This comprehensive inspection took place on 29 June 2018. This was an unannounced inspection which meant the staff and registered provider did not know we would be visiting. The service was last inspected on 22 May 2017 and was rated as Requires Improvement.

Haythorne Place is a ‘care home’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. Haythorne Place is registered to provide accommodation, nursing and personal care for up to 120 people. The service is divided into six houses and a main office. Each house can accommodate up to twenty people. One house accommodates younger people with physical disabilities, another house specialises in the care and support of people who live with mental ill health. Four houses accommodate older people. Two of these provide support for people living with dementia. At the time of our inspection, 111 people were living at the service.

The manager had registered 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.

At our last inspection in May 2017 we found concerns about the premises and equipment at the service. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan with details of the improvements they planned to make to meet the requirements of the regulation. At this inspection, we saw that action had been taken and was still on going to continuously improve the premises and equipment at the service. We found sufficient improvements had been made to meet the requirements of the regulation.

Following the inspection, the group director of operations and compliance informed us that all the outstanding premises and equipment action had been completed, meeting the provider’s deadline of July 2018.

During the inspection, we found some concerns about the staffing levels in some of the houses. This was reflected in the feedback we received from some of the people using the service and relatives we spoke with. Some of the staff we spoke with also shared some concerns about staffing levels at the service. We shared these concerns with the regional operations manager and the registered manager.

Following the inspection, the regional operations manager informed us the staffing levels within some of the houses would be increased immediately and the registered manager would recruit additional care staff for the service to cover the increase in hours. We will monitor this at our next inspection.

During the inspection, we found some concerns about cleanliness within some of the individual houses. Following the inspection, the registered manager confirmed action had been taken to improve the cleanliness of these areas. We have made a recommendation about the management of cleanliness at the service. We will monitor this at our next inspection.

We received mixed reviews from people and relatives about the quality of care at the service. Some people and relatives we spoke with were satisfied with the quality of care provided, whilst others were less satisfied. We saw the level of satisfaction expressed by people and relatives corresponded to concerns about staffing levels and/or cleanliness within the house people lived in.

The registered provider had a process in place to respond to and record safeguarding concerns. Staff confirmed they had been provided with safeguarding vulnerable adults training so they understood their responsibilities to protect people from harm.

People

The inspection was carried out 22 May 2017 and was unannounced, which meant the provider and staff did not know we would be visiting. The service was last inspected in May 2016 at which time the service was rated as Requires Improvement.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Haythorne Place’ on our website at www.cqc.org.uk’

Haythorne Place is registered to provide accommodation, nursing and personal care for up to 120 people. The home is divided into six units. One unit accommodates younger people with physical disabilities, another unit specialises in people with mental health problems. Four units accommodate older people. Two of these provide support for people living with dementia. The home is situated in the Shiregreen area of Sheffield and has access to the shops, public transport and other amenities. At the time of our inspection 115 people were 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 home was clean in the main; however the décor looked tired and worn. Some outside areas posed a potential risk to people because they had been poorly maintained and designed.

The home had a safeguarding policy in place to protect people from the risk of abuse. Staff we spoke with knew the importance of reporting any incidents. Assessments identified risks to people and management plans to reduce the risks were in place. Where safeguarding alerts had been submitted for investigation the registered manager acted appropriately to address issues and prevent them re-occurring.

We received positive feedback from people who used the service and their relatives. People we spoke with told us they felt safe and relatives also said the home provided safe care.

People were really clear about who they could turn to if they were worried or had any concerns. The staff were also aware of the role they played in keeping people safe by reporting any concerns.

Accidents and incidents were appropriately recorded, however, more detail should be added to identify any trends and prevent further incidents re-occurring.

There was an infection control policy and a procedure in place, Staff were trained in the prevention and control of infection, wore clean uniforms and wore appropriate personal protective equipment (PPE), such as gloves and aprons when providing care and when serving food. At the last inspection of the service we identified areas within each house that required improvement. At this inspection there remained several areas which required cleaning and refurbishment.

The registered provider had a policy and procedure in place for the safe management of medicines. Staff were working in accordance with this policy which assisted in keeping people safe and well.

During the day staffing numbers were sufficient to meet people's needs. Some people felt staffing numbers during the night should be increased.

Staff employed at the home had been recruited in a way that helped to keep people safe because thorough checks were completed prior to them being offered a post.

People and their families were involved in making decisions about their care. A range of healthcare

professionals visited the home to offer support and advice to staff about people's varying needs.

In the main people said the food provided was good and there was plenty of choice available.

People who used the service and their relatives spoke positively about the staff and told us they were kind and caring. We saw staff advising and supporting people in a way that maintained their privacy and dignity. Staff observed were caring towards people and h

This inspection took place on 4 May 2016. The inspection was unannounced which meant the staff and provider did not know we would be inspecting the service.

The service was last inspected on 26 August 2015. At that inspection we found the service was in breach of regulations in that people had not received care and treatment that met their needs, and not had appropriate arrangements in place to manage medicines, and had failed to effectively operate systems and processes to protect people from abuse and improper treatment. The provider had failed to ensure that there were sufficient staff deployed and had failed to ensure that staff received the appropriate training. The provider did not have effective systems to monitor the quality of the service, and had not ensured that accurate and complete records were kept in respect of each person.

As a result the service had been rated Inadequate. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Haythorne.Place’ on our website at www.cqc.org.uk’

Haythorne Place is a nursing home for up to 120 people. The service is divided into six houses, each providing accommodation for up to 20 people. One house accommodates younger people with physical disabilities, another house specialises in people with mental health problems. Four houses accommodate older people. Two of these provide support for people living with dementia. At the time of the inspection there were 100 people living at the service.

The home had a registered manager. 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.

During this inspection we found significant improvements had been made since our last inspection in August 2015.

We found that people had care and support plans in place, and care records reflected the care they required. The plans had been reviewed and updated when people’s needs had changed. People’s risk assessments had also been reviewed to ensure their safety.

The provider had ensured that an accurate, complete and contemporaneous record was maintained in respect of each person.

We found significant improvement in the arrangements for the recording, safe keeping and safe administration of medicines. Staff were aware of how to raise any safeguarding issues. We found the provider had ensured the service effectively operated systems and processes to protect people from abuse and improper treatment.

The provider had ensure that there were sufficient staff deployed to meet people’s needs and that staff received the appropriate training to enable them to carry out the duties. Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work.

The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that staff were following the code correctly, although some records were not detailed enough about how best interests decisions had been reached.

People told us they felt safe and were treated with dignity and respect. People were happy with the quality of care they had received and made positive comments about the staff.

People’s individual dietary needs and preferences were being met and we received positive comments about the quality of the food.

We observed some staff giving care and assistance to people throughout the inspection. Staff were respectful and treated people in a caring and supportive way.

Although we found that the standard of cleanliness, maintenance and décor was better maintained in some houses than in others, people were protected against the risks of inappropriate or unsafe care or treatment because the provider had effective systems to monitor the quality of the service provision. Most of the maintenance issues we found had been picked up by the provider

A scheduled inspection took place on 26 August 2015. The inspection was unannounced which meant the staff and provider did not know we would be inspecting the service. A scheduled inspection took place on 26 August 2015.

The service was last inspected on 9 September and 10 September 2014. At the last inspection we found the service was not meeting the requirements of the following regulations: care and welfare of people who use services and assessing and monitoring the quality of service provision. As a response to the last inspection the provider sent a report to the Care Quality Commission of the action they would take to become compliant with the regulations. The provider told us they would complete the actions for care and welfare of people who use services and assessing and monitoring the quality of service provision by the 31 December 2014.

Haythorne Place is a nursing home for up to 120 beds. The service is divided into six houses. One house accommodates younger people with physical disabilities, another house specialises in people with mental health problems. Four houses accommodate older people. Two of these provide support for people living with dementia. At the time of the inspection there were 118 people living at the service.

There was a registered manager for this service in post at the time of the inspection. The registered manager was on annual leave at the time of the inspection. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people were not protected against the risks associated with the unsafe management of medicines. We shared our concerns with deputy manager and regional manager during the inspection.

The provider had not ensured that an accurate, complete and contemporaneous record in respect of each person was maintained.

We found that some people had not received appropriate care. We shared our concerns regarding people’s individual care with the senior member of staff on duty in the house, the deputy manager and the regional manager.

People told us they felt safe and were treated with dignity and respect. People were satisfied with the quality of care they had received and made positive comments about the staff.

Relatives and people’s representatives felt their family member or friend was in a safe place. Relatives gave mixed views regarding the quality of care their family member had received.

People’s individualised diets were being met. We received both negative and positive comments about the quality of the food.

We observed some staff giving care and assistance to people throughout the inspection. People were respectful and treated people in a caring and supportive way. However, we also observed some staff were focussed on tasks and did not check on people’s wellbeing or check if they required assistance.

Although our discussions with staff told us they were aware of how to raise any safeguarding issues, we found the provider had failed to ensure the service effectively operated systems and processes to protect people from abuse and improper treatment.

Robust recruitment procedures were in place and appropriate checks were undertaken before staff started work. This meant people were cared for by qualified staff who had been assessed as suitable to work with people.

The provider had failed to ensure that there were sufficient staff deployed to meet the needs of people and that staff received the appropriate training to enable them to carry out the duties they were employed to do.

The service had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found that staff were not following the code correctly. We shared this information with the deputy manager and regional manager.

People were not protected against the risks of inappropriate or unsafe care or treatment because the provider did not have effective systems to monitor the quality of the service provision.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the back of the full version of this report.

The overall rating for this service is “Inadequate” and the service is therefore in “Special measures”. Services in special measures will be kept under review and if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We spoke with people who lived at the home, observed care in the communal areas, checked care plans and spoke with staff on duty during the day. We can confirm that the care given to people reflected what was written in their plans.

People’s care needs were followed up by risk assessments to make sure planned care minimised the risk to people and promoted their independence. One person told us, “I go out with one of the carers to town. I like the outings.”

The home was made up of six houses each had 20 bedrooms. We looked around three houses including some of the vacant bedrooms. The houses were kept clean and tidy. The environment looked homely. One person said, “I am happy with my room. I have a TV and I like watching my programs.”

People had access to safe and suitable equipment because the provider had made sufficient resources available so that people were supplied with correct equipment.

The manager followed the procedures when staff employed by them were no longer fit to work in health or social care.

There was an open and inclusive atmosphere at the home where people were able to air their feelings and speak to staff without fear.

We visited three of the six units. We spoke with eight people who lived at the service, three visitors and 12 staff.

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. One person said that staff included them in the discussions about their care and their family were also informed if changes were made. They said they were very satisfied. A further three people said that staff spent time explaining things to them and helping them with personal hygiene.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. One person and their relative told us that due to their condition the person needed a bedrail to help them stay in bed safely. They said the staff carried out an assessment and gave them options as to the best ways to be safe whilst in bed. Only when they had agreed to the plan bed rails were installed.

People said that they were confident that staff would respond and take action to make sure the people who lived at the home were protected from any abuse. A relative said that they had found the staff kind and compassionate towards people. Three people told us they were comfortable and did not have any fears about living at the home. One person said, “Girls are very good they are caring. They look after us well.”

An adult social care inspector and a specialist advisor visited the service. At the time of the inspection 118 people were living at the service. We observed the care people received; spoke with ten people and one relative. We also spoke with the registered manager, deputy manager, regional manager, three nurses, one senior care assistant, four care assistants, two domestic staff, one activities worker and an administrator. We also reviewed a range of records.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; 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?

All the people spoken with told us they felt “safe” and had no worries or concerns. One person told us staff listened to them and commented: “I would tell them [staff] if they were hurting me”. Another person commented: “I feel very safe and comfortable”.

We observed individual staff members treating people with respect.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). We found the DoLS checklist used by the service highlighted an apparent lack of Mental Capacity Act assessments and subsequent best interest process for residents with advancing and advanced dementia. This did not reflect the outcome of the recent Supreme Court ruling about people who are subject to continuous supervision and who lack the option to leave their place of care.

We found the arrangements in place to safeguard people using the service from financial abuse could be more robust.

Is the service effective?

People’s health and care needs were assessed and care plans formulated. However, a few people’s needs were not always being met in accordance with those plans.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to people’s care and welfare.

People were cared for by staff who were supported deliver care and treatment safely and to an appropriate standard.

Is the service caring?

People spoken with told us they were satisfied with the quality of care they had received. Their comments included: “they [staff] keep my room really clean”, “I am satisfied, I would tell them [staff] if I wasn’t”, “I feel a hundred percent better since I came to live here”, “the staff are kind. The food’s good too. I can’t stand up but they [staff] help me have a shower every few days”, “they [staff] look after me so well.” “all the things we’ve asked for, they do here”, “I feel safe here; they [staff] look after me” and “I’m so much happier here than the other place”.

We spoke with a relative about the quality of care that had been provided to their family member. Their comments included: “[family member] is so happy here. She looks outside and can see people walking about. She’s so much brighter and has even started to eat. She’s really well cared for”.

Is the service responsive?

People told us staff responded to their calls for assistance when they used their call buzzer in their room. Their comments included: “sometimes during the day it is busier and you have to wait longer for staff to come, sometimes they come immediately, sometimes it is five to ten minutes” and “I’m really happy here. I came from another place and the staff here are wonderful. They come when I ring the bell”.

The provider's complaints process was displayed in each house and in included in the service user information pack.

Is the service well led?

There was a range of quality monitoring checks in place to make sure the manager and staff learned from checks. However, our findings indicated the audits in place had not effectively identified the concerns we found during the inspection.

We have asked the provider to tell us what they are going to do to meet the requirements of the legislation in relation to identifying, assessing and managing risks to health, safety and welfare of people who use the service and others.