Hulton House Care Residence

Hulton House Care Residence is a dementia specialist care home providing personal and nursing care to 53 people at the time of the inspection. The service can support up to 74 people across four separate units, each unit has separate adapted facilities. Two of the units specialise in providing care to people living with complex dementia nursing needs.

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

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Staff were recruited safely and there were sufficient staff to meet people's needs, however some concerns were raised from people, staff, and relatives about staffing levels. The provider increased staffing levels in response to the feedback shared during our inspection. Improvements had been made to the quality and the safety of the service, although the provider's systems needed further oversight to ensure they remained effective. People told us they were safe; systems were in place to protect people from abuse and concerns had been appropriately reported.

People received their medicines safely and the provider was working to reduce the use of 'as and when required' medicines. Staff were suitably trained for their roles and understood risks to people's safety and well-being and worked to lessen these risks. The building was clean, tidy and people could visit family members without restriction.

The manager, provider and management team had been responsive in implementing positive change and worked with health and social care professionals to improve people’s quality of life. We received positive feedback about the manager, deputy manager and the culture of the service. People and their relatives had been included in the development of the service.

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 inadequate (published 01June 2023) and there were breaches of regulation. 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.

At our last inspection we recommended that when risk assessments identified a change was required to keep people safe, immediate steps were taken to implement that change. We recommended preadmission information ensured people's needs could be met upon admission and for each service user type supported, there is the associated service user band on their registration with us. The provider had made changes to address these concerns.

This service has been in Special Measures since 25 February 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We carried out an unannounced inspection of this service on 09 November 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements. 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 inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

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

Hulton House Care Residence is a nursing home providing nursing and residential care to up to 74 people. The home supports people with advanced dementia and other physical and mental health needs. At the time of our inspection there were 69 people living in the home. The home has two floors and four distinct units. The kitchen and laundry facilities are on the first floor which houses two units and offices are on the ground floor with the remaining two units.

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

Risks to people living in the home were not effectively assessed or mitigated. People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Medicines were not always safely managed or administered by staff with an appropriate competency assessment. There were enough staff, but they were not always suitably trained or deployed to best meet people’s needs. Staff were not routinely supported to ensure any reasonable adjustments were made in response to their health needs.

Suitable systems had not been developed to ensure effective oversight of the service. Records used to keep people safe required attention to assure the service delivered met their specific needs. Audits did not identify action which was required to improve delivery and safety.

Care and support were not always delivered in a person-centred way. The lack of activities to engage people had a detrimental effect on people’s wellbeing. Most people received care and treatment which met their needs and the home sought support from professionals to meet people’s physical health needs. People we could speak with spoke highly of the staff and felt supported.

Equipment and the building were checked to ensure their safety

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 21 May 2021). 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

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk to people living in the home. This focused inspection examined those risks, checked the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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 key question 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 Hulton House Care Residence on our website at www.cqc.org.uk.

Enforcement and recommendations

We have identified breaches in relation to safe management of risks including medicines and safeguarding people from abuse, staff competence and the recruitment of staff. We have also found breaches in relation to support being provided to meet people’s individual and specific needs and the overall governance and oversight of the service delivered to people at this inspection.

We took urgent action to ensure the provider took steps to keep the most vulnerable people at the home same. The provider did not appeal this action and has been adhering to the the requirements of the conditions added to their registration.

Follow up

We will meet 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 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 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.

Hulton House Care Residence is a dementia specialist care home providing personal and nursing care to 69 people at the time of the inspection. The service can support up to 74 people across four separate units, each unit has separate adapted facilities. Two of the units specialise in providing care to people living with complex dementia nursing needs.

We found the following examples of good practice.

The provider had established systems to prevent visitors from spreading and catching infections. They had followed guidance on supporting safe visiting including displaying notices at the entrance to the home advising people not to enter if experiencing symptoms of COVID-19. Visitors were screened for symptoms and their contact details were recorded to support the NHS Test and Trace service. The provider had established an area for facilitating safe visiting.

Social media platforms were used to facilitate contact between people and their relatives where physical visiting was not possible. Where appropriate, people were supported by staff to use this technology and this included the use of handheld devices.

The provider had established safe admission procedures for staff to follow. This included requiring new people to a negative COVID-19 test before moving into the home and to be self-isolated in their bedrooms for 14 days after moving in.

During our visit we observed staff using Personal Protective Equipment, (PPE) safely. The provider had ensured sufficient stocks of appropriate PPE were available to protect people.

People living in the home and the staff were tested regularly for COVID-19. The provider had also arranged and supported staff and people to receive the COVID-19 vaccines.

The home was clean and hygienic. Cleaning schedules were in place and frequently touched areas were cleaned regularly throughout the day to reduce the risk of infection.

The provider had detailed and up-to-date infection prevention and control policies and procedures. They sought and acted on advice to further improve infection prevention and control procedures. They were aware of appropriate agencies to contact in the event of an outbreak of COVID-19.

The home had spacious sitting areas and a conservatory. During the inspection we observed people relaxing together in lounges and where possible, staff ensured they were socially distanced.

The provider had adapted the layout of the building to support cohorting in the event of an outbreak.

Hulton House Care Residence is a dementia specialist care home providing personal and nursing care to 52 people at the time of the inspection. The service can support up to 74 people across four separate units, each unit has separate adapted facilities. Two of the units specialise in providing care to people living with complex dementia nursing needs.

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

At the last inspection, we found people were at risk of avoidable harm because they were not always supported by staff with the skills or experience to keep them safe. At this inspection, we checked to see whether improvements had been made and found that they had.

Since the last inspection, the service had a new management structure in place who had worked hard to implement an improved culture with an emphasis on providing high quality care and support. Staff told us they welcomed and valued the changes made by the new manager, were well supported and felt happy in their role. One member of staff told us, “The biggest difference is the change in positive culture, it’s now an open culture, whereas it was once closed.”

The service had recruited numerous new staff and had implemented a programme of training to help equip staff with the skills and knowledge they needed to care for people living with complex dementia needs.

Although there were still some gaps in training for staff, this had been identified by the service and training courses had been arranged.

There were still some issues around the safe management of medication, but this was mainly amongst agency staff who were unfamiliar with the service’s processes.

Any incidents which were deemed to be a safeguarding concern had been referred to the local authority and shared with us appropriately, meaning the service were committed to being open and honest when things had gone wrong.

Accidents and incidents were reported, and processes were in place to help identify trends and themes to help prevent recurrence.

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 did supported best practice.

We observed staff deliver care and support with kindness, respect and dignity.

We received positive feedback from people's relatives about the care and support provided to their family member.

People enjoyed living in a safe environment which was considerate to the requirement and needs of people living with dementia.

Staff used PPE appropriately and followed infection control practices which helped protect people from the risk of transmitting COVID-19.

Although significant improvements had been made since the last inspection, further time was required to ensure that new systems were fully embedded, and consistency of improved practice was evidenced.

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 inadequate (report published 12 October 2020) and there were multiple breaches of regulation. 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 although improvements had been made, the provider remained in breach of one regulation.

This service has been in Special Measures since 12 October 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive 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.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hulton House Care Residence is a dementia specialist care home providing personal and nursing care to 50 people at the time of the inspection. The service can support up to 74 people across four separate units, each unit has separate adapted facilities. Two of the units specialise in providing care to people living with complex dementia nursing needs.

We found the following examples of good practice.

The provider had established systems to prevent visitors from spreading and catching infections. They had followed guidance on supporting safe visiting including by displaying notices at the entrance to the home advising people not to enter if experiencing symptoms of COVID-19. Visitors were screened for symptoms and their contact details were recorded to support the NHS Test and Trace service. The provider had established an area for facilitating safe visiting. Technology such as video calling was used to facilitate contact between people and their relatives where physical visiting was not possible due to Covid-19 outbreaks.

Whilst there were no new admissions in the home, the provider had established procedures for staff to follow. Their procedures included requiring new people to a negative COVID-19 test before moving into the home and to be self-isolated in their bedrooms for 14 days after moving in.

During our visit we observed the staff using Personal Protective Equipment, (PPE) safely. The provider had ensured sufficient stocks of appropriate PPE were available to protect people.

People living in the home and the staff were tested regularly for COVID-19. The provider had also arranged for people and staff to receive the COVID-19 vaccines.

The home was clean and hygienic. Cleaning schedules were in place and frequently touched areas were cleaned regularly throughout the day to reduce the risk of infection.

The provider had detailed and up-to-date infection prevention and control policies and procedures. They sought and acted on advice to further improve infection prevention and control procedures. They were aware of appropriate agencies to contact in the event of an outbreak of COVID-19.

The home had spacious sitting areas and a conservatory. However, improvements were required to ensure seating arrangements in communal and resting areas for people and staff room could support social distancing. Following the inspection the manager assured us they had taken immediate action to resolve this.

The provider had adapted the layout of the building to support cohorting in the event of an outbreak. However we found some bedrooms did not have hand soap and paper towels for staff to use. We asked the provider to take immediate action. Following the inspection we received confirmation that the required work had been carried out and bedrooms were now equipped with hand hygiene facilities.

Hulton House Care Residence is a dementia specialist care home providing personal and nursing care to 66 people at the time of the inspection. The service can support up to 74 people across four separate units, each unit has separate adapted facilities. Two of the units specialise in providing care to people living with complex dementia nursing needs.

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

People were at risk of avoidable harm because they were not always supported by staff with the skills or experience to keep them safe. We found examples of people causing actual harm to themselves and others. This had not been adequately managed or escalated in line with safeguarding and duty of candour processes. There was a closed culture which meant staff did not always feel able to raise their concerns. During the inspection staff disclosed serious allegations of people being exposed to abuse and improper treatment which we ensured were reported to the local safeguarding authority and investigated. The provider acted on our concerns and worked with external health and social care professionals to ensure improvements were made and they provided a safe environment for staff to disclose their experiences and concerns.

The registered manager failed to consistently deploy staff with sufficient training and experience to administer people’s medicines in a safe way. We observed and untrained care staff confirmed, they were asked to administer people’s medicines by staff deployed to undertake this task, this meant people were exposed to the risk of serious harm. People were not always protected from this risk of transmitting Covid-19 and other infectious disease because we found a number of staff failed to comply with the use of personal protective clothing and the processes to manage infection control were not robust.

There was a significantly high number of unreported accidents and incidents. There was evidence of electronic records being voided on the system which meant processes to identify trends, themes and incident levels in the service were ineffective.

People’s needs and choices were not always assessed to ensure their care, treatment and support was delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes. There were significant shortfalls in the assessment of people’s mental health needs and management of behaviours that challenge. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support best practice. Some staff told us about their participation in unplanned control and restraint techniques and we also observed this during the inspection.

People were not always treated with kindness, respect and compassion. There was a systemic culture were some staff did not have the skills or compassion to effectively engage and support people living with dementia. We found examples of people’s wellbeing being significantly impacted on negatively because staff did not always support them in a caring way.

We received mixed feedback from people’s representatives, some told us they were very happy with the support people received others told us they were concerned about their relative’s safety and the competency of staff supporting them. People were not always supported to express their views and be actively involved in making decisions about their care, support and treatment. People’s independence was not always promoted.

The service was not well-led. There was a systemic closed culture which had not been identified by the organisation, this meant staff did not consistently feel able to raise their concerns. Some staff told us they felt bullied and told not to raise their concerns. The senior leaders within the organisation were not aware of the level of risk at the service and the registered manager had not internally escalated a number of incidents including safeguarding alerts.

Throughout the Covid-19 pandemic the senior management team had visited the service less frequently to reduce the increased risk of transmission however, this meant staff had less opportunities to share their concerns at a higher level. Staff told us the registered manager told them not to escalate their concerns outside of the home, or with senior leaders. During the inspection senior leaders took effective steps to encourage staff to feel confident to whistle-blow by means of anonymous surveys, staff surgeries, meetings and one to one supervision.

People’s concerns and complaints were listened to. We found people and their representatives were satisfied with the way senior management responded to their concerns.

People did not always receive personalised care that was responsive to their needs.

People had access to meaningful activities when they were scheduled. Some people told us they would like to engage more in life skills, routine life activities to maintain their independence and this was restricted to scheduled times rather than being part of their daily routine.

The environment was fit for purpose and there had been substantial consideration around the adaptation, design and decoration of the premises for people living with dementia. People on all units could access outdoor areas and had plenty of communal space to walk with purpose.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 22 August 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the care people received, infection control, staffing and a closed culture. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, medicines management, safeguarding, person-centred care, 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 for 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 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 ‘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 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.