Haddon Hall Care Home

Haddon Hall Care Home is a residential care home providing personal and nursing care to up to 75 people. The service provides support to older people, people living with dementia and younger adults. At the time of our inspection there were 61 people using the service.

Haddon Hall Care Home accommodates people in one building across 3 floors. Each floor has communal areas and outside balcony space. All bedrooms have ensuite bathroom facilities.

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

People were still not always protected from known risks to their safety, care plans did not always provide staff with enough information on how to support people with their skin integrity or hydration. Monitoring records in place for repositioning and fluid intake had not been fully completed or monitored. We found when people had experienced a fall, staff had not completed post fall observations and actions recorded as taken were not always evident in people’s care records.

Relatives and staff raised concerns with us about the staffing levels in the service. We reviewed the provider’s dependency tool and staffing rotas and found they did not consistently demonstrate the assessed number of staff had been deployed. Medicines were managed safely, and safeguarding systems were in place and followed by staff. Infection, prevention and control measures were found in place which reduced infection risk in the service.

Assessments of people’s needs had been carried prior to people using the service, however care had not always been delivered in line with people’s choice and preference. Where people had been assessed risks associated with eating and drinking, the monitoring of these risks had not been regularly reviewed to identify actions that may be required. Mental capacity assessments and best interest decisions were not always completed for all aspects people's care.

People were provided with a choice of balanced meals. Relatives consistently told us the food was good. Staff spoke positively about the training they had received, and effective systems were in place to supervise and support staff.

Systems and processes continued to not always be effective in identifying potential risks. Audits of monitoring charts had not always been thorough and did not identify the gaps in recordings we found. The provider’s policies had not always been followed in relation to fall prevention and this had not been identified by the audits carried out. The provider had not always learnt from feedback given and improved the quality of care. Whilst we found improvements in some areas, not all concerns we had found previously had been adequately addressed.

Relatives and staff spoke positively about the manager. People and their relatives had opportunities to provide feedback on the service in various ways such as in meetings, through questionnaires and in person and relatives told us they felt involved in the planning of people’s care.

Rating at last inspection and update

The last rating for this service was inadequate (published 9 May 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Haddon Hall Care Home on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, staffing and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains 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.

Haddon Hall Care Home is a residential care home providing nursing and personal care to up to 75 people. The service provides support to older people, people living with dementia and younger adults. At the time of our inspection there were 69 people using the service.

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

People did not always receive safe care. Some people had developed sore and broken skin and were not always receiving the appropriate care to make them better. Risks to people’s safety were not always assessed or reduced. Staff were not always deployed effectively to make sure people received safe care. The registered manager had failed to report all safeguarding incidents to external safeguarding professionals.

The provider had failed to ensure the service was well-led. The registered manager had not always worked effectively within the provider’s governance processes. Recent audits and risk meetings had not identified the risks to people’s safety we found during this inspection. Staff did not feel listened to valued or respected. The registered manager had failed to complete an investigation into repeated staff concerns of unsafe care.

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.

The home was clean and free from malodours throughout. Staff wore Personal Protective Equipment and worked within best practice guidance to protect people from illness such as COVID-19.

Relatives consistently praised the hard-working, kind, caring and dedicated staff.

Immediately after the inspection the provider responded to our feedback and put measures in place to improve the safety of the care provided. They also carried out whole home audits to identify if there were other areas they needed to improve.

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 25 January 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of the full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Haddon Hall Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safety, governance, staffing and recruitment at this inspection. Please see the action we have told the provider to take at the end of this report. 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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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 of 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.

Haddon Hall is a care home providing personal and nursing care for up to 75 people aged 65 and over. At the time of the inspection there were 50 people using the service. The service is provided over three floors, with communal facilities on each floor including dining rooms and lounge areas.

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

Care planning did not always include comprehensive information about people. Risk assessments were not always in place to keep people safe.

There was insufficient staffing to ensure that people’s needs were met. Medicines were not always administered safely.

Management were not always consistent in their approach to overseeing the service. Staff lacked confidence in management.

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.

People were kept safe from abuse and avoidable harm. Staff were knowledgeable about safeguarding.

The service was clean, and staff were wearing personal protective equipment appropriately. However checks of professional visitors in relation to COVID-19 including vaccination were not always being carried out.

Staff were recruited safely, pre-employment checks were carried out.

Rating at last inspection and update

The last rating for this service was good (published 17 September 2019)

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about unsafe staffing levels. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with staffing, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

Follow up

We will be in contact with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Requires Improvement'.

You can see what action we have asked the provider to take at the end of this full report.

We found the following examples of good practice.

• The management and staff were adhering to all guidelines for infection prevention and control during the inspection. Staff were supported to understand and follow guidelines through training and supervision.

• Although the home was closed to visiting, the manager had ensured there were safe processes by which people could have visitors when this was permitted again.

• People only moved into the home after a negative coronavirus test.

• People and staff were regularly tested for corona virus.

• There was a cleaning schedule to ensure surfaces and areas that could be touched more frequently were regularly cleaned.

Further information is in the detailed findings below.

People were supported to eat and drink enough to maintain a balanced diet. However, the mealtime experience varied between different units on the day of the inspection. A few people on the dementia unit were not offered choices in a way they could understand.

The dementia unit had not been designed to be easy for people living with dementia to navigate. The home was pleasant and tastefully decorated throughout. There were facilities such as a hair dressing salon, gym, secure garden and private spaces for families to spend time together away from a person’s bedroom.

Processes were in place to protect people from the risk of avoidable harm. Risk assessments were completed for all areas where there was a potential risk.

Safeguarding referrals were made to the local authority and investigated where necessary. There was an open culture of learning from accidents, incidents, mistakes and concerns.

There were enough staff to meet people’s needs and provide companionship. Staff had been safely recruited.

Staff were well trained and supported with supervisions and appraisals. New staff received a thorough induction and were not permitted to work unsupervised until assessed as competent to do so.

People were cared for by staff who were kind and caring and respected their individual needs and preferences.

People, relatives and staff all spoke highly of the registered manager. People and relatives told us she was approachable and listened to them. Staff told us she was fair, supportive and approachable at all times.

Governance frameworks were in place to review, audit and analyse care provided. The registered manager adhered to the duty of candour.

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.

People were empowered to retain independence and links with the wider community. Care was planned and delivered in a person-centred way. Care needs were reviewed regularly.

People received their medicines as prescribed. There were clear procedures for the receipt, storage, administration and disposal of medicines.

Throughout the inspection the home was clean and free from malodours.

People who were known to be approaching the end of their lives were supported to be cared for in the way they chose.

People told us they knew how to complain and felt confident to do so if they wanted to.

Positive feedback was received from a visiting healthcare professional who told us that the staff referred people as necessary and followed clinical advice.

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 Requires Improvement (published 04 August 2018).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

The inspection took place on 25 June 2018 and was unannounced. At the last inspection we rated the home overall as ‘Good’ with a request to the provider to make improvements within the ‘Responsive’ section. At this inspection we found some improvements had been made, however further improvements were required in the ‘safe’ and ‘well-led’ sections of the report.

Haddon Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home has accommodation set over three floors. Each floor has access to dining areas and small and large lounge or relaxation spaces. Each room has an ensuite; there are also large communal bathrooms with adapted baths on each floor. There is a small gym and a dining area which can be used by people and their relatives. The garden is access with areas of seating and a circular pathway to support people to navigate around the landscaped flowerbeds. The upper floors also had access to the outside on large balconies with seating.

The service was registered to provide accommodation for up to 75 people. At the time of our inspection 60 people were using the service.

Haddon Hall has a registered manager. 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 not always enough staff to support people’s needs. Medicine was not always managed safety to meet peoples prescribed needs. Risk assessments had not always been completed and behaviour plans were not completed to support a consistent approach. When audits had been completed they did not reflected actions which required completion. New systems had not been checked to ensure staff had the knowledge to use them effectively.

People enjoyed living at the home. It was well maintained and any risk to infection was managed. Staff showed knowledge about people’s needs and they had established relationships with people. Dignity and respect for people was maintained.

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 supported this practice. Their views were considered and improvements developed from these meetings and connections.

Staff understood how to protect people from harm and when required people were supported with their health care needs. Nutritional needs had been considered and dietary needs met.

Activities and areas of interest were on offer, which linked traditional things with new initiatives. The community had also been encouraged to link with the home and partnerships had been developed.

Complaints had been responded to and the registered manager understood their role in relation to notifications. We saw the rating was displayed at the home and on the provider’s website.

We found breaches 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.

Haddon Hall Care Home provides accommodation, nursing and personal care for up to 75 older adults, including people living with dementia. At the time of our visit, there were 53 people living at the service, including 19 people receiving nursing care. There was a registered manager at this service. 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.

People felt safe and relatives felt people were safely supported. Staff usually responded promptly to provide people with the assistance they needed to support them safely. Arrangements for staff planning and deployment, helped to mitigate risks to people’s safety from their increased numbers and needs and ensure people’s safe supervision.

The provider’s arrangements helped to protect people from harm and abuse. Staff understood their role and responsibilities to recognise and respond to any suspected or witnessed harm and abuse of a person receiving care. Staff were recruited and monitored in a way that promoted safe care and practice.

Known risks to people’s safety associated with their health needs, medicines and their environment, were assessed before they received care and regularly reviewed. People’s care was planned and delivered in a way took account of this. People received care in an environment that was clean and well maintained. This helped to ensure that people received safe care and treatment.

People and relatives were happy with the care provided and felt that people’s health needs were being met. People’s care plans were sufficient to inform people’s care. Staff referred to and followed instructions from external health professionals for people’s care when required.

Staff received the training they needed to perform their role and responsibilities for people’s care and they were conversant with people’s health needs and related care requirements. Staff training and development needs and opportunities were regularly reviewed and sought to help ensure a consistent and thoughtful approach to effective care.

Staff understood and followed the Mental Capacity Act 2005, to obtain people’s consent or appropriate authorisation for their care.

People received effective nutrition and they were supported to do this by staff who understood and followed their dietary needs and preferences.

People received care from staff who were motivated in their role, respectful, kind and caring. Staff understood and promoted people’s independence, involvement, rights and choices in their care and also the appropriate involvement of their relatives.

Care was not consistently personalised and staff did not always provide people’s care in a timely manner. Staff did not always respond promptly when people needed assistance or to support their independence.

A range of aids, adaptations and adjustments helped to support people living with dementia or sensory and physical disabilities. Further improvements were planned to enhance people’s access to information.

People were supported to engage with others and in home life. This was done in a way that helped to promote people’s participation and inclusion in home life and the extended community.

People and relatives were asked for their views about the care provided and informed how to make a complaint or raise any concerns. These were listened to, taken seriously and acted on and used to make improvements for people’s care when required.

The service was well managed and led and people, relatives and staff were confident in this. The provider’s record keeping and governance arrangements helped to inform and ensure continuous service improvement and accountability for people’s care.