This inspection was carried out over three days on the 3 and 4 December 2015, and 9 February 2016. Our visits on the 3 December and 9 February were unannounced.
Our inspection was brought forward following concerns raised by the local authority about the general safety of people who used the service.
We last inspected the service on the 5, 8 September 2014, we found the service was meeting all the regulations that we reviewed.
Hadfield House is a large converted Victorian house, overlooking Alexandra Park and within 1 mile of Oldham Town Centre. There are two storeys with bedrooms on both ground and first floors. There are also some attic rooms which are generally used for storage, and accessed through a separate stairway which is generally kept locked. Set back from the road, the home has gardens to the front, and a secure paved ‘sensory garden’ at the side containing raised beds, garden furniture and lighting was directly accessible from the main lounge. Staff said that in fine weather the door leading out into the garden was left open so that people could walk freely between the two areas.
The service is registered to provide personal care and accommodation for up to 28 adults and older people with Dementia and Mental Health conditions.
The home had a manager who has been registered with the Care Quality Commission (CQC) who was present on all days 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. The manager has been registered since October 2010
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to the safety of the premises and information held about people. You can see what action we told the provider to take at the back of the full version of this report.
We also made a recommendation relating to staff references. See the comments in the main body of the report.
The home did not have processes to ensure that systems could maintain accurate, complete and contemporaneous records for the people who used the service and therefore were unable to assess, monitor and mitigate the risks associated with the health, safety and welfare of these people.
When we looked around the building we saw that grab rails were used to store objects which would cause an unnecessary hazard to anyone who required the use of handrails. There was also an electric wire hanging from a grab rail to the floor which caused a trip hazard.
We saw that disposable razors had been left in a communal bathroom increasing the risk to the health and safety of people who used the service.
Staff recruitment files did not always contain sufficient details to ensure the suitability of staff to work with vulnerable people.
People who used the service told us they felt safe, and that they thought there were enough staff available to support them. A member of staff told us “We treat people as individuals; we get to know them and what they like, being sensitive to their feelings. We make sure they have their glasses and hearing aids, and get to know them as individuals.”
The home had good procedures in place for staff to identify and raise any safeguarding concerns, and staff showed a good understanding of how abuse could occur.
The building and equipment were safe and secure. We saw that the home was clean and that cleaning rotas were in place and being followed to ensure that all areas were kept clean and hygienic, including kitchen and laundry areas.
We looked at Procedures to manage people’s medicines safely and to control the risk of infection.
We saw that systems were in place to ensure that all medicines were stored correctly and dispensed by staff trained to ensure that medicines were dispensed and recorded in line with policies and procedures.
The staff we spoke with had a good understanding of people’s individual needs and the support they required, and we found that care was delivered consistently by a team of workers who knew how to support people and meet their assessed care needs. We saw that care was delivered to people using the service in accordance with their needs and wishes, and we found that there was enough information in people’s care records to guide staff on the care and support needs required. All care records had been reviewed and included detailed risk assessments for risks such as falls, moving and handling, pressure relief and nutrition, with clear plans in place to show how to minimise the risk.
The people we spoke with believed that the carers were competent and knowledgeable.
People told us that they liked the meals and we saw that the food looked appetising and hot and was in sufficient quantities.
Staff were attentive to people’s health care needs and where needs were identified they sought appropriate medical attention.
One visitor described how the staff knew how to care for their relative and commented “there’s nothing they wouldn’t do for him here, it’s the next best thing to home’’ Visiting professionals we spoke to were impressed with the quality of care. They informed us that Hadfield House will accept people who are difficult to place and help them to settle, improving their quality of life.
People who used the service told us that staff responded to their needs and provided them with support when they required it.
We saw that there was little staff turnover. Care was delivered by a stable and consistent staff team who spent time with the people who used the service, and knew them well.
We saw that there were a wide variety of activities on offer to people who used the service.
The service’s complaints policy and procedure were prominently displayed in the main hallway of the home.
There were policies and procedures in place to support the daily running of the home and help to make sure that staff were clear about their duties when they were involved with all aspects of people’s healthcare and wellbeing.