About the service:

Hayward Care Centre is registered to provide accommodation for up to 80 persons who require nursing or personal care. The service is arranged over four units and provided specialist dementia care in two ground floor units. People were accommodated in all units.

People’s experience of using this service:

• Some people, relatives and staff told us there were shortages of staff. We saw this had been raised at residents’ meetings and by relatives through surveys. When we carried out observations of interactions with people we saw that staff were not always visible. When staff were present they engaged with people and we saw signs this interaction was enjoyed.

• While medicines were well managed there were areas that needed to improve. Medicines prescribed to be taken ‘when required’ (PRN) lacked detail and for some people were not personalised. Although protocols described how people might present when agitated, they did not inform staff of steps they should take to relieve the anxiety before resorting to the use of medicines. For some people their PRN protocols for pain relief were not personalised because there was no detail on how individual people would express pain and what ‘body language’ people might display.

• People told us they felt safe living at the home. The registered manager made referrals to the local authority safeguarding team as required. The staff we spoke with were knowledgeable about the procedures for safeguarding people from abuse. They knew the types of abuse and the reporting of abuse.

• . Risk assessments were in place. The care plans reflected the risk and gave staff guidance on minimising the risk. Where people’s behaviour was triggered by anxiety and frustration care plans gave staff guidance on managing these situations. We observed staff following this guidance.

• People told us the types of decisions they made and who supported them with more complicated decisions. Staff were knowledgeable about the principles of the Mental Capacity Act (2005). Records were in place to demonstrate the decision makers. Deprivation of Liberty Safeguards (DoLS) conditions were followed.

• The performance of staff was monitored, and their skills developed. There was a system for supporting staff’s performance. Staff feedback about the quality of the training was variable.

• We saw good interaction between people and staff and with relatives. There was good support for relatives to have meaningful time with their families. We saw people were not rushed.

• Care planning systems had improved. Guidance to staff was more detailed and included people’s preferences. Staff knew people well and where there was input from healthcare professionals this was part of the care plan.

• Quality Assurance systems were in place. There was a consolidated action plan in place. Staff said improvements had taken place. There was learning from accidents and incidents. There was a reflection meeting and input from health and social care professionals. Records were kept secure.

Rating at last inspection:

At the last inspection dated 21 and 22 March 2018 the Hayward Care Centre was rated Requires Improvement. This report was published on 20 June 2018.

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. At the inspection dated March 2018 we imposed conditions on the provider. The provider was required to develop the service and make improvements. We monitored the monthly action plans submitted.

Follow up:

We recommended the provider ensures the Duty of Candour guidance was followed.

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At the previous inspection in October 2016 we found breaches of Regulation 9 because staff were not following guidance to ensure people’s needs were met. Guidance to staff on meeting people’s needs had not improved and we repeated the breach.

This is the third time this service has been rated as Requires Improvement since 2015 and we are considering what further action will be taken in response. Full details of CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

This inspection took place on 21 and 22 March 2018 and was unannounced. The registered manager was aware of the visit arranged for the second day of the inspection.

Hayward Care Centre 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.

Hayward Care Centre is registered to provide accommodation for up to 80 persons who require personal care. The service is arranged over four units Avebury, Bromham, Keevil and Potterne. Specialist dementia care is provided to people accommodated in Potterne. At the time of the inspection there were 68 people living at the service.

A registered manager was not in post. The current manager told us they will be applying to register as 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.’

Risk management systems were mostly effective. The staff we spoke with were knowledgeable about people’s individual risks and the actions needed to minimise the risks. Risks were assessed and for some people risk assessments were developed but lacked detail on how to minimise the risk.

There were people who expressed their anxiety and frustration using behaviours that staff found difficult to manage and placed others at risk of harm. Staff told us they had attended training to develop their understanding of people living with dementia. Emotional plans did not give staff guidance on how to respond to people when they became anxious. For example, staff were to give encouragement but did not specify how this was to be provided to gain the desired outcome.

The safety of the living environment was regularly checked to support people to stay safe. For example, fire risk assessments, fire safety equipment checks and fire training for staff. Some people on the first floor said their access to the garden would be better if their accommodation was in the ground floor. Currently people depended on staff to access the garden.

Steps were taken to ensure medicine systems were safe. People told us staff administered their medicines. Medicine profiles included a photograph of the person and essential information such as known allergies and how the person preferred to take their medicines. However, for some people photographs were not updated. Members of staff were not always signing records to indicate the medicines administered. Procedures on the administration of medicines to be prescribed “when required” were not always person centred.

Staffing rotas were designed using dependency tools. However, feedback from relatives was that at times there were staff shortages and there was reliance on agency staff. We observed some people needed high levels of attention which limited the time staff spent with others. This meant people’s preferences were not always considered. At times people in Keevil and Rowde were left in lounges without staff supervision and engagement was task focussed.

The staff we spoke with were knowledgeable about the day to day decisions people made. Mental capacity

At the last inspection on 11, 12 and 13 May 2015 we asked the provider to take action to make improvements on reporting important events to the Care Quality Commission, ensuring staff were supported and trained to meet people’s needs and to follow guidance from healthcare professionals. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

Hayward Care Centre is registered to provide accommodation for up to 80 persons who require personal care. The service was arranged over five units and provided specialist dementia care in Potterne. The other units provided residential and nursing dementia care.

A registered manager was 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.

Risks were assessed and action plans were developed for identified risks. Members of staff knew the actions needed to minimise risks. However, we found staff had not consistently followed the guidance for monitoring people’s fluid intake. We found the fluid intake records we audited for two people were not completed on consecutive days. We also found the target intake was not recorded on fluid monitoring charts. This meant staff were not always aware of people’s target fluid intake and were not provided with an audit trail of people with poor intake of fluid. The registered manager described the systems to be introduced to improve recording.

We saw staff enabling people to make decisions from the options given. Staff said there were people who at times became aggressive towards each other and the staff. Clear guidance on how staff were to respond to incidents of aggression were in place. However, records showed staff were not following guidance. For one person staff were given guidance to administer, when required, medicines before delivering personal care but had not followed the guidance and the person had become anxious during these periods.

Staff said staffing levels were not appropriate on two units. We saw that on one unit, during the lunchtime meal, the staff were stretched and did not give people attention and assistance with eating their meals. Staff said there had been changes of staffing with the opening of a unit and for some staff this had created low morale. The staff said there was heavy reliance on agency staff. The registered manager said the staffing levels were consistent with the dependency needs of people.

Care plans were developed in line with people’s assessed needs and for some people their likes and disliked were included. Life stories were not in place for all of the people living with dementia but were to be developed with the introduction of a staff member who was to be the dementia lead. Structured planned activities were not taking place. Staff said activities were more ad hoc but were taking place such as baking and music.

The people able to respond to our request for feedback told us they felt safe and people we observed greeted staff in a positive manner and did not show signs of distress when staff were present. Members of staff were knowledgeable about the procedures for safeguarding people from abuse. They knew the types of abuse and the actions they must take for alleged abuse.

People were supported with their ongoing health. People had regular visits from their GP and there was partnership working with healthcare professionals such as the care liaison team. Medicine systems were safe. Staff said medicine systems had improved. Protocols in place gave staff instructions on administering medicines prescribed to be taken when required.

Staff said the training was good and a variety of courses were available. Some staff said specialist

This is the first inspection for this newly registered service . The inspection was unannounced and took place on 11 and on the afternoons of the 12 and 13 of May 2015.

Hayward Care Centre was registered to provide accommodation for up to 80 persons who require nursing or personal care. The service is arranged over five units and at present provides specialist care for people living with complex dementia needs in the Potterne unit. On Avery, Bromham and Keevil unit residential care for people living with dementia is provided. In October 2015 the fifth unit will open to provide nursing care to people living with dementia.

A registered manager was not in post. This post has been vacant since 26 March 2015. An interim manager was in post while a registered manager is recruited to this 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.

Risk management systems did not protect people from harm or from the potential of harm. Risk assessments were not analysed appropriately following an incident or accident. This meant trends and patterns were not identified to prevent them from reoccurring.

Incidents of aggression by people towards each other and accidents were not reported to statutory agencies such as the Local Authority safeguarding adults lead and as required by CQC.

Members of staff on one unit said staffing levels were not sufficient to meet people’s needs. They said people were left unsupervised when the senior on duty was in meetings and the other two carers on duty were needed to provide personal care to people.

An induction was not provided to all new staff. The training considered as mandatory by the provider was not provided to all staff. Specialist training to meet the needs of people living with dementia  was not provided to all staff. Staff did not have an opportunity to have one to one meetings with their line managers to discuss their concerns, performance and training needs.

People were at potential risk of their health deteriorating. Action was not taken by staff following guidance given to them by healthcare professionals such as the Occupational Therapist.

Staff showed a lack of understanding on seeking consent and making best interest decisions for people who lacked capacity.

The care plans and risk assessments we reviewed were not updated for all the people living at the home and did not reflect people’s preferences and their current needs.

Quality assurance visits took place monthly and at these visits the standards of care were assessed. An action plan was set by the area manager following their visit. However, the action plan set in April 2015 had not taken effect.

People said they felt safe living at the home and they were protected from safe management of medicine.

People’s dietary needs were catered for. They said they enjoyed the meals served.

We were told complaints were taken seriously and acted upon.

The staff showed a good understanding of promoting independence and choices. We saw staff had good interactions with people and they were clear on how to protect people’s rights to privacy and dignity.

Staff said the manager was good and the team worked well together.

We found breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.