Hartford Hey is a residential care home which provides accommodation and personal care for up to 28 older people, some of whom have dementia. At the time of our inspection, 20 people were living at the home.

At the last inspection, the service was rated Good. At this inspection, we found the service remained Good.

People still felt safe living at the home. Staff had received training in, and understood, how to recognise and report abuse. Plans were in place to reduce any risks to people's safety and wellbeing, which staff were aware of and followed. People’s needs were met safely, as appropriate staffing levels were maintained. People’s medicines were handled and administered by trained staff in accordance with the provider’s procedures.

People still had confidence in the knowledge and skills of the staff supporting them. Staff received a structured induction, and had ongoing training and support to enable them to work effectively. People's right to make their own decisions was understood and respected by staff. People’s dietary and nutritional needs were assessed and managed, with appropriate specialist input. People were supported to access professional medical advice and treatment when they needed this.

Staff treated people in a kind and caring manner, and took the time to get to know people well. People's involvement in decision-making that affected them was encouraged, and their views on the service were welcomed by the provider. Staff treated people with dignity and respect.

People received care and support that reflected their individual needs and requirements. They had support to participate in a range of social activities. People knew how to raise complaints and concerns about their care, and felt comfortable doing so.

The management team promoted an open, ongoing dialogue with people, their relatives and the community professionals involved in their care. Staff were clear what was expected of them at work, and had confidence in the management team’s ability to act on issues. The provider carried out audits and checks to assess, monitor and improve the quality of the service people received at Hartford Hey.

Further information is in the detailed findings below.

We visited this service on 13th May 2015 and the inspection was unannounced.

The last inspection was carried out on 23 June 2014 and we found that there were breaches in the regulations. We asked the registered provider to take action to make improvements with the assessment of people’s needs; meeting nutritional needs; and quality assurance. We received an action plan from the registered provider and they stated they would meet the relevant legal requirements by 31st December 2014. We found on this inspection that these actions had been completed and the necessary improvements made.

Hartford Hey is a residential care home which provides personal care and accommodation for up to 28 older people. At the time of our visit there were 22 people living at the home.

There was a new manager in post and they had started the process to register with the Care Quality Commission. 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 told us that they felt safe at the service and that the staff understood their care needs. People commented “I like it here”, “The staff are lovely”, “I have no complaints” and “The staff are lovely, couldn’t be better.” People told us the food had improved. People said they enjoyed the meals and now had a choice of meals.

We found the registered provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. Policies and procedures related to safeguarding adults from abuse were available to the staff team. Staff had received training in safeguarding adults and during discussions said they would report any suspected allegations of abuse to the person in charge or the local authority safeguarding team if appropriate. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at the service.

The registered provider had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), safeguarding and staff recruitment.

We found that people, where possible were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the GP, where it had been identified that there were changes in someone’s health needs. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and caring towards people who lived at the service.

The home was clean, hygienic and well maintained in all areas seen.

We found that care plans contained good information about the support people required and were written in a way that recognised people’s needs. We saw that care plan reviews were completed and up to date.

We saw that medication administration and records were completed appropriately, which helped to ensure that people who used the service received their medication as prescribed.

There were good recruitment practices in place and pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people who lived at the service could be confident that they were protected from staff that were known to be unsuitable.

There were enough staff working at the service to meet people’s needs. An activities coordinator was employed at the service. A range of activities were undertaken throughout the week. Staff had undertaken a range of training. This included moving and handling, food safety, first aid, dementia awareness and dignity and nutrition. Staff had regular supervision sessions and the opportunity to attend staff meetings.

People told us they would approach the management if they had any concerns about the service. We saw the complaints policy and the documentation used during the complaints process. People having access to the complaints policy helped ensure that people had the opportunity to raise concerns and that they were encouraged to voice their concerns.

The registered provider had a range of quality assurance systems in place. When concerns were noted these had been followed up and this meant that shortfalls identified in the service provision were addressed.

We considered our inspection findings to answer questions we always ask; Is the service Safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

This is a summary of what we found.

Is the service safe?

Fire equipment at the home had been well maintained and serviced regularly.

People who used the service told us they felt safe at the home. Comments from them included; "Oh yes, I feel safe. They take a lot of anxiety and worry away from me". All of the relatives we spoke with believed their relative was safe at the home.

Is the service effective?

People told us they were happy with the care provided and their needs had been met. Our observations and discussions with staff showed they were knowledgeable about the people they supported.

Six people who used the service told us they did not get a choice of what they wanted to eat for their main meal. We saw one staff member did not offer people an alternative choice of hot food when they did not like the meal provided during the lunchtime period of our visit. A person who used the service told us; "I'll be honest. I don't know what the chef looks like. It would be nice if he came to ask us what we wanted to eat".

We found people had access to external healthcare services such as GP's, District Nurses and the continence care team.

Is the service caring?

We saw that people were supported by staff who were kind and caring towards them. We saw staff and people who used the service interacted well with each other throughout our inspection. People were seen to be comfortable with the staff who supported them. People told us they were able to express their views and were involved in making decisions about their care. Comments from people included; "The staff help me relax. They always check on me throughout the day and the night and bring me a hot drink" and "The girls are very nice".

Is the service responsive?

We saw that before a person started to use the service, an assessment of their needs and abilities was undertaken. However, the care plans we looked at were not centred on the person and did not always show how the needs of the people who used the service were to be met, including any risks to their well-being. Care plan reviews did not always pick up the changes to people's needs and people were at risk of receiving care that was not safe or appropriate. However, a relative of a person who used the service told us; "The staff are friendly and approachable and are responsive to Mum's needs".

Is the service well led?

The registered manager had been in place for a long period of time at the home. Staff, people who used the service and the relative's spoken with spoke highly of the manager and said they were listened to when concerns or suggestions were made.

The service did not have an effective system in place to monitor the quality of the service provided. Systems were not in place for monitoring health and safety and medication management at the home.

We looked at three care records and all had an assessment of their health and social needs completed.

We spoke with six people who lived at Hartford Hey, one relative, three staff and four professionals involved in the home. Comments included “The staff are very friendly”, “I have no complaints”, “I have been involved in my care plan”, “The staff are always caring and kind” and “It’s a homely service.” All people spoken with said they didn’t have any concerns or complaints. Staff commented “The staff team get on well together”, “I like the people who live here and the interactions with them”, “We have regular staff meetings” and “The manager is very good and understanding.”

We looked at staffing levels at the home. We saw the rota and discussed staffing issues with the manager.

We saw that the home had not received any formal complaints in the last year and we had not received any complaints about Hartford Hey.

We observed interactions between the people who lived at Hartford Hey and the staff during the morning and found there was a relaxed and friendly atmosphere within the home. We saw during a tour of the home that it was clean and odour free.

The people we spoke with said that they liked living in Hartford Hey and could make choices about how they spent their day.

People said “the home is really good, the girls look after me in the way I want.” “I have not been here long but I am settling in well”, “This is a very nice place. You can stay in your room if you want to and no one minds. “

They said that they felt well cared for and happy at Hartford Hey. One person said, “The home is lovely , I have my things around me to make me feel better.” Other people spoken with said, “I fell well looked after here “, “I have no issues it is a good place to live.”

Relatives spoke with said, “This is a really good home, my relative is well looked after and I am kept informed of any changes that happen.”

People we spoke with said they felt safe and happy at Hartford Hay.

One person said, “I know who to talk to if I have any concerns. “Another said, “I could talk to any of the girls if I had a problem.”

They told us that, “the girls are really lovely and look after me well.” “I feel well supported by the staff here”, “we can have a laugh with all the girls.”

People we spoke with at Hartford Hey said they have meetings with the manager to discuss anything they want to.