Little Hayes is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates up to 34 people and at the time of our inspection 27 people were living at the home. The home was based on two floors connected by two passenger lifts. There was a good choice of communal spaces where people were able to socialise and all bedrooms had en-suite facilities.
This inspection took place on 18 and 19 January 2018 and was unannounced. It was prompted by concerns identified at another service operated by the directors of the provider’s company where systematic failings were found.
There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.
We found the governance arrangements were not effective in ensuring the provider met their legal obligations and the service made necessary improvements in a timely way. Recommendations made by professionals from the Clinical Commissioning Group (CCG) had not been implemented.
An action plan to make improvements to the premises did not include all of the work that was required. A structural defect identified a year ago had not been repaired. Audits completed by managers had not always led to improvements and there was no process in place to audit people’s care plans.
We found some individual and environmental risks to people were not managed effectively. Risk assessments relating to the use of bed rails and for a person at risk of choking had not been completed. We also found two fire doors were wedged open which would have posed a risk in the event of a fire. However, people were protected from the risk of falling and developing pressure injuries.
Infection control procedures in the laundry were not effective, although staff used personal protective equipment to reduce the risk of cross contamination when supporting people with personal care.
Appropriate recruitment procedures were in place, although these were not always followed.
Staff received training to help ensure they could meet the needs of the people they cared for. Some refresher training was overdue, but this had been scheduled. Staff said they felt supported in their work by the management.
Staff followed the principles of legislation designed to protect people’s rights. However, the views of family members involved in decision making were not always recorded and managers were not clear about the criteria for applications to deprive people of their liberty.
Staff demonstrated an in-depth knowledge of people and their needs. However, people’s care plans did not support staff in the delivery of personalised care as information in them was not always accurate or up to date.
People were supported at the end of their lives to have a comfortable, dignified and pain-free death, although people’s wishes and preferences were not always recorded. This posed a risk their wishes might not be followed.
Effective systems and processes were in place to protect people at risk of abuse and staff understood their safeguarding responsibilities. There were enough staff deployed to meet people’s needs. Medicines were managed safely and people were supported to take their medicines as prescribed.
People were usually supported to access healthcare services when needed, although referrals were not always made to speech and language therapists when needed. There were clear procedures in place to help ensure people received consistent support when they moved between services.
Adaptations had been made to the home to make it supportive of the people who lived there. People were complimentary about the food. They were supported to eat and drink enough. Staff monitored people’s weight and took action if they experienced unplanned weight loss.
People were treated well, by kind and compassionate staff with whom they had built positive relationships. Staff promoted people’s independence and involved them in decisions about their care. They protected people’s privacy respected their dignity at all times.
There was a complaints policy in place and people felt able to raise concerns. People had access to a range of activities designed to meet their individual interests.
Staff enjoyed working at the home and felt valued by management. They communicated effectively between themselves and expressed a shared commitment to providing high quality care to people.
There was an open and transparent culture. Visitors were welcomed and the provider sought and acted on feedback from people.
We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of the report.