This inspection took place on 14 and 15 May 2018 and was unannounced. At the last inspection completed 30 June 2016 we rated the service as good. At this inspection we found the service was no longer good. We found there were breaches of regulation, you can see what action we told the provider to take the end of this report.

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

Hafod Nursing Home accommodates up to 29 people. At the time of the inspection there were 26 people using the service.

The registered manager had recently left their post prior to the inspection. The provider told us a new manager would be registering with us. 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.

People’s medicines were not always administered in line with guidance. Risks to people were not clearly understood by staff and guidance was no always followed.

People did not always have their rights protected and the principles of the Mental Capacity Act 2005 were not always followed.

The systems in place to monitor people’s care delivery were not consistently effective and we could not be assured the systems were sustainable.

People were not always supported by suitably deployed staff. Staff were sometimes unable to provide dignified care due to being task orientated. Staff training was not up to date and competency was not always checked.

The building was not always designed to meet people’s needs; in particular people with dementia. Some decoration, adaptations and furnishings also required updating. Infection control required improvements to ensure furnishings were replaced promptly.

People’s care plans were not always up to date and held conflicting information. Care plans did not have much personalised information. People were not always receiving support to be stimulated with activities and to follow their interests.

If people required their health conditions monitoring following guidance being provided, this was not always being done. Records of care delivered were not always completed as required as stated in people’s care plans. People were not always receiving consistent care and support.

People had their needs assessed but further improvements were needed to how this informed people’s care plans. People were supported by knowledgeable staff, however further improvements were required in supporting people living with dementia. Improvements were needed to the environment to ensure it was suitable for people living with dementia.

People were safeguarded from potential abuse. People were supported in a way that met their wishes and effectively at the end of their life.

People received support from staff that were caring and people were involved in decisions and had their choices respected by staff. People understood how to make a complaint.

Notifications were submitted as required and the provider understood their responsibilities for notifying us of specific incidents which had occurred at the service. We found people, their relatives and staff felt supported by the provider.

This inspection took place on 30 June and 1 July 2016 and was an unannounced comprehensive rating inspection. The location was last inspected on 5 and 6 November 2014 and was rated as Requires Improvement. During the inspection the provider was found to be in Breach of; Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Care and welfare of people who use services. The provider must ensure that people are protected against the risk of receiving unsafe care by monitoring staff practice.

Regulation 18 HSCA 2008 (Regulated Activities) Regulations 2010 Consent to care and treatment

The provider must ensure where any restrictions apply that the appropriate assessments have been carried out to ensure any restrictions are in the person best interest.

During this latest inspection we could see that all issues relating to these breaches had been addressed and rectified.

HAFOD Nursing Home is a registered care home providing accommodation and nursing care for up to 29 people. At the time of our inspection there were 27 people 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 provider failed to protect people’s confidential data and records.

Management systems to audit, assess and monitor the quality of the service provided were ineffective to ensure that people were benefitting from a service that was continually developing.

People were safe and secure. Relatives believed their family members were kept safe. Risks to people had been assessed and managed appropriately.

Staff had been recruited appropriately and had received relevant training so that they were able to support people with their individual needs. People safely received their medicines as prescribed to them.

Staff sought people’s consent before providing care and support. Staff understood when the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) should be followed.

People had a variety of food, drinks and snacks available throughout the day. They were able to choose the meals that they preferred to eat and meal times were flexible to meet people’s needs.

People were supported to stay healthy and had access to health care professionals as required. They were treated with kindness and compassion and there was positive communication and interaction between staff and the people living at the location. Staff were aware of the signs that would indicate a person was unhappy and knew what action to take to support people effectively.

People’s right to privacy were upheld by staff that treated them with dignity and respect. People’s choices and independence was respected and promoted and staff responded appropriately to people’s support needs.

People received care from staff that knew them well and benefitted from opportunities to take part in activities that they enjoyed.

There were 27 people living at the home at the time of our inspection. We spoke with five people using the service, three staff, four relatives, the manager and observed staff caring for people.

People told us and we saw that staff respected their privacy and dignity and that they were given choices about their care. One person told us, “I have been here for two years and I like it, staff are very kind’’.

People’s care and health needs were planned and met in a personalised way. All staff spoken with told us they had the information they needed to care for people safely.

Staffs were clear about the action to take should they become aware of an allegation of abuse in the home. All five people spoken with told us they felt secure and knew who to tell if they had concerns and were confident that these would be acted upon.

Staff spoken with told us they felt supported by the manager, and had regular training opportunities. This meant staff had the skills to care for people safely.

There were systems in place to monitor, investigate and respond to complaints received. One relative told us that when they made a complaint the provider ensured that the complaint was resolved. This meant the provider took the appropriate action to resolve issues that were brought to their attention.

During our inspection we spoke with four people who lived at Haford Nursing Home. Some people were unable to verbally share with us their views about the care they received due to their health conditions. We used a Short Observational Framework for inspection (SOFI).This is a specific way of observing care to help us understand the experience of people who could not talk with us. We observed five people living at the home.

We spoke with four members of staff and the registered manager. We also spoke with three relatives and sampled people's care records. On the day of our inspection there were a total of twenty five people living at the home.

People we spoke with said they were afforded dignity as well as respect and independence was promoted.

We saw people enjoyed their meals and were protected from the risk of poor nutrition.

Suitable arrangements were in place to ensure people were safeguarded against the risk of abuse as concerns were not always responded to appropriately.

Systems were in place to ensure that people received medication safely.

We saw evidence that there were sufficient staffing numbers to meet people's needs in a timely manner.

Staff were supported and trained to provide a suitable standard of care.

The complaints system was not robust enough to ensure complaints were handled effectively.

Records were comprehensive, relevant to the needs of people and regularly reviewed.

We spoke to a person who told us that they could not move from the chair by themself and needed a hoist to move about and pressure relieving equipment when sitting down. We asked them if they felt safe and comfortable and they said that they did. We asked if staff helped them with dignity and sensitivity and they said that staff did.

We asked if staff looked after them well. They told us "I wish I could still walk but I'm happy enough".

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 5 and 6 November 2014 and was unannounced.

Hafod provides nursing care for 29 people who require nursing care. 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 to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider. 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.

People were not always supported safely when equipment was used such as a hoist. Risk assessments were in place so staff had the information to assist people safely, However staff did not always following instructions so people were not always transferred safely. This resulted in a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Regulation 9 You can see what action we told the provider to take at the back of the full version of this report.

The manager told us some people lacked the capacity to make some decision about their care however no formal assessments had been made to establish what abilities people did have to make specific decisions when they needed to. The manager told us that although she was aware of the MCA she was unsure of the procedure to take. The manager had not updated her knowledge in relation to the MCA so application had not been made to ensure people’s rights were protected. This resulted in a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 18 2010. Regulation.

We observed staff caring for people and this showed that staff were kind and compassionate and listened to people.

We saw that people’s dignity was not always maintained because some staff were not always discreet when assisting people.

People told us they felt safe and staff were kind. People knew who they could talk to if they were concerned. People told us that they felt confident they were listened to and taken seriously.

Staff were recruited safely so that only suitable people were recruited to work in the home.

People’s health care needs were met because they were supported to see healthcare professionals when needed and they received their medicine as prescribed.

People had equipment to support them and were encouraged to be as independent as possible.

We saw that systems were in place to monitor and check the quality of care provided. However these systems were not always used effectively so people were supported safely at all times.