Hadrian House 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.

Hadrian House is a care home for a maximum of 43 people with a range of care needs, including needs associated with ageing, dementia, sensory impairment and physical disabilities. The service is in Thurmaston, Leicestershire. The building has two floors. All bedrooms are single rooms. There are many communal lounges within the home and one large dining room (although people can eat in smaller rooms if they wish). At the time of our inspection visit, 40 people lived in the home.

At our last inspection we rated the service as ‘good’. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service continued to be safe. There were enough staff on duty to meet people’s needs; and checks had been made on staff before working for the service to make sure they were safe to work with people. Staff understood how to safeguard people from harm and knew the risks to people’s health and wellbeing. People received their medicines as prescribed. The home was clean and tidy and staff understood infection control practice. Premises were well-maintained.

The service continued to be effective. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The principles of the Mental Capacity Act (MCA) were followed. Staff received training to support them work effectively with people who lived at the home. People had access to different health and social care professionals when required, and good relationships had been formed between the service and those professionals. People received food they enjoyed, and choices with each meal.

The service continued to be caring. People received care from staff who were kind, treated them with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. The service supported people to maintain and develop relationships with their family.

The service continued to be responsive. People’s needs were assessed and staff were responsive in ensuring their needs were met. The appointment of a new activity co-ordinator had improved the range of activities available to people. The small number of complaints had been responded to well. The service ensured people’s end of life care needs were met.

The service continued to be well-led. Management acknowledged there had been a period since our last visit where standards in the home had dropped, however the new registered manager and the provider had worked hard to ensure the home returned to providing a good quality of service. They provided good support to the staff group, and to people who lived at the home. Checks were made to ensure the service met its obligations to provide safe accommodation to people and to deliver care and support which met people’s individual needs.

Further information is in the detailed findings below

We inspected the service on 7 June 2016 and the visit was unannounced. We returned on 13 June 2016 and this was announced.

Hadrian House is a purpose built care home that provides care without nursing for up to 40 people. At the time of our inspection there were 38 people using the service.

The service had a registered manager. 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 felt safe and staff knew how to protect them from abuse and avoidable harm. The service had safeguarding and whistleblowing procedures in place. Staff were aware of their responsibilities in these areas.

The registered manager investigated accidents and incidents to reduce future risk. Where people were assessed as being at risk there were plans in place that were available to staff to minimise risk.

There were emergency plans available to support people in the event of emergencies such as fire and loss of services.

People felt there were enough staff available. The provider’s recruitment processes were robust and included checking prospective staff before they started to work at the home.

People received their medicines at the right times. The provider had safe arrangements for the management of medicines.

People received support from staff who had the appropriate skills and knowledge to support people. Staff had received regular training in areas relevant for the people they supported.

Staff knew about their roles and responsibilities. Staff received an induction when they had started in their role and on-going support from the registered manager.

Staff understood the relevance of and acted in accordance with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when they supported people.

People liked the food that was offered to them. They were supported to choose a healthy diet and their preferences and special dietary needs were known by staff.

People had access to healthcare professionals to maintain good health. Staff monitored people's wellbeing and acted promptly where concerns were identified.

Staff developed caring relationships with people and understood people’s needs and preferences. People’s dignity and privacy was promoted by staff.

People’s care plans were focused on their individual needs. People were supported to maintain their independence. They were able to follow a range of hobbies and interests. People using the service and their relatives knew how to raise concerns and their views were acted upon.

Where people could, they had been involved in and had contributed to the planning and reviewing of their care and support. Where this had not been possible, relatives had been included.

People’s support plans were individual to them and written in detail so that staff would know how to offer care and support.

People using the service, their relatives and staff were involved in developing the service. The provider acted upon their feedback. The registered manger and senior staff monitored staff care practice.

The provider had effective procedures for monitoring the quality of the service and took action to make improvements in areas identified by them as requiring improvement.

The registered manager was described as approachable and supportive.

Staff were clear about their roles and responsibilities. They knew how to raise concerns if they had needed to about the practice of a colleague. Staff were able to make suggestions for how the service could improve.

The registered manager understood the requirements of their role. They had carried out quality checks to monitor and improve what the service was offering people.

We spoke with six people, two visitors to the service and six members of staff. We also reviewed five care records and four staff files.

We viewed one record for a person who was deemed to lack capacity to make an informed decision. We saw that the person had access to a financial advocate and a personal representative had been made available to them.

We noted from the monthly weight recordings that one person who used the service had lost a considerable amount of weight in a month. We asked the manager to demonstrate the action taken. We saw that the General Practitioner had been consulted, the person had been referred to the dietician and a food and fluid chart was being completed.

We asked the domestics about their work pattern and saw a daily and weekly cleaning schedule. The domestic explained to us they had a programme of tasks to be completed on a daily and weekly basis.

We saw and heard evidence that all staff had received a recent supervision with their manager. We asked the staff we spoke with to describe to us how supported they felt. Their responses indicated that they were very well supported.

During our inspection we reviewed four sets of staff records. These were well organised and easy to follow. We noted all the files contained a robust recruitment and selection process, an induction programme, supervision evidence and a comprehensive collection of certification for completed training and development.

We spoke to six people who used the service, five members of staff. We also reviewed four care records and four staff files.

People who used the service understood the care and treatment choices available to them because we saw evidence of the completion of a listening form. The forms included questions on what the person liked most and least about their care, their meals, the environment and their activities and leisure time

We reviewed the care record of one person who had recently commenced using the service. The record detailed a comprehensive pre assessment and information had been obtained from the person and a variety of health professions.

We reviewed the training matrix for all the staff. We noted that seventeen members of staff had been trained in safeguarding in the three months since our last visit.

The people we spoke with also told us that they felt there were enough staff to support them. One person explained: “The staff have time for me. They can be a bit rushed but they always respond when I need them and they are always helpful”.

We saw an hourly walk round of the premises conducted by a senior member of staff. The walk round consisted of observational checks on personal care, staff interaction, activities, general atmosphere and the environment.

We undertook our visit jointly with the local authority compliance team who were undertaking a follow up visit following an inspection they made on 23 November 2012.

We spoke with nine members of staff and six people who used the service. We also reviewed five care plans.

People told us they were generally content with the service and all the people we spoke with told us they felt safe. Most of the people we spoke with felt involved in their care. One person we spoke with told us:" I am happy here".

However one person told us: “I was dragged out of bed and I feel rushed. CQC alerted the staff to the situation. The staff intervened and the person became settled. Another person told us:” The staff don’t talk much because they are so rushed”.

We saw there were opportunities to join in activities, however on the day of our visit we saw very little recreational or therapeutic stimulation for the people who used the service.

We spoke to a member of staff who told us: “There are not enough seniors to cover all of the shifts.” Another member of staff told us; “I worked the late shift then slept here last night and I am now working the early shift. I hate it.” Another member of staff told us: “The work load is demanding. I was absolutely on my knees on my last shift, we don’t get breaks, just the odd five minutes here and there.”

We saw little evidence of a quality assurance programme.

During this inspection we spoke with seven people who used the service, one relative, and six members of staff. Below is a summary of what we found. The summary describes what we observed, the records we looked at, and what people using the service, their relatives, and the staff told us.

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

Is the service safe?

The people who used the service told us they felt safe in the home and trusted the staff. One person told us, “If I was not happy with something I’d go to the care staff or the manager.” Another person said, “If there was a problem I’d talk to one of the girls (the care workers) and if nothing was done I’d tell the manager or social services.”

At our first visit to the home on 16 April 2014 the area manager told us that following recent safeguarding concerns being raised, staff had had further safeguarding training. We spoke with two care workers and both were clear about their responsibilities in this area. One care worker told us, “I wouldn’t hesitate (to report a safeguarding concern).”

We looked at the management of medication in the home. People told us they received their medication on time and when they needed it. One person said, “The staff bring me my medication twice in the morning and then during lunch and tea. It’s nice that I can rely on them to do this.”

At our second visit to the home on 29 April 2014 we followed up an incident reported to us by the home regarding some missing medication. The home had taken appropriate action when the error was discovered.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

The people who used the service told us they liked living at Hadrian House. One person said, “It’s a pleasant place and easy to get to know people here. If I need help I just ask the staff.” Another commented, “If I want to see a doctor one of the staff takes me to the surgery.”

At our first visit to the home we looked at falls management as concerns had been raised about this with us and the local authority. The area manager told us she had introduced a weekly and monthly falls audit. We looked at the records for March and the beginning of April 2014. These showed that falls had been analysed and action taken to minimise risk.

We looked at the care of people who were prone to falling. They had detailed care plans and risk assessments in place to advise staff on how to care from them safely. One person had been referred to an occupational therapist who had advised staff on how to prevent them falling. Other people’s care plans and risk assessments showed similar interventions had been used to minimise the likelihood of falls.

At our second visit we looked at pressure area care. Prior to this visit a local authority social worker had twice found a person left in an armchair without a pressure cushion in place. This was despite this person having their own pressure cushion and a care plan saying it should be used at all times when the person was seated.

We discussed with the area manager who said that on both occasions staff had forgotten to bring the cushion through to the lounge. The area manager said this was unacceptable and she had taken steps to ensure it would not be forgotten again. These included labelling pressure cushions with their owner’s names, and reviewing all care plans and risk assessments to ensure information about pressure care was highlighted.

Is the service caring?

People told us they were pleased with the staff at Hadrian House. One person said “The staff have got a good attitude and are nice and friendly.” Another commented, “I am happy with the staff particularly when they go out of their way to talk to me.”

One person described the relationship they had with a particular staff member. They told us, “X (a care worker) is so thoughtful. She always brings me something back from her holiday. And when she’s on the evening she comes and sits on the edge of my bed and talks to me. I love it when she does that, it makes me feel really special.”

Prior to our inspection concerns were raised with CQC and the local authority about the quality of care at night. This had resulted in the local authority carrying out a night visit in March 2014 to check how people were being cared for. The local authority concluded that care at night was not always of the required standard.

At our first visit to the home we discussed this with the area manager who said action had been taken to address the problem. This included changes to the staff team, further staff training, and monitoring handovers and night-time records to help ensure care at night was effective and safe.

Is the service responsive?

We toured the premises and saw that although the home had a range of lounges (six in total), most people were using the main lounge near the entrance to the building. This made the room busy with almost every chair occupied, visitors and staff coming and going, and the television on at one end of the room. One person who used the service told us, “Sometimes I can’t hear myself think in here it’s so noisy.” But another person said they liked the main lounge because there was ‘a lot going on’.

We looked at the other lounges. All were empty apart from the smoking lounge which one person was using. One of the lounges, known as the ‘reminiscence room’, had been transformed into a 1950s parlour with period furniture, decoration, and household items. A lot of work had gone into this room and there was plenty for people to see and do, but it was a long way from the main lounge and not being used.

We discussed this with the area manager and the acting manager. They suggested moving the ‘reminiscence room’ to a large office adjoining the main lounge to make it more accessible, and providing organised activities such as crafts and games in some of the lounges to tempt people to use them and ease the pressure on the main lounge. They said they would discuss these suggestions with the provider with a view to implementing them.

Is the service well-led?

The home had been through a time of change. The registered manager was no longer in post, although her name appears on this report as the provider has not yet applied to deregister her. At our first visit to the home an area manager was in charge, while a newly appointed acting manager was being inducted. We met the new acting manager when we returned to the home for our second visit.

We discussed how the people who used the service and their relatives were involved in the running of the home. The area manager told us monthly residents meetings and quarterly relatives meetings were in progress. We saw posters for these in the foyer. The provider also published quarterly newsletters to keep people up to date with events at Hadrian House and its other homes.