Haythorne Place

Haythorne Place is a nursing and residential service, providing personal and nursing care for up to 120 people, some of whom were living with mental health conditions or dementia. The service comprised of six houses and one management building.

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

People told us they felt safe living at the service and the standard of care they received was quite good. However, aspects of the service were not safe. Staffing arrangements negatively impacted the quality of support people received, and in some cases, placed people at risk. Although processes had been established to protect people from risks relating to the spread of infection, these processes were not consistently followed by staff. People received their medicines as prescribed.

The systems of governance were comprehensive, but they had not been effective at meeting regulatory requirements or improving the quality of care people received. For example, this was the third consecutive inspection where feedback about staffing was poor. Despite our initial concerns, the new registered manager and provider were very proactive in engaging with CQC after the inspection. The provider took immediate action to address infection prevention control concerns after our visit and confirmed they will take onboard our comments about staffing. The registered manager understood aspects of the service must improve.

Throughout the inspection we saw caring interactions between staff and people who used the service. We have made a recommendation about how the provider embeds a person-centred culture at the service.

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

Rating at last inspection

The last rating for this service was good (published 8 October 2019).

Why we inspected

We received concerns in relation to staffing and the culture of the service. As a result, we undertook a focused inspection to review the key questions of safe, caring 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.

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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this report. You can see what action we have asked the provider to take at the end of this full report.

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 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 staffing, infection prevention and control and 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 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.

We found the following examples of good practice.

The service was clean and tidy. There were enhanced cleaning schedules in place to include high touch areas which were regularly checked to ensure completion.

There were robust procedures in place to support visiting when it is safe to do so. There was purpose built visiting pods at each of the six houses, which enabled outdoor visits to take place safely. For indoor visits, procedures were implemented so visitors entered a designated area directly via a fire escape, so they did not come into contact with people’s shared living spaces.

Staff were cohorted as much as possible, which involved staff working with the same colleagues and being allocated to a specific house or houses. This helped reduce the risk of the virus spreading throughout the service.

Risks to staff and people relating to Covid-19 were assessed and managed. The service had assessed and taken measures to protect people who may be at increased risk, for example BAME people.

Haythorne Place is a nursing and residential service, which at the time of this inspection was providing personal and nursing care to 110 people, some were living with mental health conditions or dementia. The service comprised of six houses and one management building. The service can support up to 120 people.

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

The leadership team were very committed to delivering good care and they had made some positive changes at Haythorne Place since the last inspection. The staffing arrangements were much improved and staff consistently told us there were enough of them available to ensure people’s needs were met. This included an increased staffing provision in each house and an overall reduction of placements for people who required nursing level support. Some people and relatives fedback staff interactions sometimes appeared rushed or task-led.

The systems of governance were effective, which helped raise standards and promote better outcomes for people living at the service. The provider implemented new requirements to the content of people’s care records to ensure they covered key areas relating to their care and support. This aimed to improve the quality and consistency of information staff had access to about a person’s care. In most cases this had improved the quality of people’s care records; however, in some cases a number people had missing sections in their care file. We also identified some people’s risk assessments relating to their health and safety did not always accurately reflect their needs. The registered manager was aware of issues with people’s care records and assured us steps would be taken to robustly address this.

The registered provider had refurbished some areas of the service and plans were ongoing. We found some areas of the service was still in need of refurbishment, which we fedback to the registered manager. The provider’s refurbishment plans included areas we identified during the inspection.

People told us they felt safe living at the service and the standard of care they received was generally good. Relatives we spoke with also raised no concerns about the safety of their loved ones. We received one concern from a relative during the inspection, but this was responded to quickly and sensitively by the registered manager. Staff were knowledgeable about how to identify and report any safeguarding concerns. Accidents and incidents were documented, with lessons learned discussed as a staff team to help prevent a reoccurrence.

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.

People spoke positively about the food and drink provided, confirming they were offered choice and received enough.

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 10 September 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Haythorne Place is a ‘care home’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Haythorne Place is registered to provide accommodation, nursing and personal care for up to 120 people. The service is divided into six houses and a main office. Each house can accommodate up to twenty people. One house accommodates younger people with physical disabilities, another house specialises in the care and support of people who live with mental ill health. Four houses accommodate older people. Two of these provide support for people living with dementia. At the time of our inspection, 111 people were living at the service.

The manager had registered 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.

At our last inspection in May 2017 we found concerns about the premises and equipment at the service. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan with details of the improvements they planned to make to meet the requirements of the regulation. At this inspection, we saw that action had been taken and was still on going to continuously improve the premises and equipment at the service. We found sufficient improvements had been made to meet the requirements of the regulation.

Following the inspection, the group director of operations and compliance informed us that all the outstanding premises and equipment action had been completed, meeting the provider’s deadline of July 2018.

During the inspection, we found some concerns about the staffing levels in some of the houses. This was reflected in the feedback we received from some of the people using the service and relatives we spoke with. Some of the staff we spoke with also shared some concerns about staffing levels at the service. We shared these concerns with the regional operations manager and the registered manager.

Following the inspection, the regional operations manager informed us the staffing levels within some of the houses would be increased immediately and the registered manager would recruit additional care staff for the service to cover the increase in hours. We will monitor this at our next inspection.

During the inspection, we found some concerns about cleanliness within some of the individual houses. Following the inspection, the registered manager confirmed action had been taken to improve the cleanliness of these areas. We have made a recommendation about the management of cleanliness at the service. We will monitor this at our next inspection.

We received mixed reviews from people and relatives about the quality of care at the service. Some people and relatives we spoke with were satisfied with the quality of care provided, whilst others were less satisfied. We saw the level of satisfaction expressed by people and relatives corresponded to concerns about staffing levels and/or cleanliness within the house people lived in.

The registered provider had a process in place to respond to and record safeguarding concerns. Staff confirmed they had been provided with safeguarding vulnerable adults training so they understood their responsibilities to protect people from harm.

People had individual risk assessments in place so that staff could identify and manage any risks appropriately.

The recruitment systems were designed to make sure new staff were only employed if they were suitable to work at the service.

The service had appropriate arrangements in place to manage medicines. However, we saw the storage of medicines required improvement to ensure they were stored at the right temperature.

People told us they received care and treatment from external healthcare professionals when required. People’s care plans and risk assessments were reviewed regularly and in response to any change in needs.

People’s nutritional needs were monitored and actions taken where required. We received mixed views about the quality of the food provided at the service.

People and relatives, we spoke with made positive comments about the activities that had been provided at the service. Some of the people and relatives we spoke with were concerned that one of the two activities workers had recently left. The regional operations manager told us the registered provider was actively recruiting another activities worker, who would work full time at the service.

There were end of life care arrangements in place to ensure people had a comfortable and dignified death.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People we spoke with told us they felt consulted and staff always asked for consent. The care staff spoken with had a good understanding of their responsibilities in making sure people were supported in accordance with their preferences and wishes.

Staff underwent an induction and shadowing period prior to commencing work, and had regular updates to their training to ensure they had the skills and knowledge to carry out their roles.

We found the service had responded to people’s and/or their representative’s concerns and taken action to address any concerns.

Resident and relative’s meetings took place so people had opportunities to feedback about the service and suggest improvements.

Accidents and untoward occurrences were monitored by the registered manager and provider to ensure any trends were identified.

We found some of the regular checks completed at the service were ineffective in practice. During the inspection we found concerns about staffing levels, the cleanliness of the service and the storage of medicines.

At this inspection we found two breaches of the Regulations of the Health and Social Care Act 2008. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

Haythorne Place is registered to provide accommodation, nursing and personal care for up to 120 people. The home is divided into six units. One unit accommodates younger people with physical disabilities, another unit specialises in people with mental health problems. Four units accommodate older people. Two of these provide support for people living with dementia. The home is situated in the Shiregreen area of Sheffield and has access to the shops, public transport and other amenities. At the time of our inspection 115 people were living at the home.

There was a registered manager in post. 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 home was clean in the main; however the décor looked tired and worn. Some outside areas posed a potential risk to people because they had been poorly maintained and designed.

The home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with knew the importance of reporting any incidents. Assessments identified risks to people and management plans to reduce the risks were in place. Where safeguarding alerts had been submitted for investigation the registered manager acted appropriately to address issues and prevent them re-occurring.

We received positive feedback from people who used the service and their relatives. People we spoke with told us they felt safe and relatives also said the home provided safe care.

People were really clear about who they could turn to if they were worried or had any concerns. The staff were also aware of the role they played in keeping people safe by reporting any concerns.

Accidents and incidents were appropriately recorded, however, more detail should be added to identify any trends and prevent further incidents re-occurring.

There was an infection control policy and a procedure in place, Staff were trained in the prevention and control of infection, wore clean uniforms and wore appropriate personal protective equipment (PPE), such as gloves and aprons when providing care and when serving food. At the last inspection of the service we identified areas within each house that required improvement. At this inspection there remained several areas which required cleaning and refurbishment.

The registered provider had a policy and procedure in place for the safe management of medicines. Staff were working in accordance with this policy which assisted in keeping people safe and well.

During the day staffing numbers were sufficient to meet people's needs. Some people felt staffing numbers during the night should be increased.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

People and their families were involved in making decisions about their care. A range of healthcare

professionals visited the home to offer support and advice to staff about people's varying needs.

In the main people said the food provided was good and there was plenty of choice available.

People who used the service and their relatives spoke positively about the staff and told us they were kind and caring. We saw staff advising and supporting people in a way that maintained their privacy and dignity. Staff observed were caring towards people and had a good understanding of any behaviour triggers.

We asked for some information that was on show in one house to be moved to a more private place so that the privacy and confidentiality of people who used the service was not compromised.

People were able to discuss their health needs with staff and had regular contact with a range of healthcare professionals as needed.

People and their relatives knew how to complain and they told us they would inform the staff if they were unhappy with their care.

There were meetings for people who used the service, relatives and staff where they could share ideas and good practice.

The registered manager was working in partnership with other professionals to improve the quality of the service.

We found one breach in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was a breach in regulation 15: Premises and equipment.

You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below

The service was last inspected on 26 August 2015. At that inspection we found the service was in breach of regulations in that people had not received care and treatment that met their needs, and not had appropriate arrangements in place to manage medicines, and had failed to effectively operate systems and processes to protect people from abuse and improper treatment. The provider had failed to ensure that there were sufficient staff deployed and had failed to ensure that staff received the appropriate training. The provider did not have effective systems to monitor the quality of the service, and had not ensured that accurate and complete records were kept in respect of each person.

As a result the service had been rated Inadequate. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Haythorne.Place’ on our website at www.cqc.org.uk’

Haythorne Place is a nursing home for up to 120 people. The service is divided into six houses, each providing accommodation for up to 20 people. One house accommodates younger people with physical disabilities, another house specialises in people with mental health problems. Four houses accommodate older people. Two of these provide support for people living with dementia. At the time of the inspection there were 100 people living at the service.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

During this inspection we found significant improvements had been made since our last inspection in August 2015.

We found that people had care and support plans in place, and care records reflected the care they required. The plans had been reviewed and updated when people’s needs had changed. People’s risk assessments had also been reviewed to ensure their safety.

The provider had ensured that an accurate, complete and contemporaneous record was maintained in respect of each person.

We found significant improvement in the arrangements for the recording, safe keeping and safe administration of medicines. Staff were aware of how to raise any safeguarding issues. We found the provider had ensured the service effectively operated systems and processes to protect people from abuse and improper treatment.

The provider had ensure that there were sufficient staff deployed to meet people’s needs and that staff received the appropriate training to enable them to carry out the duties. Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work.

The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that staff were following the code correctly, although some records were not detailed enough about how best interests decisions had been reached.

People told us they felt safe and were treated with dignity and respect. People were happy with the quality of care they had received and made positive comments about the staff.

People’s individual dietary needs and preferences were being met and we received positive comments about the quality of the food.

We observed some staff giving care and assistance to people throughout the inspection. Staff were respectful and treated people in a caring and supportive way.

Although we found that the standard of cleanliness, maintenance and décor was better maintained in some houses than in others, people were protected against the risks of inappropriate or unsafe care or treatment because the provider had effective systems to monitor the quality of the service provision. Most of the maintenance issues we found had been picked up by the provider’s audits and included in their on-going maintenance action plan.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; 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?

All the people spoken with told us they felt 'safe' and had no worries or concerns. One person told us staff listened to them and commented: 'I would tell them [staff] if they were hurting me'. Another person commented: 'I feel very safe and comfortable'.

We observed individual staff members treating people with respect.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found the DoLS checklist used by the service highlighted an apparent lack of Mental Capacity Act assessments and subsequent best interest process for residents with advancing and advanced dementia. This did not reflect the outcome of the recent Supreme Court ruling about people who are subject to continuous supervision and who lack the option to leave their place of care.

We found the arrangements in place to safeguard people using the service from financial abuse could be more robust.

Is the service effective?

People's health and care needs were assessed and care plans formulated. However, a few people's needs were not always being met in accordance with those plans.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to people's care and welfare.

People were cared for by staff who were supported deliver care and treatment safely and to an appropriate standard.

Is the service caring?

People spoken with told us they were satisfied with the quality of care they had received. Their comments included: 'they [staff] keep my room really clean', 'I am satisfied, I would tell them [staff] if I wasn't', 'I feel a hundred percent better since I came to live here', 'the staff are kind. The food's good too. I can't stand up but they [staff] help me have a shower every few days', 'they [staff] look after me so well.' 'all the things we've asked for, they do here', 'I feel safe here; they [staff] look after me' and 'I'm so much happier here than the other place'.

We spoke with a relative about the quality of care that had been provided to their family member. Their comments included: '[family member] is so happy here. She looks outside and can see people walking about. She's so much brighter and has even started to eat. She's really well cared for'.

Is the service responsive?

People told us staff responded to their calls for assistance when they used their call buzzer in their room. Their comments included: 'sometimes during the day it is busier and you have to wait longer for staff to come, sometimes they come immediately, sometimes it is five to ten minutes' and 'I'm really happy here. I came from another place and the staff here are wonderful. They come when I ring the bell'.

The provider's complaints process was displayed in each house and in included in the service user information pack.

Is the service well led?

There was a range of quality monitoring checks in place to make sure the manager and staff learned from checks. However, our findings indicated the audits in place had not effectively identified the concerns we found during the inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to identifying, assessing and managing risks to health, safety and welfare of people who use the service and others.

People's care needs were followed up by risk assessments to make sure planned care minimised the risk to people and promoted their independence. One person told us, 'I go out with one of the carers to town. I like the outings.'

The home was made up of six houses each had 20 bedrooms. We looked around three houses including some of the vacant bedrooms. The houses were kept clean and tidy. The environment looked homely. One person said, 'I am happy with my room. I have a TV and I like watching my programs.'

People had access to safe and suitable equipment because the provider had made sufficient resources available so that people were supplied with correct equipment.

The manager followed the procedures when staff employed by them were no longer fit to work in health or social care.

There was an open and inclusive atmosphere at the home where people were able to air their feelings and speak to staff without fear.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person said that staff included them in the discussions about their care and their family were also informed if changes were made. They said they were very satisfied. A further three people said that staff spent time explaining things to them and helping them with personal hygiene.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person and their relative told us that due to their condition the person needed a bedrail to help them stay in bed safely. They said the staff carried out an assessment and gave them options as to the best ways to be safe whilst in bed. Only when they had agreed to the plan bed rails were installed.

People said that they were confident that staff would respond and take action to make sure the people who lived at the home were protected from any abuse. A relative said that they had found the staff kind and compassionate towards people. Three people told us they were comfortable and did not have any fears about living at the home. One person said, 'Girls are very good they are caring. They look after us well.'