Halland House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Staff completed training that reflected the needs of people who lived at the home. There were regular environmental safety checks and the home was currently being refurbished and updated. Improvements were needed in relation to medicines to ensure they were managed safely. Staff were knowledgeable about abuse and knew how to raise concerns and alerts. Risks to people were managed in the least restrictive way possible. Staff knew people well and understood the risks associated with their support needs. However, care plans and records did not always contain the relevant or up to date information. Work was ongoing to improve this.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

One relative told us about an incident that had occurred. They said the management team had told them about actions they had taken to prevent it happening again.

The management team told us they had oversight of accidents and incidents. These were investigated and included discussions with staff and the wider management team. They told us this helped them to make changes and reduce the risk of reoccurrences. They also told us it helped identify if changes were needed to people’s support or care needs. Staff told us they were informed of incidents, what had happened, any observations that were required and changes to people’s support.

Following an accident or incident staff completed a form with details of what had happened and what immediate actions were taken. This was then reviewed by the registered manager and at a weekly health and safety meeting with the provider and management team. This helped ensure that any themes or trends were identified and action taken to prevent a reoccurrence. It also helped to identify any shortfalls with the care or support provided. For example, if staff were following the Positive Behaviour Support plan, or not identifying what may trigger people’s distress. Staff were updated about incidents and this information was shared at handover.

Relatives told us their loved one’s move to Halland House had been positive. One relative told us that their loved one’s move into Halland House was well managed. They told us, “It’s been a good move.” Another relative told us, their loved one had done “Incredibly well” since moving to Halland House. They said staff were, “Relationship building.”

The management team told us how they supported people when they moved into the home. As far as possible people were invited to spend time at the home to meet other people and staff and to check they would be happy to live there. The management team told us about one person who had been unable to visit the home prior to moving in. In this instance staff had regularly visited the person in their original environment. They spent time getting to know the person, understanding their preferences and routines. These staff continued to support the person when they moved into Halland House. We were told when the person arrived they were pleased and excited to see the staff known to them. Staff were aware of allowing people time to adjust when they moved into the home. One person appeared to be displaying signs of distress. Staff spoke to each other to confirm the person’s well-being. They explained to us that they were getting to know the person and although they may appear distressed they were not at this time. They said, “We are still getting to know [name] and this is quite usual for them.”

We did not receive any feedback specific to transitions. However, one professional told us “I have not heard of any concerns in relation to transitioning.”

There were processes in place to support people who moved into the home or when they transitioned between services, such as hospital admissions. Assessments of people’s needs took place before they moved into the home to ensure their support needs could be met. Assessments were recorded and these were used to inform and develop care and support plans. Social stories were developed. These provided details of what was going to happen in a pictorial format, using language that was appropriate for each individual. There were hospital passports which people could take with them for hospital admissions or medical appointments.

People and their relatives told us they felt safe living at Halland House. One relative said, “He’s safe, happy, out and about.” Another told us, “He is very safe, staff are mindful.” Relatives were aware when their loved ones had Deprivation of Liberty safeguards in place.

Staff told us what actions they would take if they identified anyone was at risk of harm from abuse or discrimination. They said they would reassure people involved, report their concerns to senior staff and complete a statement. Staff told us they were updated by the management team about actions that had been taken, and where appropriate, outcomes. Staff were aware of the process to contact external safeguarding agencies if they felt their concerns were not being responded to appropriately.

We saw people approaching staff freely throughout our visits. People were comfortable and relaxed in staff company. We observed people bringing concerns to staff attention or approaching them when they were distressed. Staff responded with patience and care. One person became upset and staff supported them reminding them of things that would help them. We saw people busy with staff and engaging with them and enjoying each other’s company.

There was a safeguarding policy. Staff received safeguarding training and this was discussed during supervision. There was a system in place for referring concerns to the local authority safeguarding team and CQC to ensure appropriate actions were taken to protect people from the risk of harm, abuse or discrimination. However, we identified two occasions when referrals had not been made. The management team explained why the referrals had not been made. We explained that all allegations of abuse must be referred. The management team understood this and referrals were made promptly. We discussed this as an area that needs to be reviewed and improved.

People’s relatives told us risks associated with their loved one’s support were well managed. One relative told us, “They are strict on risk” and then explained their loved one’s risks. Another relative told us about support that had been introduced to support their loved when they were distressed or angry.

The management team and most staff knew people well and were able to tell us about the risks associated with the people they supported. Some people were living with visual impairments. Staff told us how people relied on the handrails in communal corridors to find their way around the home. They told us redecoration of these areas would ensure handrails remained to keep people safe and independent. Staff told us how they supported people who were prone to having seizures, this included giving medicines appropriately. They told us how they supported people who, for example, may be sensitive to noise and crowds to ensure they remained safe and free from distress. Staff told us some people had positive behaviour support plans (PBS) and how these provided guidance for them to support people. However, some staff told us they were unclear of PBS guidance for some people.

We saw staff supporting people safely. They enabled people to take risks they had been assessed as safe to do. We saw people assisting with the preparation of ingredients for meals. Where people required specialist diets we saw they received these. Some people needed one to one support from staff and this was provided. Staff were observant of changes in people’s manner and intervened to redirect people, for example, if they appeared to become distressed. People were part of conversations about risks. A person and a member of staff talked about possible games for a party and things they needed to think about when deciding on a game.

Improvements were needed to care plans and risk assessments to ensure they included all the relevant information about risks associated with people’s care and support needs. This included lack of clear or full guidance for managing seizures, catheter care and pressure area management. Although there were clear positive behaviour support (PBS) plans there were occasions when staff had not followed these. The management team were taking action to address this.

One person told us they liked their room and kept it tidy. A relative spoke about the stair lift which would help make the home safer and more accessible for people.

The provider and management team told us they had identified improvements were needed to the home. They had identified changes were needed to maintain people’s safety as people were becoming older and had increased needs due to ageing and general frailty. They had recently installed a stair lift and changes were being made to an outside area to allow level access between buildings. There was ongoing redecoration throughout the home. Whilst staff told us they would like to see improvements to the general decoration of the home, making it more homely, they did not express any concerns about the safety of the home.

Systems were in place to ensure the environment was safe for people and met their needs. There was ongoing redecoration at the home. Changes had been made to the flooring to reduce the risk of trip hazards. There were handrails in the communal corridors, this provided people with support and guidance when they were walking. We saw some radiators and a hot pipe did not have covers to protect people from the risk of burning. The management team were aware of the radiators and told us this would be addressed as part of the ongoing refurbishment. A temporary cover was applied to the hot pipe to help reduce the risks.

There were regular servicing contracts which included, legionella, electrical safety and fire risk assessment. Regular checks took place to ensure a safe environment was maintained. There were regular fire, water temperature and window restrictor checks. Staff received fire safety training and fire drills were undertaken to ensure staff knew what actions to take in an emergency. Each person had a personal emergency evacuation plan to guide staff in case an evacuation was required at any time. The home was currently undergoing a full refurbishment and upgrade. People’s bedrooms had been updated and work was commencing on the communal areas. The management team were mindful of the impact on people and people were involved throughout the process.

Feedback from people and their relatives was generally positive about the staff. One relative said, “There are enough staff.” Another relative told us that staff knew their loved one well and provided them with safe care. However, on occasions staff were very busy and although they provided safe care they didn’t provide the support they would if they had the time.

Staff told us they received training. At the time of the inspection the provider had changed to a new training program which meant staff were completing a lot of training to ensure they were compliant with the new training provider. Whilst staff understood the need for this they found the process frustrating and time consuming. We discussed this with the provider who was aware of the concerns and told us how they would support staff to complete this. Staff told us the training they received helped them to support people safely. They told us, where appropriate, training was face to face. They said this was helpful as it related to people that lived at Halland House. This included positive behaviour support training, moving and handling and fire training. Staff told us there were enough of them working each shift to ensure people’s needs were met. They told us that when agency staff worked at the home they were regular staff who knew people. They told us that people who had been allocated 1:1 support received this.

Staff were present in communal areas to provide support and engage with people. Staff used their knowledge and understanding of people to support them safely. This included responding to signs of distress and supporting people to mobilise safely.

There were processes in place to ensure staff were recruited safely. This included references, employment history and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. We found this process had not been followed for one staff file we observed. This was addressed immediately and the relevant information obtained. An audit of staff files was then undertaken to identify and address any other shortfalls.

One person told us they helped to keep their room tidy. A relative said , “The home is clean.”

Staff told us about their housekeeping and laundry responsibilities. There were 2 regular housekeepers and they were supported by the staff team. They told us about their cleaning schedules and how they recorded what work had been completed. In addition to the daily cleaning, they told us about deep cleaning that took place regularly. They told us they made sure that any odours were dealt with promptly and they worked with the management team to ensure any underlying odour issues were managed. Staff told us about actions they would take in case of any outbreaks. This included enhanced cleaning and increased use of Personal Protective Equipment (PPE). The management team told us they had recognised that a new laundry room was needed and plans were in place to build this. However, the current systems in place helped protect people from the risk of cross infection through poor laundry practices. This including ensuring clean and soiled laundry remained separated.

The home was clean and tidy throughout. There was extensive redecoration taking place and this gave the home the appearance, in places, of being unkempt, for example where pictures had been removed from the walls before repainting took place. However, this did not impact on the cleanliness of the home.

There was an Infection Prevention and Control (IPC) policy and regular audits and checks were completed to identify any areas of risk that may impact people. PPE was available and this was seen to be used appropriately.

Relatives told us they felt their loved one’s medicines were managed safely. One relative told us how staff support their loved one to take their medicines, another relative spoke about the support received from the GP in relation to medicines.

Staff told us that only staff who had received medicine training and been assessed as competent gave people their medicines. They told us that medicines were assigned to a staff member each shift which meant they were aware of their responsibilities. Staff were knowledgeable about the medicines that people took and how people liked to take them.

Medicine policies and processes were in place. However, improvements were needed to some aspects as these processes were not always followed. The providers policy stated when staff amended medicine administration records (MAR) this needed to be checked by a second staff member, both who have been assessed as competent. These entries needed to be dated and signed by both staff members. We saw changes had been made which had not followed this process. Some handwritten entries were untidy and difficult to follow. A new MAR had not been commenced for each new month. Where people had been prescribed ‘as required’ (PRN) medicines, for example for pain or distress PRN protocols were not always in place to guide staff as to when these medicines needed to be given. Staff told us that PRN protocols had been in place however it had been identified that more information was required. Therefore, the protocols had been removed with a view to being updated but this had not yet been completed. Audits had been completed but they had not identified these issues. We discussed these concerns with the management team and they told us they would be addressed. The PRN protocols that had been removed from the MAR were reinstated. Although they did need to be reviewed they included basic information to guide staff. The lack of protocols had a limited impact on people due to other processes in place. Before staff gave any PRN medicine they were required to discuss this with a team leader to ensure it was safe and appropriate to do so. If PRN medicines were needed because someone was anxious or distressed the team leader was required to discuss with one of the management team to ensure other actions had been tried before the medicine was given. This helped to ensure PRN medicines were given safely and appropriately. There were systems in place to ensure medicines were ordered and stored appropriately.