Archived: Hopes Green Also known as http://crmlive/epublicsector_oui_enu/start.swe?SWECmd=GotoView&SWEView=HC+Account+Dashboard+View&SWE

Hopes Green is a residential care home providing accommodation and personal care to up to 50 people. The service provides support to older people, some of whom had physical frailty and some who were living with dementia. At the time of our inspection there were 45 people using the service.

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

Medicines were not always managed in a safe way. The providers governance arrangements did not provide assurance the service was well led. We were not assured the systems, processes, and leadership currently in place to oversee the quality assurance of the service were robust and effective and regulatory requirements were not always being met.

People living at the service were happy with the support they received. People felt safe and told us staff were kind and caring and were confident any concerns they may have would be listened to and action taken. Staff understood how to raise concerns and knew what to do to safeguard people.

Risks to people had been assessed, reviewed, and updated in people’s care plans when their needs changed. Staff had access to personal protective equipment (PPE) and there were effective infection prevention control measures in place.

Effective arrangements were in place to ensure recruitment checks on staff were safe. Staff had received an induction and training to enable them to meet people’s needs. Supervisions, appraisals, and competency assessments for staff were carried out and staff told us they felt supported by the senior team.

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.

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 (published 27 October 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when.

At this inspection we found improvements had been made in relation to infection control however we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 26 September 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment.

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. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hopes Green on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to medicines management, good governance, and the notification of incidents.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Hopes Green is a residential care home that was providing personal care and accommodation for up to 50 older people, some of whom had physical frailty or were living with dementia. On the day of the inspection, there were 43 people living at the service.

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

We received mixed feedback from people and relatives. One person said, “I don’t like it here.” Another person said, “I like it very much and don’t want to move.” A relative told us, “The staff are very good.”

Infection prevention control measures needed to improve to ensure people remained safe from the risk of infection.

There was a need for consistent staffing at the service to provide meaningful interactions with people. The provider was in the process of recruiting more staff..

Care and treatment was planned to be person centered. Medicines were dispensed by staff who had received training to do so. People were safeguarded against the risk of abuse and staff knew how to raise concerns. Lessons were learned from accidents and incidents.

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.

The provider had put systems in place to maintain oversight at the service. Support from the provider's senior management team had been put in place to instigate improvements at the service.

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

The last rating for this service was requires improvement (published 31 March 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hopes Green on our website at www.cqc.org.uk.

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.

Why we inspected

We received concerns in relation to safe care and treatment. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained at requires improvement. This is based on the findings at this inspection.

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 monitor the service.

We have identified breaches in relation to preventing and controlling infection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve standards. 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.

Hopes Green is a residential care home that was providing personal care and accommodation for up to 50 older people, some of whom had physical frailty or were living with dementia. On the day of the inspection, there were 47 people living at the service.

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

People were not always protected from the risk of infection. Government guidelines were not always followed to minimise the risk of infection from COVID-19. Staff did not always wear appropriate personal protective equipment (PPE).

Systems were not always effective in identifying and addressing areas for improvement to ensure a high-quality service.

People were supported by a consistent staff team who were safely recruited and there were enough staff to meet people’s needs.

The service had received positive compliments from relatives. Staff told us they felt supported by the registered manager and were able to raise concerns.

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

The last rating for this service was requires improvement (published 18 April 2019)

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hopes Green on our website at www.cqc.org.uk.

Why we inspected

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.

We received concerns in relation to infection control and care practice. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained at requires improvement. This is based on the findings at this inspection.

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 monitor the service.

We have identified breaches in relation to preventing and controlling infection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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.

People’s experience of using this service:

The home was overall unclean and poorly maintained. We identified concerns with infection prevention and control measures in place.

Documentation was not always completed to evidence that routine daily tasks had been completed in areas such as care delivery, health and safety and cleanliness.

Staffing levels were not appropriate for people’s assessed needs. Communal areas were left unstaffed for significant periods of time which meant that people’s care and safety needs were not always met.

The provider has a quality assurance system in place and regular checks of the service provided were carried which identified areas of concern, however the necessary improvements had not been made.

People received their medicines as prescribed. We have made a recommendation about the management of topical medicines and creams.

People were supported to engage in meaningful activities. We have made a recommendation about dedicated activities staff to ensure that more people can access activities or dedicated one to one time on a regular basis.

Risks associated with people’s health and care were assessed and staff knew how to keep people safe.

Staff were caring, dedicated and treated people with dignity and respect. People told us they liked living at Hopes Green.

Staff had received training to enable them to provide effective care. Supervisions had been inconsistent but this was improving.

People's capacity to make day-to-day decisions had been considered and assessed and the provider was working within the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Complaints were investigated and responded to.

We received positive feedback about the open and transparent culture in the home.

Rating at last inspection: At the last inspection this service was rated Good (Report published May 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: Due to the regulatory breaches identified on the inspection, we formally wrote to the provider to request an action plan to address our concerns. We will continue to monitor progress made against the provider's action plan and any regulatory action as an outcome of this full inspection report.

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

Hopes Green is registered to provide accommodation and care for up to 50 people some of whom may be living with dementia. There were 49 people living at the service at the time of our inspection. The home does not provide nursing care.

A manager was in post and was going through the process to become a registered manager with the Care Quality Commission. 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 was supported by a deputy manager to ensure the daily management of the service.

People told us the service was a safe place to live. The registered provider’s recruitment procedures ensured that only suitable staff were employed. People were supported by staff that had the skills and experience needed to provide effective care and there were enough staff to help keep people safe and meet their needs. Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. Medication was managed and administered safely and people received their medicines as prescribed.

Assessments of people’s capacity were carried out in line with the Mental Capacity Act 2005 (MCA). The manager and staff understood and complied with the requirements of the MCA and the associated Deprivation of Liberty Safeguards (DoLS).

Staff knew people well and understood how to meet their care and support needs. People and, where appropriate, their families were fully involved in the planning and review of their care; care plans were person centred and were regularly reviewed. Staff promoted people’s independence and encouraged people to do as much as possible for themselves.

Staff were kind and caring and treated people with respect and dignity. People and their relatives told us they were happy with the care and support they received. People’s nutritional needs were met and people were supported to maintain a healthy and balanced diet. People were supported to access health and social care professionals and services when needed.

People living and working in the service had the opportunity to say how they felt about the service provided. Their views were listened to and actions were taken in response. There was an effective system in place to respond to complaints and concerns.

There were a number of effective systems in place to regularly assess and monitor the quality of the service. The manager was able to demonstrate how they measured and analysed the care and support provided to people to ensure the service was operating safely and was continually improving to meet people’s needs.

Hopes Green provided a service for people with personal care and dementia related needs. We looked at the care records for six people who used the service. We also looked at how people were involved and consented to their care, staffing and quality assurance checks.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

The service had ensured that staff were provided with the knowledge and skills to keep people safe and protect them from harm.

All staff had received training in the Safeguarding of Vulnerable Adults from Abuse (SOVA), the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff we spoke with told us that they were aware of the action they would take if they suspected abuse was or had taken place.

We found that the service had suitable arrangements in place to gain people's consent and assess their mental capacity to make decisions before acting on their behalf. No DoLS authorisations were in place for anyone at the service, although applications had been made after assessments had been completed.

The policy, procedures and quality monitoring of the service included health and safety, dependency scores and reviews of care planning and delivery. People were provided with care and support that ensured their welfare and safety.

Is the service effective?

People's assessments showed that their care, support and treatment was planned and delivered in a way that ensured that their needs were being met. People were fully involved, where possible, in choices and decisions about their lives. This made their care more effective as it enhanced their wellbeing and independence. One person said, "Yes I am fully involved in all things to do with me. I do things my own way and that is what I like."

Is the service caring?

We saw good interaction between staff and people who used the service. Staff spoke to people respectfully; they were considerate, courteous and kind. People told us that the staff were very caring. One person said, "Oh yes, they [staff] are lovely people, never grumpy in the mornings like me and always come in with a smile."

Staff had a good knowledge of people's likes and dislikes. People told us that the staff treated them respectfully. People's preferences and diverse needs had been recorded in their care files and care and support had been provided in accordance with their wishes. This showed that people were cared for by staff who were respectful and caring.

Is the service responsive?

Regular checks on the dependency levels of people who used the service were undertaken. There were sufficient staff on duty to respond to people's needs appropriately.

The service offered a range of activities for people to enjoy. These had been developed from listening to the views of people who used the service and their relatives. One person said, "I think there is enough to do, if you want to do things." Another person said, "It is up to us to say what we want to do and to help organise the things we want to do."

We saw from the records viewed that the service worked well with other agencies. A range of health and social professionals from the community were involved in people's care. This showed that people received their care in a joined up way.

Is the service well-led?

A comprehensive quality monitoring process and improvement plan was in place. Regular care reviews and discussions about people's quality of life at Hopes Green were discussed with them and their families. This ensured that people's changing needs and preferences were always taken into account.

Staffing levels were reviewed in order to ensure there were always sufficient staff to meet people's needs.

The service was well-led as it was continually improving in its care provision and in the environment to make Hopes Green a good place to live and work.

Each person was noted to have a support plan in place detailing their specific care needs and how they were to be supported by staff. Records showed that people who use the service were supported to maintain their healthcare needs. We saw that staff arranged for people to be seen by their doctor when they became unwell or their medical or mental health condition required a review. People told us they liked living at Hopes Green and found the staff to be kind and caring. People we spoke with said they were happy with the way the service managed their medicines.

The atmosphere within the service was calm and relaxed and staff interactions with people who lived there were noted to be positive. Staff were able to demonstrate a good understanding of people's care and support needs.

Records showed that the provider had an effective recruitment and selection process in place and this involved all relevant checks being carried out prior to the member of staff commencing employment at Hopes Green.

Although the service had received a small number of complaints and safeguarding concerns, appropriate systems were in place to deal with these. Records showed that these had been addressed by the Local Authority and provider.

We found at this visit that appropriate improvements in relation to the service's quality assurance system had been made to ensure positive outcomes for people who use the service. However we found that further improvements were required to ensure that people are protected against the risks associated with medicines management and that their personal records are accurate.