About the service:

Little Hayes 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. Little Hayes is registered to provide accommodation and personal care for up to 34. At the time of the inspection there were 18 people living at the service, most of whom were living with dementia.

What life is like for people using this service:

• We found further improvement was needed to the home’s environment to make it safe and more supportive of the people who lived there. Staff did not always follow best practice guidance for managing medicines. Some people were at risk of being deprived of their liberty unlawfully and more information was needed to help ensure people’s end of life wishes and preferences would be met.

• There was a new management team in place. Quality assurance systems were still being developed and further time was needed for them to become fully effective.

• However, people were happy living at Little Hayes. They told us their needs were met in a personalised way by staff who were competent, kind and caring. They said the culture of the service had improved and was more person-centred.

• People were empowered to make all their own choices and decisions. They were involved in the development of their personalised care plans that were reviewed regularly.

• People knew how to raise concerns. They had confidence in the home manager and told us they would recommend the home to others.

• The service has been rated requires improvement as it met the characteristics for this rating in three of the five key questions. More information is in the full report, which is on the CQC website at: www.cqc.org.uk

Rating at last inspection:

The service was rated as requires improvement at the last full comprehensive inspection, the report for which was published on 27 February 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Little Hayes 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.

The home accommodates up to 34 people and at the time of our inspection 27 people were living at the home. The home was based on two floors connected by two passenger lifts. There was a good choice of communal spaces where people were able to socialise and all bedrooms had en-suite facilities.

This inspection took place on 18 and 19 January 2018 and was unannounced. It was prompted by concerns identified at another service operated by the directors of the provider’s company where systematic failings were found.

There was a registered manager in post at the service. 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 and associated Regulations about how the service is run.

We found the governance arrangements were not effective in ensuring the provider met their legal obligations and the service made necessary improvements in a timely way. Recommendations made by professionals from the Clinical Commissioning Group (CCG) had not been implemented.

An action plan to make improvements to the premises did not include all of the work that was required. A structural defect identified a year ago had not been repaired. Audits completed by managers had not always led to improvements and there was no process in place to audit people’s care plans.

We found some individual and environmental risks to people were not managed effectively. Risk assessments relating to the use of bed rails and for a person at risk of choking had not been completed. We also found two fire doors were wedged open which would have posed a risk in the event of a fire. However, people were protected from the risk of falling and developing pressure injuries.

Infection control procedures in the laundry were not effective, although staff used personal protective equipment to reduce the risk of cross contamination when supporting people with personal care.

Appropriate recruitment procedures were in place, although these were not always followed.

Staff received training to help ensure they could meet the needs of the people they cared for. Some refresher training was overdue, but this had been scheduled. Staff said they felt supported in their work by the management.

Staff followed the principles of legislation designed to protect people’s rights. However, the views of family members involved in decision making were not always recorded and managers were not clear about the criteria for applications to deprive people of their liberty.

Staff demonstrated an in-depth knowledge of people and their needs. However, people’s care plans did not support staff in the delivery of personalised care as information in them was not always accurate or up to date.

People were supported at the end of their lives to have a comfortable, dignified and pain-free death, although people’s wishes and preferences were not always recorded. This posed a risk their wishes might not be followed.

Effective systems and processes were in place to protect people at risk of abuse and staff understood their safeguarding responsibilities. There were enough staff deployed to meet people’s needs. Medicines were managed safely and people were supported to take their medicines as prescribed.

People were usually supported to access healthcare services when needed, although referrals were not always made to speech and language therapists when needed. There were clear procedures in place to help ensure people received consistent support when they moved between services.

Adaptations had been made to the home to make it suppo

This inspection took place on 13 and 15 June 2017 and was unannounced. The home provides accommodation for up to 32 people, including some people living with dementia care needs. There were 26 people living at the home when we visited. The home was based on two floors connected by two passenger lifts; there was a good choice of communal spaces where people were able to socialise; all bedrooms had en-suite facilities.

There was a registered manager in place. 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 had access to a range of activities, but we found these were limited and were not tailored to meet people’s individual interests. The registered manager acknowledged that activity provision was an area for improvement and was trying to recruit an activity coordinator.

Most people told us staff encouraged them to make choices, although two people said their preferences for their daily routines were not always met. The registered manager took immediate action to address this.

People felt safe living at Little Hayes. Staff knew how to identify, prevent and report abuse. They assessed and managed individual and environmental risks effectively.

There were enough staff to meet people’s needs in a timely way. Appropriate recruitment procedures were in place and most pre-employment checks had been completed fully before staff started working with people.

Arrangements were in place for the safe management of medicines. People received their medicines at the right time and as prescribed. The home was clean and staff followed appropriate procedures to prevent and control the risk of infection.

People and relatives praised the standard of care delivered and the quality of the meals. People’s dietary needs were met and they received appropriate support to eat and drink enough.

Staffed received regular training and felt supported in their role by managers. They followed legislation designed to protect people’s rights and freedom and supported people to access healthcare services when needed.

People were cared for with kindness and compassion. Staff protected people’s privacy and dignity. They encouraged people to remain as independent as possible and involved them in planning the care and support they received.

People’s personal care needs were met in a personalised way. Each person had a comprehensive care plan centred on their individual needs. The provider sought and acted on feedback from people. People knew how to make a complaint, though no complaints had been recorded.

People and their relatives felt the service was run well. There was a clear management structure in place. Staff enjoyed working at the home and told us they felt valued and listened to by management, who they described as “approachable”.

A quality assurance process was in place to assess and monitor the service. There was an open and transparent culture where visitors were welcomed at any time. Staff enjoyed positive working relationships with external professions and the provider notified CQC of all significant events.