This responsive inspection took place on 12 September 2018 and was unannounced. The last inspection of the service was 28 and 29 September 2016. The service was given a good rating with no breaches of regulations. The purpose of our inspection on 12 September 2018 was to focus on two key questions; safe and well-led, after a recent significant incident had occurred. We did not identify any immediate risks but found areas which could be improved upon.

Hasley House is a care home with nursing. People in care homes receive accommodation and nursing 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 service can accommodate up to 89 people. At the time of our inspection there were 79 people using the service.

At the time of our inspection 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.

During our inspection we found the service had not always ensured people were safe and protected from hazards in line with their assessed needs. Following a serious incident, the service had reviewed their processes and had taken actions to safeguard people in their care. However significant shortfalls contributed to avoidable harm and this resulted in a breach of Regulation 12 of the Health and Social Care Act: Safe care and treatment.

People were safeguarded from abuse as far as reasonably possible because staff received the necessary training to help them recognise abuse. They had access to policies and procedures so they knew what actions to take. The service reported concerns to the safeguarding team but since the last inspection failed, on two occasions, to report these to the CQC. This resulted in a breach of Regulation 18: Notification of Incidents – CQC (Registration) Regulations 2009 (Part 4)

Care plans included a health profile which described people’s physical, mental health and well-being and helped staff provide holistic care.

The environment provided people with comfortable accommodation which was flexible around their individual needs. The service promoted people’s independence and right to positive risk taking and control over their lives.

We observed people received kind, considerate care by staff mostly familiar with their needs. Recently the service had been using regular agency staff to cover staff vacancies or to support existing staff whilst new staff were being inducted. Ongoing staff recruitment meant vacant posts were being filled and there was a gradual reduction in the use of agency staff.

People’s needs were being reassessed to help ensure that the service could continue to meet their needs safely and in line with current staffing levels.

The service had a registered manager. They said they felt well supported but it was clear that the last year had been difficult in terms of staff recruitment and having effective deployment of staff to meet people’s needs. The deputy manager had recently left which had left the registered manager short within the management team. A deputy and assistant deputy manager had been recruited in the last two months which had helped to improve the overall quality of the service people were receiving.

Recent audits had helped to clearly identify where the service needed to make improvements and audits identified timescales and who should carry out any necessary actions.

Medication audits were in place and the service identified where things needed to improve. Action plans were in place to help ensure people received their medicines safety and medicines were available as required.

The cleanliness and maintenance of the service was good and the e

Halsey House is a residential home that provides care, support and accommodation for up to 89 older people, some of whom may be living with dementia. Danbury Lodge is located in the grounds of Halsey House and is a specialised dementia unit. Danbury Lodge is included in the registration for Halsey House. At the time of our inspection there were 16 people living in Danbury Lodge and 66 people living in Halsey House.

The service had 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.

Halsey House was a well led service, with strong values and a vision to involve people as much as possible and continually improve people’s experience. The service adopted various initiatives such as Namaste Care (a sensory program designed to improve the quality of life for people with advanced dementia.) We saw evidence that these initiatives had a positive impact on people and significantly improved their lives and wellbeing.

The service had achieved repeated accreditation to the “Six Steps to Success” (a nationally recognised end of life care programme). Halsey House had also adopted the principle of Advance Care Planning from the Gold Standards Framework (an accredited, systematic evidence based approach to optimise care for people approaching the end of life). In addition, the service had integrated Namaste care into its palliative and end of life care approach. It was evident that these approaches also had a positive impact on people by enabling people to live well until the end of their lives.

People lived in a safe environment because staff knew how to recognise signs of possible abuse and knew the correct procedures for reporting concerns. Staffing levels were sufficient to meet people’s needs and appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home.

Identified risks to people’s safety were recorded on an individual basis and there was guidance for staff to be able to know how to support people safely and effectively. The premises were well maintained and any safety issues were rectified promptly. Medicines were managed and administered safely in the home and people received their medicines as prescribed.

People were supported effectively by staff who were skilled and knowledgeable in their work and all new members of staff completed an induction. Staff were supported well by the manager and the provider.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS), and to report on what we find. The manager and staff understood the MCA and ensured that consent to care and treatment was sought in line with legislation and guidance.

People had enough to eat and drink and enjoyed their meals. When needed, people’s intake of food and drinks was monitored and recorded. Prompt action and timely referrals were made to relevant healthcare professionals when any needs or concerns were identified.

Staff in the home were caring and attentive. People were treated with respect and staff preserved people’s dignity. Visitors were welcome and people who lived in the home were encouraged and supported to be as independent as possible. People were also able to follow a wide section of pastimes or hobbies of their choosing.

Assessments were completed prior to admission, to ensure people’s needs could be met. People were involved in planning their care and received care and support that was person centred and individual to their needs. Risk assessments detailed what action was required or needed to be carried out to remove or minimise any identified risks.

People and their families and frien

We spoke one person who told us, “I can’t fault it here, it’s brilliant.” Other comments included, "I have no complaints, what have I got to complain about, look at it…” “It’s very well led.” “It’s all good here.” “Staff are very good, all of them.”

We found that staff obtained people's consent before care and treatment was provided. We found examples where people hadn't agreed to something and their wishes had been respected and their decision upheld. Where someone's capacity to consent was in doubt over a significant decision staff knew what action to take and were aware of their responsibilities under the Mental Capacity Act.

Care plans were well organised. We found risk assessments that were generic in nature supported by risk assessments specific to the individual. These individual risk assessments resulted in care plans personal to the individual. For example, we saw detailed plans in place to support one person who on occasion presented challenging behaviour.

Staff we spoke with were clear about safeguarding and training had been booked for those where it had become due. The provider's policies were considerably out of date and were being revised at the time of our inspection.

Staff recruitment processes were robust and systems were in place to ensure that the service being provided was monitored on an ongoing basis to ensure the quality of the service provision.

One person told us that, “I am happy here and feel involved in the home and what goes on here.” Another person told us, “The staff are always very polite to me and ask my permission before trying to help me”. This showed us that people’s privacy, dignity and independence were respected. People’s care and welfare needs were recorded in detail and their care plans showed that they were being met in line with people’s assessed needs. This demonstrated to us that people experienced care, treatment and support that met their needs and protected their rights.

Systems were in place to record when medicines were received into the service, when they were given to people and when they were disposed of. Those seen were completed appropriately and provided an audit trail of medicines in use. This showed us that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Staff told us that there was a good provision of training opportunities in the home. We saw that all the staff who worked in the dementia unit had received additional training in dementia awareness. This demonstrated to us that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Information about making a complaint was present in the service user guide. This showed us that there was an effective complaints system available for the people using this service.

People with whom we spoke told us that they were happy with all aspects of the service. One person told us they were, "Very fortunate to be here, the care is excellent." Another person told us that his wife had been well looked after since moving to Halsey House. People in two of the areas of the house told us there were not a lot of social and recreational activities going on. The manager was aware of this and had taken steps to address it.

People told us that the staff were very good. one person said, "I get on well with the staff, I never feel worried or afraid about who is coming on duty." We were told that there were a lot of agency staff working in the home. One person said they thought this affected their care but others did not.

Everyone we spoke with said they liked their bedrooms. One person said, "The building is first class and the rooms are lovely, very comfortable."