Hydon Hill - Care Home with Nursing Physical Disabilities

Hydon Hill is registered to provide accommodation and personal care for up to 46 people who may have a nursing need, a disability, learning disability or an acquired brain injury. There were 38 people living at the service at the time of our inspection

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

Systems to monitor people receiving their medicines in line with their prescriptions were not always effective. This meant the provider was unable to assure themselves that medicines were being administered correctly. People and relatives told us there was a core team of staff who knew them well. However, due to difficulties in recruitment there was a large number of agency staff used which on occasions impacted on how people received their care.

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.

Based on our review of key questions Safe and Well-Led the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The model and size of the service was not in line with current best practice guidance for people with learning disabilities. Hydon Hill is a large service in a rural area with limited access to community resources. The provider had implemented additional training and support planning systems for some people, but this had not acknowledged this should be applied to all people with a learning disability living at the service.

Risks to people’s safety had been assessed and where people had complex needs which put them at a high risk support was provided by regular staff. Staff had worked alongside healthcare professionals and implemented guidance on how to support people safely. Staff had received training in safeguarding people from abuse and people were given the opportunity to raise any concerns.

People told us that staff were kind and caring and that the management team were available to them. People and staff had the opportunity to feedback their views of the service through regular resident and staff meetings.

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 (6 October 2020). We carried out an unannounced comprehensive inspection of this service on 14 October 2019. Breaches of legal requirements were found. The provider completed an action plan to show what they would do and by when to improve. We carried out a focussed inspection of the key questions Safe and Well-led in August 2020 and found the breaches in these areas had been met. At this inspection we found additional concerns and the provider is in breach of regulations.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Hydon Hill - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk

Why we inspected

The inspection was prompted in part due to concerns received about risks to people’s care in relation to support with eating. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found the provider had implemented systems and worked with healthcare professionals to implement guidance and minimise further risks.

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 of medicines, staffing and good 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 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.

Hydon Hill is a care home with nursing for up to 46 adults with physical disabilities. There were 33 people living at the home at the time of our inspection. The home is set within a campus-style setting in a semi-rural location. The building is single-storey and many rooms have direct access to the garden.

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

People felt safe at the home and when staff provided their care. They received their care from regular staff with whom they had established positive relationships.

People told us staff were available when they needed them. People said staff had worked hard to keep them safe during the coronavirus pandemic.

Additional infection control measures had been implemented to protect people and staff during the pandemic. These measures included the use of appropriate personal protective equipment (PPE), more frequent cleaning of the home and ensuring staff were up-to-date with guidance about infection control.

The documentation and recording of people’s care had improved since our last inspection, which helped ensure people received safe and effective care. For example, people were protected from the risk of developing pressure damage because their repositioning charts were kept up-to-date confirming they have been repositioned as required. Support plans were structured, detailed and personalised. Information about people’s needs was comprehensive and up-to-date.

Quality monitoring tools had been introduced since our last inspection which had improved the management oversight of the service. Accident and incident records were reviewed and action taken to reduce the risk of a similar event happening again.

People told us they had opportunities to give feedback about the home and the support they received. They said staff listened to and acted upon what they had to say. People told us they could speak with the registered manager or a senior member of staff if they wished.

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.

Managers and staff had worked closely together during the pandemic to keep people safe. Staff told us this had strengthened the sense of teamwork within the home’s staff team. Communication of important information amongst the staff team had improved. Staff were given daily updates about people’s needs and any changes to their care.

Why we inspected

We carried out an unannounced inspection of this service on 14 October 2019. Breaches of legal requirements were found. The service was rated ‘Inadequate’ overall and placed in special measures. We served Warning Notices in relation to Safe care and treatment and Good governance. 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 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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Hydon Hill - Care Home with Nursing Physical Disabilities on our website at www.cqc.org.uk

Follow up

We will continue to monitor the service action plan to understand what the provider will do to improve 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.

Hydon Hill is registered to provide accommodation and personal care for up to 46 people who may have a nursing need, a disability or may have an acquired brain injury. There were 40 people living at the service at the time of our inspection.

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

There were not enough staff deployed at the service which left people at risk. Risks associated with people’s care were not always being managed in a safe way. Incidents of safeguarding were not always being investigated appropriately. Although staff received training and supervision, this was not effective in ensuring good practice within the service.

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. People did not always have access to meaningful activities and people in their rooms were at risk of social isolation. Pre-assessments of care and care plans did not always have accurate information about people’s care and staff did not always understand people’s needs.

People did not always have choices around their care delivery and at times were not treated with dignity and respect. Quality assurance was not always effective. Where shortfalls in care had been identified with staff this had not been addressed robustly. The leadership needed to be more effective in ensuring staff were delivering appropriate care. The provider had failed to maintain robust oversight of the service. As a result, the level of care had deteriorated from the last inspection.

People and relatives told us that staff were kind and caring and we did see some examples of this. There were some people who were supported and encouraged to remain as independent as possible and were able to access the community. Relatives and visitors were welcomed as often as they wanted. People and relatives knew how to complain and were confident that complaints would be listened to and addressed.

People had access to health care professionals to support them with their care. The lay out of the service helped to support people that had difficulties with their mobility.

Previous Inspection

The last rating for this service was Good (report published 14 September 2017).

Why we inspected

The inspection took place earlier than planned as we had received concerns about the quality of care being provided. We have found evidence that the provider needs to make improvement. 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.

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.

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

There was a registered manager in post on the day of the inspection. 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.

There was sufficient numbers of staff deployed at the service to meet people's needs and people received care when they needed. People and staff felt there were enough staff. People told us they felt safe at the service and staff had a good understanding about the signs of abuse. Staff were aware of what to do if they suspected abuse was taking place. There were systems and processes in place to protect people from potential risks and people felt their risks were well managed.

Recruitment practices were robust and relevant checks had been completed before staff started work. Nurse’s professional registration was kept up to date. Medicines were managed, stored and disposed of safely. Any changes to people's medicines were prescribed by the person's GP and administered appropriately.

Fire safety arrangements and risk assessments for the environment were in place to help keep people safe. Staff understood what they needed to do in an emergency. The service had a business contingency plan that identified how the service would function in the event of an emergency.

Staff had received appropriate supervision with their managers including clinical supervision. The staff team were knowledgeable about people's care needs. People told us they felt supported and staff knew what they were doing and that the training they received was effective.

Staff were up to date with current guidance to support people to make decisions. Where people had restrictions placed on them these were done in their best interests using appropriate safeguards. Staff had a clear understanding of Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) as well as their responsibilities in respect of this. MCA assessments took place decisions where appropriate were made in people’s best interests.

People had sufficient amount to eat and drink and there were arrangements in place to identify and support people who were nutritionally at risk. People told us that they enjoyed the food at the service. People were supported to have access to healthcare services and were involved in the regular monitoring of their health. The provider worked effectively with healthcare professionals and was pro-active in referring people for assessment or treatment.

Staff involved and treated people with compassion, kindness, dignity and respect. We saw staff treat people in a caring way. People's preferences, likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken. People told us that staff treated them well and that they were caring.

People's needs were assessed when they entered the service and on a continuous basis to reflect changes in their needs. Care plans were detailed and provided staff with guidance on how to provide the most appropriate care.

People were encouraged to voice their concerns or complaints about the service. Concerns were used as an opportunity to learn and improve the service.

People had access to activities that were important and relevant to them. There were a range of activities available within the service and outside.

The provider had systems in place to regularly assess and monitor the quality of the care provided.

The provider actively sought, encouraged and supported people's involvement in the improvement of the service.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the service. Staff told us they would report any concerns to their manager. Staff felt that management were very supportive and staff felt valued.

The registered manager had informed the CQC of significant events. Records were accurate and kept securely.

There was a registered manager in post on the day of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During our last inspection on 9 and 10 November 2015 we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service was rated as 'Inadequate'. We carried out this inspection to establish whether the requirements were being met. On this inspection sufficient improvements had been made to meet the Regulations and therefore the service is no longer in ‘Special measures.’ Where key questions have been previously rated as inadequate we expect any improvements to have been sustained over a period of time. Due to the length of time since the last inspection, although improvements have been made we have been unable to show that the service will maintain these. This is why Safe and Well-led have been rated as requires improvement.

People said that they felt safe. One person said, “I use my emergency bell and I know staff will come.” There were enough staff deployed around the service to ensure that people’s needs were being met. Staff had knowledge of safeguarding adults procedures and what to do in the event of abuse occurring.

Risk assessment guidance for people was detailed and being followed by staff. Appropriate checks were undertaken on staff before they started work. In the event of an emergency, such as the building being flooded or a fire, there was a service contingency plan which detailed what staff needed to do to protect people and make them safe.

Medicines were stored appropriately and audits of all medicines took place. Medicines Administrations Records (MARs) charts for people were signed for appropriately and all medicine was administered, stored and disposed of safely by staff who were trained to do so.

People’s rights were met under the Mental Capacity Act 2005 (MCA). Assessments had been completed specific to the decision that needed to be made. DoLS applications had been submitted to the local authority and were supported by the appropriate mental capacity assessments.

People received care from staff who had received appropriate training and supervisions and appraisals for staff had been undertaken.

People said that they enjoyed the food at the service. People at risk of dehydration and malnutrition had their needs met and people were supported to remain healthy.

Staff treated with people with kindness and compassion. One person said, “The staff really care and they are patient with me”. People were treated with dignity and respect and staff were attentive to people and anticipated their needs. People were involved in the planning of their care and care was provided with around people’s preferences.

Care plans for people were detailed around their needs with clear guidance for staff that ensured the appropriate care was provided.

People had access to meaningful and person centred activities. There were times where people in their room were left without much social interaction however the manager started to address this on the day of the inspection.

There was a complaints procedure and complaints were recorded appropriately with information around how there were responded to.

There were effective systems in place to assess and monitor the quality of the service. Audits and surveys had been undertaken with people and had been used to improve the quality of care for people. Incidents and accidents were recorded and there was evidence of any learning from these.

People’s records were kept securely. Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The manager had informed the CQC of all significant events.

People and staff said that the management of the service had improved and said that they felt supported and listened to.

Staff had told us they guidance they had access to had improved and showed us a number of documents and guidance regarding infection control. Cleaning schedules were detailed and this enabled the reader to have a clear understanding of the tasks that needed to be carried out. A new system of audits had been implemented and were being embedded into practice.

People were supported to eat and drink suitably nutritious food and commented, in the main positively about food and the support of staff. Food was said to be "Very nice" and "Generally good." Staff were observed to carry out their supportive duties with compassion, respect and afforded people due dignity.

The environment was suitably clean; however there were deficiencies in the systems and processes for monitoring standards of cleanliness and therefore people were potentially exposed to risk of infections. Measures had been taken to upgrade the sluice area, removing the former risks to staff and improving this environment for them.

There were effective recruitment procedures in place so that people could be confident the right people were employed in the service.

One person told us that the staff were fantastic and very kind. This person also told us that the care and the food was very good.

Another person told us that they took part in a lot of activities; they liked the new bathrooms and toilets and felt that things in the home, especially the cleaning, had been improving.

We saw that people enjoyed healthy banter with staff and one person was talking with the volunteer in the homes shop. We saw that the service provided transport for eight people to go out for the day to have a Christmas lunch.

We saw that visitors were welcomed by staff and all the people we spoke with told us that staff worked really hard and were very loyal to the manager and their colleagues.

We found that some of the records kept by the service were not up to date and the sluice room was in a poor state of repair.