CQC report explained · a care home with nursing
What the CQC found at Hayes Court
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, January 2018
Hayes Court was rated Good; inspectors found safe, kind and well-organised care, with a recommendation about adapting the environment for people living with dementia.
This was an unannounced inspection. Inspectors observed care, spoke with people living there, relatives, staff and health professionals, and checked care plans, staff records, medicines records and management records. The home could support up to 56 people and 52 were living there at the time, including 12 people receiving short-term reablement after hospital discharge.
All five areas were rated Good: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safer medicines systems, personalised care plans, kind staff and good support with food, health care, activities and complaints.
The home had improved since the previous inspection in December 2016, when it was rated Requires Improvement and breached regulations. The report says those actions had been completed. Inspectors made one recommendation that the provider seek current best practice on adapting the environment for people living with dementia.
Medicines were better managed
The home had overhauled its medicines systems. Inspectors found the medicines administration records they checked were complete and accurate.
“the MAR we looked at were fully completed, accurate and up to date.” from the report
Enough staff
Inspectors found enough staff with the right mix of skills and experience. Staffing had improved since the previous inspection.
“There were enough staff working at the home with the right mix of skills and experience to meet people's needs.” from the report
Kind and respectful care
Staff spent time talking with people, respected privacy and dignity, and supported people at their own pace.
“Throughout our inspection we observed many instances of positive interactions between people and staff.” from the report
Personalised support
Care plans included people's preferences, abilities, life histories and preferred ways of receiving care. People and relatives were involved in planning and reviewing support.
“People and where appropriate their relatives were involved in planning and reviewing their care.” from the report
Strong management checks
The home had regular audits and checks covering care, medicines, staff training, records and maintenance. Inspectors found the service well organised and well led.
“There were comprehensive arrangements for checking the quality of the care people received.” from the report
Dementia-friendly environment
minorInspectors recommended that the provider seek advice on current best practice for adapting the environment to meet the specialist needs of people living with dementia. This was a recommendation, not a breach.
“We recommend that the service finds out more about appropriate adaptations, based on current best practice in relation to the specialist needs of people living with dementia.” from the report
- 01What changes have been made, or are planned, to adapt the environment for people living with dementia?
- 02How many staff are normally on duty at night, and how do you check that this is enough for people's needs?
- 03How are medicines checked each week, and what happens if a medicines record does not match what was given?
- 04How will you make sure my relative's care plan reflects their routines, preferences and life history?
- 05What activities and opportunities to go out are currently available for people who want to take part?
This was an unannounced comprehensive inspection covering all five areas, although the report's front page gives the visit dates as 24 and 27 November 2017 while the main text says 23 and 24 November 2017. This explanation was written from the published report of 9 January 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2017
Overall Requires Improvement; Safe was rated Inadequate because medicines and staffing were not safe, although inspectors found kind and respectful care.
Inspectors visited the home without notice on 8 and 9 December 2016. They spoke with people using the service, staff and managers. They observed care, checked the building and equipment, and reviewed care files, staff records and management records.
The main safety concerns were medicines management and staffing levels. Inspectors found unsafe arrangements for storing, giving and recording medicines. There were not enough nursing or care staff, and some people had to wait for help with eating or were moved using a hoist by one staff member when two were needed.
Staff did not understand the Mental Capacity Act well enough. Capacity assessments and best-interest records were missing. Care plans focused on tasks and health needs, with little information about people's preferences, interests or social lives. Inspectors found little meaningful activity and limited opportunities for people to go out.
The overall rating was Requires Improvement. Caring was rated Good, but Safe was Inadequate and Effective, Responsive and Well-led were Requires Improvement. The report says the provider had made major changes to medicines systems after the visit, but these still needed to be embedded, checked and supported by staff training.
Kind and respectful staff
People described staff positively. Inspectors saw staff being patient, polite and encouraging, while respecting people's privacy and preferred ways of being addressed.
“Our observation showed staff responded to people in a kind, caring and respectful manner” from the report
Food and health support
People had enough to eat and drink and were satisfied with the choice and quality of meals. Health checks and referrals to healthcare professionals were in place.
“People were protected from the risk of poor nutrition and dehydration.” from the report
End-of-life care
People were involved in decisions about end-of-life care. Care records contained detailed information about their preferences.
“The home had an effective approach to end of life care.” from the report
Safe recruitment
The provider consistently completed appropriate checks before staff began working with people.
“Staff were recruited using a safe recruitment practice which was consistently applied.” from the report
Unsafe medicines systems
seriousInspectors found problems with ordering, storage, administration and recording. Care staff administered medicines without training or recorded competency checks, and there were risks involving creams, thickeners, allergies and crushed medicines.
“People were not always protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to store and manage the administration of medicines.” from the report
Not enough staff
seriousThere were not enough nursing and care staff to meet people's needs. People waited for help at lunchtime, and some moving and handling was carried out by one staff member when two were required.
“There was not a sufficient number of nursing staff to meet people's needs and help keep people safe.” from the report
Mental capacity decisions
seriousPeople were sometimes treated as unable to make decisions without proper, decision-specific capacity assessments. Records did not clearly explain best-interest decisions.
“Records demonstrated that people were deemed to lack the capacity to make decisions although their capacity had not been assessed.” from the report
Care was not personalised
seriousCare plans focused mainly on tasks and health needs. They did not adequately record personal histories, preferences, interests or social needs, and people were not always involved in planning their care.
“The care and treatment people received did not meet their needs and reflect their preferences.” from the report
Too little activity
needs fixingPeople had limited opportunities for meaningful activity or to leave the home. Activities were not sufficiently based on what people wanted to do.
“There was insufficient stimulation or activity for people living in the home.” from the report
Weak quality checks
seriousThe provider did not have effective systems to monitor care, staff skills and improvements. Known problems, including overdue supervision, remained unresolved.
“The provider did not establish and operate effective systems or processes to assess, monitor and improve the quality and safety of the service provided.” from the report
- 01What changes have you made to medicines storage, administration and recording since this inspection, and how do you now check staff competency?
- 02How many nurses and care staff are normally on duty during the day and night, and what happens when staffing levels are short?
- 03How do you complete and record decision-specific mental capacity assessments and best-interest decisions?
- 04How are residents involved in writing and reviewing care plans, including their preferences, interests and usual routines?
- 05What activities and opportunities to go out are now available, and how are they matched to each resident's interests?
This was an unannounced comprehensive inspection of the overall service, covering all five CQC questions and reviewing care, staffing, medicines, records and management systems. This explanation was written from the published report of 18 February 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Hayes Court
3 rated inspections over 3 years: the service has held its Good rating throughout.
- January 2018Goodcurrent ratingup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2017Requires improvementdown from GoodSafe: InadequateEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- January 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- June 2014
Report published without a new overall rating.
- January 2014
Report published without a new overall rating.
- January 2013
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 4 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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