Archived: Hartley House

During this inspection, we considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer our five key 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. The summary describes what we observed, the records we looked at and what people using the service and the staff told us. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that risk assessments with clear action plans were in place to ensure people remained safe. The members of staff who administered medicines had been appropriately trained and their competence was monitored by the service. All medicines were stored, handled, administered and disposed of safely.

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. We saw that the delivery of care was in line with people's care plans and assessed needs. A relative of a person who used the service said, "I come here every day and I am always impressed how efficient the staff are'. Care plans and risk assessments were reviewed regularly and changes in care plans were effectively communicated to staff. Staff's training was specific to meet people's needs, appropriate and up-to-date. Staff received additional training when requested.

Is the service caring?

We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. We saw that staff showed kindness and patience when they supported people at mealtimes, during hoisting and during the administration of their medication. Two people who lived in the service said, 'The staff are ever so kind', 'I like the staff, they cheer me up and they care about me'. A member of staff said, 'We make sure everyone's needs are met and that they are comfortable'.

Is the service responsive?

People's needs had been assessed before they moved into the service and their care plans were reviewed regularly to reflect any change in their needs. We observed that people's requests for help were responded to by staff without delay. People were able to choose what they preferred to eat. We spoke with a district nurse who told us, 'The staff contact us promptly when they have concerns'.

Is the service well-led?

The manager operated a system of quality assurance to check all records were appropriately maintained and up to date. They completed audits to identify how to improve the service and these were appropriately recorded. People and their relatives or representatives and staff were consulted about how the service was run. A member of staff told us, "The manager is very approachable and responds to any concerns'. A relative told us, 'The communication with the manager is excellent'.

This inspection was carried out by one inspector and a pharmacy inspector. They gathered evidence against the outcomes inspected to help answer our five key 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. Many of the people who used the service had dementia. This meant they were not always able to tell us their experiences. We spent time observing how people interacted with staff.

The summary is based on our observations, discussions with people using the service and the staff supporting them, discussions with healthcare professionals and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

This is a summary of what we found -

Is the service safe?

Relatives we spoke with told us they felt it was a safe service. One relative commented that there was 'Always someone on hand' if they needed help.

We found that overall the care provided at the home was safe but there were minor concerns in relation to how medicines were administered. There were also concerns about some of the records in the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, staff had received training concerning the Mental Capacity Act (2005) and understand the principles.

Is the service effective?

We looked at the training staff had received in order to meet the needs of people living at the home. We found that they had been trained in a number of relevant specialist areas such as the care and support of people with dementia, caring for people with diabetes and safeguarding vulnerable adults.

Where people lacked capacity to make important decisions for themselves, families or advocates and relevant health and social care professionals were involved in best interest meetings to make sure that appropriate decisions were made in regard to their health and welfare.

Is the service caring?

People were cared for by staff who were attentive and kind. We observed that staff were polite and respectful when they spoke with people. We looked at comments from a recent survey of relatives and saw that one family member had reported that there was 'A very considerate, kind approach to the residents'.

Staff knew people well and were able to describe people's preferences, interests and diverse needs. This meant that care and support was provided in accordance with people's wishes.

Is the service responsive?

We saw that staff responded promptly when people needed support or reassurance during our visit.

We looked at minutes of relatives meetings and a meeting for people living at the home. These showed that the service listened to and took action in response to comments and suggestions made by people who lived in the home and their relatives.

Is the service well-led?

At the time of our visit, a new manager had recently been appointed to run the home. Staff and relatives told us that the manager was approachable and they were able to raise any concerns they might have.

The service had an effective quality assurance system. We saw that the home had a complaints system that clearly documented the response given to complaints and outlined how the complaint was managed.

We visited on 14 May 2014 in response to concerning information. We received information that people may not be receiving the support they needed and medicines might not be administered in a safe way. We found that there were minor concerns relating to the administration of medicines and some records maintained at the home.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to record keeping and administering medicines.

During our inspection we spoke with 23 people who used the service, three relatives and friends, the provider and registered manager and eight members of staff. Some people who were living at the service were unable to talk to us directly about their experiences due to their complex needs, so we used other methods to help us understand their experiences.

People were satisfied with the care and support they received and told us they 'like living here'. One person said, 'It's lovely, we're all friends and have a laugh and a joke'. People told us they were able to make their own decisions and choices regarding their day to day care and support. Staff obtained people's consent by talking through with them their care and support at the point of delivery. Some people had involved family members in their decision making.

People told us they felt safe living at the service. People said that they felt staff had the necessary skills and experience needed to meet their needs. One person said, 'They (the staff) are very nice and caring'. Most people did not have any concerns and felt comfortable in raising any issues. One relative did have some concerns and we saw these were being addressed.

People we spoke with told us they liked living at the home. One person said 'It's beautifully organised' and another person said 'It's all right here'. Relatives we spoke with were happy with the care provided, their comments included 'I loved it right from the beginning', 'I can't praise them enough, they care and never ignore anybody' and 'They use common sense'. Relatives we spoke with were complimentary about staff and the service overall.

The home was clean, had a welcoming atmosphere and people told us they liked their rooms.

People's choices were respected and care records reflected their personal preferences about how they liked to be supported.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These included asking the people who lived there and their relatives for their views.