Hall Steads has three units, Willowgarth, Ladywood and Ferrymoor. This inspection was carried out on the Ladywood and Ferrymoor units. Ladywood is a unit for older people with nursing and personal care needs and Ferrymoor is a unit for people with nursing and personal care needs, who have dementia. People with dementia are not always able to tell us about their experiences, so we used a formal way to observe people in this inspection to help us understand. We call this the 'Short Observational Framework for Inspection' (SOFI). It includes observing people's mood, how they interact with staff members and other people who use the service and their environment. We completed the SOFI observation on the Ferrymoor Unit over one hour between 10:25 and 11:35, using five people who used the service.The SOFI observation told us that overall the experiences of four of those people were of a neutral experience. This means that most of the time people were sat passively watching what was happening around them or had their eyes closed, appearing asleep. One of the people had their eyes closed and appeared asleep throughout the hour, other than for 5 minutes, when two incidents happened in the vicinity near them, where they awoke and passively watched what was happening around them. We did not see any facial expressions or body language that would indicate signs of unhappiness, distress or anxiety or fear, indicating a negative mood state.
Staff engaged with people in a positive way and instigated conversations with people. However, during the SOFI observation they were preoocupied with other duties away from the communal areas or busy providing 1:1 assistance to other people who were not included in the SOFI observation.
The other person they had a more positive experience, because they were independently mobile and went to a dining table to initiate conversation with another person using the service. A staff member did join in that conversation for 5 minutes. The person engaged with the staff member and other people around them, chatting and waving to other people as they came into the room. During that time they also had visitors and engaged with them in conversation.
We noted that 5 minutes after we had completed our more formal observations, one of the other four people was offered a basket of crayons and paper to do some colouring by a member of staff. They smiled and began to colour. This was 1 ' hours after being observed to sit alone at the dining table, passively fiddling with their cardigan.
We saw that when staff did engage with people to provide caring tasks they had good interactions with people. For example, they made eye contact with the person and on occasions provided physical contact, such as a hug or touching people's arms, which caused people to smile, showing a positive reaction to the contact. We saw one person being assisted with eating their breakfast. This interaction was well paced for the person.
Staff did treat people with respect along with a well meaning and kind approach. We saw staff, in the main, explaining what they were going to do when they needed to provide care for people. They offered people choices, for example, whether they would like a drink or not and if they would like to move from the dining table to the lounge.
Whilst we were conducting the SOFI there was one incident between people using the service and someone fell. The staff member available to assist people, dealt with those people with dignity and respect. They spoke calmly and kindly to everyone.
We saw that on Ferrymoor the menu detail did not assist people with dementia to be orientated to time and what was happening around them. For example, the menu displayed for the day stated it was Monday. It was Friday. This may be confusing for people, as not only was the wrong day displayed, but the meals people were being served were different to the ones advertised. The nurse in charge of the unit was informed and this was corrected before we left the unit. We asked the quality consultant and manager to monitor this and make sure that improvements were made.
On the Ladywood unit our observations told us there were good interactions between staff and people using the service, when they were providing care to people. However, staff were very busy providing care for people, which meant they spent no meaningful time with people using the service. People using the service were left for long periods of time with no contact from staff.
We spoke with people on the Ladywood unit about their experience at the care home. One person was sad, because they had been to church all their life and there used to be a church service on a different unit, which they went to, but no-one has asked them to go now they'd moved units. They also said they liked to spend time in their room, but would still like to go to meetings about how the unit is run, but they haven't been asked to join in on this unit. We spoke with the quality consultant and manager about these concerns, so they could address them.
People told us staff were respectful and kind.
We saw that people on both units were well dressed and clean, which showed respect by staff for people using the service. For people being cared for in bed, their bedding and rooms were also clean and comfortable. We saw that appropriate pressure relieving equipment was in place, where it had been assessed as being needed.
We spoke with people on Ladywood unit about the care they received. One person was aware of their care plan, because they described they had discussed that they didn't want resuscitating. Another said, 'They look after you good. Meals are lovely.'
We saw care staff move people using the service when they needed assistance using wheelchairs and hoists in a safe way.