manager was supportive, easy to approach and listened to what they had to say. The manager also told us that they felt supported by the organisation and by their direct line manager, who visited the service regularly to offer support and to check compliance.