Hadley Place Residential Home was inspected on the 30 July 2018. The inspection was unannounced. The last inspection took place in December 2015 and the service was rated good. At this inspection, we rated the service Requires Improvement.

Hadley Place provides personal care and support for a maximum of 29 older people some of whom may be living with dementia or have mental health care needs.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There was no registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The person employed as manager had not started the registration process at the time of the inspection.

During this inspection, we had concerns with how medicines were managed, how the provider worked within mental capacity legislation and quality monitoring. You can see what action we have told the provider to take at the back of the report.

Some people had not received their medicines as prescribed which could impact on their health and well-being. This mainly referred to eye drops, but other medication administration records had gaps with no reason identified for the omission. Records showed that people were refusing medication over long periods of time but care plans and risk assessments did not always contain information relating to the action taken by the service. Medication prescribed to be given 'as and when required' (PRN) did not always have clear guidance to enable staff to administer it consistently. The register of controlled drugs was inaccurate as records indicated stock remained in the service when it had been returned to the pharmacy.

Accidents and incidents were not always managed effectively. People did not always have up to date risk assessments in place which identified the action required to minimise the risks to their health and well-being.

People are not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

There was inconsistency with the application of mental capacity legislation. This had led to one person potentially being deprived of their liberty unlawfully, as staff had not recognised they met the criteria for a Deprivation of Liberty Safeguard. Assessments of people’s capacity and records of best interest decisions when restrictions were in place were not consistently in place. One person was given their medicine covertly in food but there was no assessment in place identifying this was in their best interest. However, we found staff had a good understanding of the need to gain consent from people before carrying out care tasks.

The internal quality monitoring systems were not effective. The current system did not cover all aspects of care delivery. When shortfalls were identified, for example when medication was refused over long periods of time. Action was not taken in a timely way and the quality assurance systems used had not identified the shortfalls found on this inspection.

Staff had not received formal supervision or appraisal since the registered manager left. However, staff told us the new manager was very supportive and approachable and was implementing new systems to improve the service. We have made a recommendation about this.

There were enough numbers of staff deployed to meet people's needs and to keep them safe. The provider had effective recruitment procedures in place and carried out checks when they

Hadley place is registered to provide personal care and support for up to 29 older people who may be living with dementia. The service was originally three terraced houses which have been now combined. It is close to local amenities and bus routes. There is a dining room and two conservatory sitting rooms on the ground floor, one of which is for people who wish to smoke. There is a second sitting room on the first floor; a small garden and parking are at the rear of the building.

The last inspection was completed on 13 August 2014 and the service was found to be compliant with the regulations inspected at that time. This unannounced inspection took place on 21 December 2015.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager understood their responsibilities to report accidents, incidents and other notifiable incidents to the CQC. Audits were completed regularly and we saw when shortfalls were highlighted action was taken to improve the service. However, maintenance and servicing certificates for a number of pieces of equipment had expired. We discussed this with the registered manager who provided assurance our concerns would be rectified as soon as possible. After the inspection the registered manager sent us evidence to confirm relevant checks and servicing had been completed.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and understood their responsibilities to report episodes of poor care.

People were supported by kind, caring and attentive staff who understood their preferences for how their care and support should be delivered. Staff understood the importance of respecting people’s privacy, supporting them to maintain their dignity and treating them as an individual.

People’s health care needs were assessed and planned for. People were involved in the formulation of their care plans and on-going reviews of their care.

Questionnaires were completed by people who used the service, their relatives and professionals which enabled the service to understand people’s views and make improvements as required.

People ate a balanced diet of their choosing. When concerns with their general health were identified relevant professionals were contacted for their advice and guidance which was implemented effectively by the service.

People had their assessed needs met by appropriate numbers of suitably trained and experienced staff. Staff had been recruited safely which helped to ensure, as far as reasonably practicable, they were suitable to work with vulnerable people.

A complaints policy was in place which was provided to people who used the service to enable them to raise concerns as required. When complaints and feedback were received we saw evidence to confirm action was taken to improve the service.

Medicines were ordered, stored and administered safely. People received their medicines as prescribed from staff who had completed safe handling of medicines training.

The inspection was carried out by an adult social care inspector and was completed in relation to concerns we found at our inspection on 29 April 2014 with infection control practices. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff who supported them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

• Is the service caring?

Staff were aware of people's preferences and diverse needs; A member of staff told us, “I carry some PPE (personal protective equipment) with me but its also in people’s room so we can help them straight away without having to run off to find gloves or aprons.”

• Is the service responsive?

At our last inspection on 29 April 2014 we issued a compliance action for this outcome area. We were concerned that people were not protected against the risks associated with not having an effective system in place to reduce the risk and spread of infection. During this inspection on 13 August 2014 we found improvements had been made and that people were cared for in a clean, hygienic environment.

• Is the service safe?

People were protected from the risk of infection because appropriate guidance had been followed.

• Is the service effective?

There were effective systems in place to reduce the risk and spread of infection.

• Is the service well led?

Appropriate actions had been taken to address our concerns. A senior member of staff told us, “Since the last inspection we had changed certain things and its better now.”

What people who used the service and those that matter to them said about the care and support they received.

One person who used the service told us, “It’s always very clean (in the home), they do a very good job keeping it looking its best” and went on to say, “My room is always immaculate.” Another person said, “My bed is always clean and fresh and they do all my washing for me.”

The inspection was carried out by an adult social care inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

• Is the service caring?

Staff demonstrated a good understanding of the needs of the people who used the service and could describe how to maintain people’s dignity and how to ensure people’s choices were respected.

A visiting district nurse that we spoke with told us, “This is one of the best homes I go to.”

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service, their relatives, friends and other professionals involved with the service, completed an annual satisfaction survey. Where suggestions or concerns had been raised, the provider had listened and made changes to the service.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

• Is the service responsive?

Staff knew the people they cared for and understood their preferences, likes and dislikes and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated when required.

• Is the service safe?

Systems were in place to make sure that the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

The people who used the service told us they were happy and that they felt safe. We saw that people were treated with respect and dignity by staff.

The home was clean and free from odours. However, improvements were need in relation to infection prevention and control.

• Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

There was an advocacy service available if people needed to use it. This meant that when required people could access additional support.

• Is the service well led?

The service had quality assurance systems in place and records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were supported by their manager and enjoyed their jobs.

What people who used the service and those that matter to them said about the care and support they received.

People who used the service made comments including, “You can do whatever you like in here, if I want to go to Beverley races or to Hornsea, I just ask and they sort it out”, “You hear about other homes on the news but it’s not like that here, we don’t get told where to sit or what to eat or when to get up, it really is wonderful”, “You couldn’t ask to be in a nicer place, it’s clean, the food is good and the staff treat us really well”, “It’s the little things in life that are important and they understand that here, we have parties when it’s your birthday, with cakes and sandwiches and everything”, “It’s always clean; the staff do ever such a good job”

A visiting relative told us, “They get up to all sorts; they take Dad out and there are activities going on in the home all the time” and “Mum was struggling with Dad at home and things were deteriorating for both of them, now Dad gets the care he needs things are so much better. We are really grateful to the home and all the staff for what they have done for us.”

As part of this inspection we spoke with six people who used the service, the owner, the manager and four staff.

People we spoke with told us, “Staff involve me in decisions about my care and anything I ask for I can get within reason” and “I really like it here I think it’s great and the staff are brilliant.”

Suitable hand wash facilities and protective equipment was available in most areas. Staff confirmed they had completed training in infection prevention and control, and this was in the process of being refreshed for staff.

The overall building maintenance was kept to a high standard and the grounds outside were sufficiently well kept to offer outdoor activity for example gardening, to existing people who used the service and their relatives.

We found the recruitment records to be in good order and saw they contained the appropriate documentation for example; induction checklist, interview checklist, two relevant references and CRB checks.

We looked at compliments received from relatives or people who used the service. Comments included; “After visiting my relative in the home following his move, I was confident he would be well looked after with you.”

People spoken with told us they were treated with respect. People also said they could make choices about aspects of their lives. Comments included, “You only get one choice at lunch but they will make you something else if you don’t like it”, “I like it – you are free to do what you want to do”, “I’ve made some friends here – we sit and talk about football and rugby” and “I like to do my own thing – I have breakfast in bed, toast, porridge and a cup of tea.”

People said they liked the home and there were plenty of activities and entertainment to keep them occupied. One person said, “We have trips out every Thursday to places like Bridlington and Hornsea for fish and chips and the Humber Bridge.” Another person told us they preferred not to go on the trips and liked to stay at home and read instead.

People told us they could see their GP and community nurse when required. Comments included, “I see the optician and doctor and the nurse came too when I hurt my leg, but not anymore.”

People spoken with told us that staff supported them in a nice way and treated them well. Comments included, “The staff are lovely”, “They are pretty good and cheerful”, “The girls are smashing”, “They look after you well enough” and “They look after me and treat me well.”

People spoken with confirmed they were asked their views about the home and told us they could make suggestions. People told us they felt able to make complaints and said they would speak with the manager if necessary and they would sort out any problems for them.