Haldane House Nursing Home

Haldane House Nursing Home is a care home with nursing registered to provide personal and nursing care for up to 25 people. At the time of inspection there were 17 people living in the home.

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

The provider did not operate effective quality assurance systems to oversee the service. These systems did not ensure compliance with the fundamental standards and identifying when the fundamental standards were not met.

The provider did not ensure that clear and consistent records were kept for people who use the service and the service management. The management of medicines and premises was not safe. Effective recruitment processes were not in place to ensure, as far as possible, people were protected from staff being employed who were not suitable. Risks to people's health and wellbeing were not consistently assessed and staff did not always follow guidance to support people in the right way. Staff deployment was not always managed effectively as we observed people did not always receive timely or effective support. People were at risk of social isolation because the provider did not organise and upskill staff to provide further support with stimulation.

The provider did not inform us about notifiable incidents in a timely manner. When incidents or accidents happened, it was not always clear the provider had fully investigated them, or that any lessons were learnt, and themes or trends identified. Care plans and related documents had information about people, but these did not always contain information specific to people's needs and how to manage any conditions they had. We were not assured people’s hydration and nutrition needs were monitored and met in a consistent way. The provider had not ensured staff were provided with appropriate training, knowledge and skills so they could do their jobs safely and effectively. People's and relatives' feedback were not consistently sought and used to make improvements to the service. We observed a mixture of interactions between people and staff which did not always show effective practice.

People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service were in place but did not support this practice.

There had been management changes since the last inspection, which affected the service management and the culture at the service. The new home manager was in the process of getting to know the service to ensure they could review, assess and monitor the quality of care in a consistent way.

Families felt they were involved in planning people's care and were informed of any changes in health or wellbeing. Relatives were mostly positive about the staff and the service. People were safe living at the service and relatives felt their family members were kept safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. The management team was working with the local authority to investigate safeguarding cases and provided support to address any issues. People were able to access healthcare professionals such as their GP. The service worked with other health and social care professionals to provide care for people.

The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean. There was an emergency plan in place to respond to unexpected events and equipment was kept clean. Relatives said they could approach the manager and staff with any concerns. The management team appreciated staff contributions and efforts to ensure people received the care and support.

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 on 22 June 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 and the rating has changed to inadequate

Why we inspected

The inspection has been carried out based on the previous rating of requires improvement.

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 comprehensive inspection of this service on 20 May 2021. 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 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. During this inspection we have inspected the key question of Effective as we identified concerns to be reported in this key question. 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. 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 Haldane House Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to quality assurance; risk management; notification of incidents; record keeping; effective and person-centred care planning; management of medicines and premises; staff training, competence and deployment, and recruitment. Please see the action we have told the provider to take at the end of this report.

We took civil enforcement to ensure people's safety and ensure improvement occurred at the service. We served a warning notice to the provider following the inspection for the breach of regulation 12 (Safe care and treatment), managment of medicine. A warning notice gives a date the service must be compliant by and we inspect again to check that compliance against the content is achieved within the timescale.

Please see all the actions 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 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.

Haldane House Nursing Home is a care home with nursing registered to provide personal and nursing care for up to 25 people. At the time of inspection there were 13 people living in the home.

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

Staff were not always provided with required information and guidance on the safe use and administration of prescribed medicines. This potentially placed people at risk of harm from excessive administration and side effects. Quality assurance processes had not identified the shortfalls we found during our inspection in relation to the safe management of medicines. The registered manager responded immediately and produced evidence to demonstrate these issues had been addressed shortly after the site visit.

People experienced safe care and were protected from avoidable harm by trusted staff, who had completed safeguarding training and knew how to recognise and report abuse. Staff identified and assessed risks to people effectively and managed their care safely. Enough staff with the right mix of skills to deliver care and support were deployed to meet people’s needs. Staff completed a robust selection process, including their conduct in previous care roles, to assure their suitability to support people. Staff maintained high standards of cleanliness and hygiene in the home, which reduced the risk of infection.

Staff assessed all aspects of people’s physical, emotional and social needs and ensured these were met to achieve good outcomes for them. Staff were supported to develop and maintain the required skills and knowledge to effectively support people. Staff emphasised the importance of eating and drinking well and reflected best practice in how they supported people to maintain a healthy balanced diet. Staff worked together with healthcare professionals to ensure care and treatment met people’s changing needs and achieved good outcomes. Since our last inspection the provider had made the environment safer and more suitable for people living with dementia. Improved lighting and signage had enabled people with visual impairments to orientate themselves and promote their independence.

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 experienced caring relationships where staff treated them with kindness and compassion in their day-to-day care. People were supported to make decisions about their care and these choices were respected by staff. Staff consistently treated people in a respectful manner and intervened discretely to maintain their personal dignity. Staff knew how to comfort and reassure different people when they were worried or confused.

People had experienced person-centred care, which consistently achieved good outcomes and had significantly improved the quality of their lives. People received information in a way they could understand, allowing for any impairment, such as loss of eyesight or hearing. People were enabled to live as full a life as possible and were supported to take part in activities of their choice, which enriched the quality of their lives. People were supported to keep in touch with family and friends, which had a positive impact on their well-being. People knew how to make complaints and were confident the management team would listen and address their concerns. The service worked closely with healthcare professionals and provided good end of life care, which respected people’s wishes and ensured they experienced a comfortable, dignified and pain-free death.

The management team led by example and promoted a strong caring, person-centred culture where people and staff felt valued. Staff were passionate about their role and placed people at the heart of the service, demonstrating the caring values of the provider. The registered manager understood their responsibilities to inform people when things went wrong and the importance of conducting thorough investigations to identify lessons learnt to prevent reoccurrences. During the pandemic, staff had increased their contact with families to keep them up to date with events and activities going on in the home, which they found reassuring.

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 27 November 2019) and there were multiple breaches of regulation. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 30 September 2021 and found six breaches of the regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report covers our findings in relation to the key questions Safe, Effective, Caring, Responsive and Well-led which contain those requirements. The overall rating for the service has remained the same. 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 Haldane House Nursing Home on our website at www.cqc.org.uk.

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.

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 the safe management and auditing of medicines. Please see the action we have told the provider to take at the end of this report.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

Staff followed guidance to ensure visitors were prevented from catching and spreading infection. The registered manager openly shared information with friends and family about any infections, so they could understand decisions regarding visiting and any restrictions.

The provider was committed to ensuring the mental wellbeing of people during the pandemic, by enabling them to remain in contact with those who were important to them. For example, an internal perspex pod was being installed in a visiting room, only accessible through an external door, to reduce the risk of infection, whilst facilitating visits.

The provider had worked effectively in partnership with the local authority clinical commissioning group (CCG). The registered manager had acted upon the recommendations and guidance of the CCG infection prevention and control team, to improve standards of staff practice to keep people safe.

The number of suitable staff deployed was currently maintained at a level significantly above that shown to be required by the provider’s staffing needs analysis. This enabled staff to spend more time reassuring people and engaging in meaningful interaction.

Haldane House is a care home with nursing. It provides accommodation and nursing care for up to 25 people. Some of the people using the service are living with dementia.

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

The registered person did not ensure systems were in place to oversee the service and ensure compliance with the fundamental standards. The registered person did not always ensure they maintained clear and consistent records when people had injuries to evidence the Duty of Candour was applied.

The management of medicines was not always safe. Risks to people’s health and wellbeing were not consistently assessed and staff did not always follow guidance to support people in the right way. Staff’s deployment was not always managed effectively as we observed at times people, who required support, were left alone with no staff presence. People's safety was compromised in the service as some parts of the premises were not well maintained.

The registered person had not ensured staff were provided with appropriate training as was necessary for them to do their job safely and effectively. Staff said they felt supported to do their job and could ask the manager for help when needed. People were not always 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 were in place but did not support this practice.

People and relatives made some positive comments about the staff and the care they provided. However, we observed a mixture of interactions between people and staff which did not always show kind, caring and friendly practice. We also observed occasions where staff did not uphold people’s privacy or respond in a way that maintained people’s dignity. People and their families felt they were not always involved in the planning of their care. People’s and relatives’ feedback was not always sought to make improvements to the service.

The registered person did not ensure activities were more personalised and people had opportunities for social engagement according to their interests to avoid isolation. We have made a recommendation about seeking guidance from a reputable source to ensure the principles of the Accessible Information Standard were met.

There had been management changes since the last inspection, which affected the service management. The new manager had reviewed paperwork, systems and processes to ensure they could review, assess and monitor the quality of care in a consistent way. There was progress in making various improvements but not sufficient at the time of the inspection for us to judge this would be sustained.

People felt safe living at the service. Relatives felt their family members were kept safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse. They felt confident issues would be addressed appropriately. Recruitment processes were in place to ensure as far as possible, that people were protected from staff being employed who were not suitable. The equipment was clean and well maintained. The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean. There were contingency plans in place to respond to emergencies.

People were able to access healthcare professionals such as their GP. The service worked with other health and social care professionals to provide effective care for people. People had sufficient to eat and drink to meet their nutrition and hydration needs. Hot and cold drinks and snacks were available between meals.

Staff felt the management was open with them and communicated what was happening at the service and with the people living there. People and relatives felt the management of the service had improved and that they could approach manager and staff with any concerns.

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 (published 15 March 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to 9, 10, 12, 18, and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 at this inspection.

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.

Warning notices were issued with respect to the breaches of Regulations 12 (Safe care and treatment) and 15 (Premises and equipment). Requirement notices were issued for Regulations 9 (Person centred care), 10 (Dignity and respect), 17 (Good governance) and 18 (Staffing).

The registered manager and provider sent us action plans in August 2016 outlining the improvements they were going to make in order to meet the requirements of the regulations.

We carried out a focused inspection on 11 October 2016 to ensure the requirements of the warning notice for Regulation 12 (Safe care and treatment) had been met. We found the registered manager and provider had taken action to address all of the areas identified within the warning notice.

The inspection of 13 February 2017 was a comprehensive inspection to follow up and ensure the requirements of the warning notice for Regulation 15 (Premises and equipment) and the previously identified breaches of regulations had been met and to make a judgement about the overall compliance of the service.

We found the service had made sufficient improvements that it was now compliant with the regulations. Improvements seen at the focussed inspection in October 2016 had been sustained.

Haldane House is a care home with nursing. It provides accommodation and nursing care for up to 25 people. Some of the people using the service are living with dementia. The home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. At the time of the inspection there was a registered manager at the service and they assisted throughout the inspection.

Risks to people’s safety were assessed and management plans now provided more detailed guidance on how to minimise risks to people’s safety. Plans were in place to manage foreseeable emergencies and individual personal evacuation plans had been reviewed and were in place for all people using the service.

People were protected by staff who understood their responsibilities to safeguard people and knew how to report concerns. Staff were recruited safely and there were sufficient staff to provide safe and effective care. Medicines were managed safely.

The service was clean and tidy. People had benefitted from a refurbishment programme including redecoration, replacement furniture and fittings. Carpets had been repaired and cleaned where necessary and further improvements to flooring in the service were being discussed to ensure the most appropriate choice was made.

Staff supported people’s day to day health, nutrition and care needs effectively. People had access to healthcare professionals when required. People were provided with nutritious food tailored to their choice and tastes. When necessary people’s food and fluid intake was carefully monitored.

Staff were supported through training, one to one supervision and appraisal of their work. Regular team meetings and group supervision sessions enhanced the level of support provided to the care team.

Staff sought people’s consent before offering care and understood people’s rights in relation to making decisions. Appropriate authorisations were in place when people’s liberty was restricted. 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.

People’s privacy and dignity were protected. Staff had undergone training in dignity in care and taken part in the dignity challenge to increase their awareness. Areas of the service were available to provide more privacy for visitors to spend time with the people using the service.

Care was person centred. Care plans were now more focussed on the individual and their preferences. People were treated with kindness and compassion. Interactions with staff were positive and people and their relatives spoke highly of the staff team and praised their hard work.

There was an open culture which promoted trust and transparency. The registered manager encouraged staff to seek advice and support whenever they needed it. The staff felt part of a team that worked well together. Audits were carried out which identified issues and these were now addressed at the earliest opportunity.

This focused inspection was carried out to assess whether the provider had taken the necessary actions to meet the warning notice we issued in relation to Regulation 12 (HSCA) which relates to safe care and treatment. We will carry out a further inspection to assess the actions taken in relation to the second warning notice and the four requirement notices and to provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notice we issued with regard to Regulation 12 (HSCA) and we have not changed the ratings since the inspection in June 2016. The overall rating for this service is 'Requires Improvement'. You can read the report from our last comprehensive inspection by selecting 'all reports' links for Haldane House on our website at www.cqc.org.uk.

Haldane House is a care home with nursing. It provides accommodation and nursing care for up to 25 people. Some of the people using the service are living with dementia. At the time of our visit there were 24 people living there.

The home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run. At the time of the inspection there was a registered manager at the service and they assisted with the inspection.

At this inspection we found the provider had taken action to address the issues highlighted in the warning notice. The provider and registered manager had submitted a comprehensive action plan to address the breaches of regulations.

During our last inspection we found that risks assessments had not always been completed. People’s care and support plans did not always contain safe systems of work or detailed information for staff to follow in order to minimise risks. At this inspection risks assessments had been reviewed and updated to contain guidance for staff on how to minimise the risk of harm to people.

At our last inspection we found not all staff had received up to date training in moving and handling people. We could not be sure if training included practical as well as theoretical training. At this inspection the training certificates clearly indicated the practical elements of the training provided as well as the theory. All staff had received appropriate training and the provider had installed a new computerised system to record all training and alert managers when refresher training was required.

Staff were confident in their approach to assisting people to move or transfer and used appropriate techniques to promote people’s safety. The registered manager and senior staff worked alongside staff to promote best practice and provide guidance for care staff.

Haldane House is a care home with nursing. It provides accommodation and nursing care for up to 25 people. Some of the people using the service are living with dementia. The home is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At the time of the inspection there was a registered manager at the service. They assisted with the first day of the inspection before going on leave. The deputy manager and general manager assisted with the second and third days of the inspection.

Risks to people’s safety were not always assessed and when they were, the assessments were not always accurate or acted upon. Measures were not always taken to reduce or manage the identified risks to people’s safety and well-being.

Although the service was generally clean and tidy we found scale on sinks and taps as well as damage to furniture, exposing areas which may harbour bacteria.

The provider did not have a comprehensive contingency plan in place to ensure the safe continuation of the service in the event of a foreseeable emergency. Health and safety audits were completed but did not always identify risks to people.

Staff did not always understand their responsibilities to safeguard people. Accidents and incidents were not always reported or investigated.

Staff were recruited safely but there was no system in place to determine how many staff were required to meet people’s need effectively.

Medicines were managed safely and people received them when they needed them. People had access to effective healthcare from a GP and other healthcare professionals when required.

People were provided with nutritious food tailored to their choice and tastes. When necessary people’s food and fluid intake was carefully monitored.

Although staff told us they felt supported we found they did not always receive the training and supervision that they needed to meet people's needs effectively.

Staff sought people’s consent before offering care. However, not all staff understood their responsibilities with regard to the Mental Capacity Act 2005 (MCA). Therefore we could not be assured people’s rights to make decisions were always protected.

People’s privacy and dignity was not always respected. There was lack of opportunity for people to spend time alone or with their visitors. Care was not always focussed on individual people but more on completion of tasks and routines.

People were treated with kindness by friendly and attentive staff. People and their relatives spoke highly of the staff team and praised their hard work.

The provider did not have an effective governance system to monitor the quality of the service. Effective audits were not carried out and the provider had not identified the issues we found at this inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report. CQC is also considering other appropriate regulatory response to resolve some of the concerns we found and will report on any

action taken when it is completed.

As part of this inspection we spoke with two people who use the service, two visitors, the registered manager, the deputy manager, two care staff, the chef and the General Practitioner who regularly visited the home. We also reviewed records relating to the management of the home which included, four care plans, daily care records, risk assessments, audits, policies and procedures. We also spoke to the local authority Commissioners.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were cared for in an environment that was safe. People's records showed they had access to routine and specialist health services. People regularly saw doctors and when appropriate, other specialist health professionals. Directions from professionals were recorded accurately in the care plan and staff we spoke with knew how to access and follow them.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager with regard to the Supreme Court ruling which widened and clarified the definition of deprivation of liberty. They were aware of the ruling and had been in contact with the local authority deprivation of liberty safeguards (DoLSs) team. They were waiting for further guidance from this team before making any further applications. We saw one application had been made and Deprivation of Liberty Safeguards were being used appropriately.

Is the service effective?

People all had an individual care plan which set out their care needs. People had access to a range of health care professionals including speech and language therapists, tissue viability nurses and dieticians.

We observed staff supporting people in a friendly, kindly and patient manner. We saw choice being offered and explanations given. People said staff helped and explained things to them. One person said: 'staff are very friendly and helpful.'

People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed the tea time activity and spoke with people afterwards. They told us they thought the food was, 'very good.' Relatives of people living at the home told us: 'the food is good, balanced and plentiful.'

During our visit we saw staff supporting people with activities and we observed people smiling. We observed people who had become distressed being supported appropriately and responded to in a positive manner.

Is the service caring?

People said they were supported by kind and attentive staff. One person said: 'staff care.' Our observations confirmed this and we saw people being spoken to politely and with respect. Staff were patient and encouraging when supporting people in everyday tasks and activities. One relative said they were very happy with the care their relative received, calling it: 'amazing' and another said it was: 'excellent.'

Is the service responsive?

People and staff we spoke with told us they enjoyed the social gatherings organised by the home. We saw an event was organised for the weekend after our visit. We observed staff speaking to people about this event and people were smiling in response. Relatives we spoke with confirmed these events were a highlight for everyone connected to the home.

People's needs had been assessed before they moved into the home and were reviewed with them and their relatives as appropriate. Records confirmed their preferences, interests, aspirations and needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and they had been supported to maintain relationships with their friends and relatives.

We spoke with two people and two relatives of a people who use the service. They told us they could talk to staff if they were unhappy about something. They all felt confident they would be listened to. One told us: 'I've only had to raise minor things and they are put right straight away.'

Is the service well-led?

Quality assurance processes were in place. Staff told us they felt they could approach the manager for advice. They knew and understood their responsibilities and the importance of their role. Regular staff meetings were held to ensure staff were up to date. Staff we spoke with confirmed they were able to discuss matters with the manager who held an 'open door' policy. People and their relatives said they were consulted about their views and they completed satisfaction questionnaires.