Haythorne Place

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified two breaches of the legal regulations. During our assessment of this key question, we found concerns around the management of people's medicines, the management of people's risk and infection control which resulted in a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found concerns relating to staffing which resulted in a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not safeguarded from abuse and avoidable harm. You can find more details of our concerns in the evidence category findings below.

This service scored 25 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from people was mixed. Some people told us that they could raise concerns if they had an issue however others raised that they did not always feel listened to. A person told us 'We sometimes have a residents meeting, sometimes they don’t listen to us, sometimes they do.'

The management team told us that there had previously been issues within the service in relation to the quality of audits and information gathering that had taken place. Resident surveys were completed however these were due to be repeated to ensure that the information gathered was sufficiently detailed and accurate. Managers told us that 'You said, we did' should be in place at the service however this has not been utilised effectively to demonstrate that feedback from relatives and people living at the service was listened to and acted upon. Staff at the service told us they felt the service was understaffed and this had a negative impact on care delivery. Although staff told us they felt managers were approachable, they did not feel that their concerns in this area had been acted upon.

Processes were in place to respond to complaints and safeguarding concerns raised, however these processes did not lead to measurable improvements. Audits and systems had failed to identify and address issues at the service including poor levels of staff training, poor management of medicines, insufficient staffing levels and issues with infection prevention and control.

Feedback form people and their relatives was mixed. Some people felt they were involved in their care planning and the information recorded about them, however other people told us they were not involved in this. Some people told us they had not been informed when their relatives had been admitted from the service to hospital, and some relatives had not been informed about changes in health and care needs.

Staff and managers told us that information from peoples care plans and medication administration records were collated and shared at the point a person needs to move services, for example to visit hospital. However, during the inspection issues were identified with the level of accurate and up to date information in peoples written records. This placed people at potential risk of harm.

Professionals who visit the service told us that information was not always shared consistently or in a timely manner. Some professionals raised issues about difficulties with contacting the service and about the availability of staff on site to support with professional visits. Some issues were also raised in regard to the accuracy of documented information in peoples care plans.

Information documented within peoples care plans was not always accurate or detailed enough to ensure safe and effective care, this included information from professionals relating to people's nutritional needs. The processes in place for ensuring that information was up to date, accurate and consistent had not identified these issues.

Some people and relatives told us they felt people were safe at the service. However, we found that some people were having to wait for extended periods of time for their care needs to be met. We found the service did not meet people's needs safely in relation to medication management, infection prevention and control and did not ensure that care records were accurate. This placed people at risk of avoidable harm.

Staff spoken with were able to recognise signs of abuse and knew how to report such concerns. However, staff at the service told us that providing appropriate care was not always possible due to low staffing levels. Staff members told us 'I don’t feel I can respond as quickly as I need to, sometimes we have tried to deliver personal care alone [when 2 staff are required]'. And 'More needs doing, I feel we are understaffed.'

We observed people, who appeared to require support, being left for prolonged periods of time. In one instance, inspectors had to alert staff to respond to a person who required support. At lunch time staff were observed to be using prescribed drink thickener incorrectly. This placed people at risk of avoidable harm.

The processes in place at the service were not effective in ensuring that care was delivered safely. Information about peoples care needs was not always accurate in peoples care plans, and some information recorded at the service about people lacked sufficient detail to allow for accurate analysis. Governance and auditing processes within the organisation had not identified these issues.

Feedback from people and their relatives was mixed. Some people felt they were involved in their care planning and the information recorded about them, however other people told us they were not involved in this.

Some staff told us that people’s preferences and needs were ascertained by speaking to people and through the services internal processes, such as handover records. Some staff were able to tell us detailed information about the people they support. However, some staff also had difficulty in identifying safety issues in relation to people's needs at lunch time when asked by inspectors.

People's care plans were not always up to date. Inconsistent information was viewed which related to the monitoring of people’s health and care needs. Some plans and risk assessments lacked sufficient detail to ensure that appropriate care was delivered. Some care plans lacked person-centred details about people's preferences and how to meet people's communicative needs. Inspectors observed people requesting support but being declined help due to staff being busy with other tasks.

Governance and audit process at the service had failed to identify deficiencies within peoples care plans and risk assessments.

People told us they felt safe and did not raise concerns about the environment. However, relatives told us that ongoing maintenance work to the site had been disruptive, and that lifts in one building were frequently out of use. A relative told us of security issues when being let into the service, we were told 'They [staff] don’t ask who we are, they just let us in, they don't know us.'

Managers told us that they were in the process of developing a plan to improve maintenance of the buildings and had recently made improvements in relation to fire safety. Staff told us that some equipment at the service was broken, for example weighing scales and hoist charges. Staff also told us that access to hot water in kitchens, laundry rooms and some bedrooms was restricted due to boilers at the service being condemned.

The service had many areas that were worn and in a general state of disrepair. Redecoration was needed in many areas where walls had been damaged and were in the process of repair. Carpets and floor coverings were malodourous and stained. The main entrance to one of the buildings where people lived had an issue with the door locking mechanism upon people exiting, this was rectified on the day of inspection. The doors to some sluice rooms where cleaning chemicals were stored had been left unlocked.

Monitoring systems at the service had not prevented areas of the home from deteriorating. The service was in the process of implementing new management and developing a maintenance plan to prioritise required actions. This improvement will take time to embed.

Feedback from people and their relatives was mixed in relation to staffing. Most people we spoke told us that staff were kind and caring, however some people told us that there were insufficient staffing levels to meet their needs. A person told us 'Sometimes there's not enough staff for me to have a shower.'

Managers at the service told us that there had been a number of changes in leadership and that recruitment was ongoing to stabilise the management team. Staff members told us there were insufficient staff to meet people's needs. Staff told us 'There's not enough staff on each unit to meet the needs of the residents.'

During the inspection inadequate staffing levels were observed to ensure that people had their care and support needs met within a satisfactory time frame. For example, a person was observed to be calling out and no staff were in the vicinity to respond. During lunch time people were waiting for an extended period of time for meals to be served, some people left the dining area before food was brought out. One person living at the service told us 'This is because 2 carers are trying to do the impossible.'

Staffing levels were insufficient to meet the needs of people using the service at busy times, governance and auditing processes in place had failed to identify and rectify this. Staff training was not completed at a satisfactory level across the service and the service did not have a process in place to monitor the frequency and quality of staff competency checks across the service.

People we spoke to did not raise concerns about the cleanliness of the service. However, we found that people were not protected as much as possible from the risk of infection because premises was not kept clean and hygienic.

Managers told us that a recent from the Integrated Care Board (ICB) had identified multiple issues in relation to infection prevention and control. Managers told us they were in the process of completing actions to improve in this area. Staff told us that access to hot water in the laundry and some sluice rooms was not available due to boiler issues. People's clothes had to be washed twice as they were in cold water. Staff told us that access to personal protective equipment (PPE) was an issue, a staff member told us 'There's never enough gloves, we are always short on wipes.'

Areas of the home required deep cleaning. Some carpets and furnishing were visibly dirty. Sluice rooms where cleaning equipment is stored required cleaning. Some staff did not appear to have easy access to PPE and were observed to be searching for gloves to support with serving meals. Areas of the home were malodorous.

Processes in place to monitor the cleanliness and infection control measure at the home had failed to ensure that the home maintained a satisfactory level of hygiene. Managers at the service advised that they had a plan in place to rectify these issues which they were working towards. Managers told us that stocks off PPE were available at the service, however staff did not appear to know where to access these.

Some people missed doses of their prescribed medicines because there was no stock in the home. One person was unable to have their medicine, prescribed to prevent heart attacks and strokes for 6 days and another person did not have their sleeping tablet for 4 nights. Some people were prescribed medicines to be taken ‘when required’ or with a choice of dose. The protocols to support the safe administration of these medicines were either not in place or were not personalised, and there was no information for staff to follow to assist them to decide the most appropriate dose administer when there was a choice of dose. This meant people may not get their medicines consistently and at the time they were needed.

The service completed audits however they had not identified all the concerns highlighted on this inspection. One audit had been competed two weeks before the inspection and 16 concerns were identified, the actions to be taken and the target date to rectify the concerns had been recorded but no action had been recorded as taken 3 weeks later. A medicines policy was in place, but it was not followed properly. For example, when people refused medicines on a regular basis because there was no care plan in place that had been agreed with the prescriber.

The information recorded on people’s medicines administration records was not always accurate or up to date which meant it could not always be relied on to make sure medicines were given safely. The inaccurate record keeping meant that staff did not know when it was safe to give doses of Paracetamol, where to apply transdermal patches or inject insulin safely. Prescribers’ and manufacturers’ directions were not always followed which put people at risk of being given their medicines safely. Some people needed it be given their medicines hidden in food or drinks, covertly, or via a feeding tube. There was no information available, from a health care professional, for staff to follow, as to the safest way disguise or administer each individual medicine. Medicines including creams and insulin were not always stored safely or at the correct temperatures. Insulin for one person and some testing strips for use when people had a feeding tube in place were out of date. Waste medicines were not stored securely in line with current guidelines.