About the service:

Hunningley Grange Residential Home is a ‘care home’. The care home is a detached residence with a purpose-built extension registered to provide care for 35 older people. All accommodation and services are on the ground floor. The home was providing personal care to 29 people at the time of the inspection.

People’s experience of using this service:

• People were not always safe. We found improvements were needed to the time it took for person-specific care plans to be produced and individualised risk assessments undertaken. Access to health professionals had been delayed in some instances.

• There was no governance system in place to ensure the provider checked and audited the safety of the home and the quality of the care delivered.

• People were at risk from being supported to mobilise in a way not specified in their care plans.

• Prompt action was taken when things went wrong to reduce the risk of future incidents. There was an open culture of learning from incidents.

• During the inspection we observed care staff to be kind, caring and respectful. People were encouraged and supported to engage in a range of activities of their choosing. People told us the food was good and people had choice about when and what they ate. Staff offered people choice in all aspects of their lives, encouraged independence and provided support when needed. Staff supported people in the least restrictive way possible.

•People’s care records were person centred and detailed, although we identified some areas where improvements were needed to people’s life histories and preferences.

• Staff were skilled and knowledgeable and training was up to date.

Rating at last inspection:

At our last inspection the service was rated good (24 January 2017).

Why we inspected:

All services rated as good are re-inspected within two years of our previous inspection.

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received, however the inspection was brought forward slightly due to information of risk and concern.

Please see the action we told provider to take at the end of the full report.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

This inspection took place on 19 October 2016 and was unannounced. This meant the registered provider and staff did not know we would be visiting. The service was last inspected in April 2014 and was meeting the regulations we inspected at that time.

Hunningley Grange is a detached residence with a purpose built extension, registered to provide personal care for 36 older people. All accommodation and services are on the ground floor. The home is located in the centre of Stairfoot, approximately two miles from Barnsley town centre. At the time of our inspection 32 people were using the service.

There was a registered manager in place. 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 the service kept them safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring. Regular checks were made of the premises and equipment to ensure they were safe for people to use. Procedures were in place to monitor and respond to accidents and incidents.

Plans were in place to keep people safe in emergency situations. Policies and procedures were in place to help protect people from abuse. People’s medicines were managed safely.

The registered manager monitored staffing levels to ensure they were sufficient to support people safely and the registered provider’s recruitment processes reduced the risk of unsuitable staff being employed.

Staff told us they received the training they needed to support people effectively and said they found it useful and would be confident to ask for any additional training they felt was needed. Staff were supported through regular supervisions and appraisals.

Staff worked within the principles of the Mental Capacity Act 2005, but improvements were needed in recording information on people’s capacity. We made a recommendation that the service finds out more about MCA record keeping.

People were supported to maintain a healthy diet and to access healthcare professionals to maintain and promote their health.

People spoke positively about staff at the service, saying they were kind and provided high-quality care. People said they were treated with dignity and respect and we saw this was the case during the inspection. Throughout the inspection we saw staff delivering kind and caring support.

Procedures were in place to support people to access advocacy services and to plan end of life care where needed.

Care was based on people’s assessed needs and preferences and was person-centred. The registered manager and staff looked at how to support people to lead independent lifestyles and develop new skills.

People were supported to access activities they enjoyed and spoke positively about the activities on offer. Procedures were in place to investigate and respond to complaints and people and their relatives told us they knew how to complain and were confident any issues raised would be acted on.

People spoke positively about the registered manager, who was a visible presence around the service. The registered manager carried out a number of quality assurance checks to monitor and improve standards at the service. Feedback was sought from people using the service, their relatives, staff and external healthcare professionals through an annual survey.

The registered manager had informed CQC of significant events in a timely way by submitting the required notifications, though we did note that we had not been informed of some safeguarding incidents.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at this time.

Hunningley Grange is a residential care home which was providing care and support to 24 people at the time of our inspection. We spoke with a group of eight people who were sitting in a lounge and with three people individually in their rooms. We also spoke with five members of staff, two relatives, a visiting healthcare professional and the area manager who is currently working as home manager.

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?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and staff understood their role in safeguarding the people they supported. Staff had received training in safeguarding to ensure people were protected from the risk of abuse. People who lived in the home said, “I feel very safe here, everyone looks after me” and “I’m as safe as can be here.” One relative told us, “I can go home at night and sleep knowing my family member is safe and well.”

Care and treatment was planned and delivered in a way that was intended to promote people's welfare. Staff used risk assessments. There were risk assessments in place with people’s planned care. These gave details of how individual risks to a person could be removed or minimised.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit one. This meant that people would be safeguarded as required.

In December 2013 we carried out a responsive inspection at Hunningley Grange because we had received some information of concern regarding this service. This alleged that staff were working at the home without having a completed enhanced Disclosure and Barring Service (DBS) check, formally known as a Criminal Records Bureau (CRB) check. Following the responsive inspection the provider sent us an action plan stating the action they would take so they could be assured people who used the service were provided with care that did not present a risk to people.

At this inspection we found there was an effective recruitment procedure in place to ensure people employed were of good character and had the skills and experience necessary for the work they performed. All staff had completed DBS checks which helped to safeguard people who lived in the home.

Is the service effective?

Care files we checked confirmed that initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. People’s health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People and their relatives said they had been involved in writing them and they reflected their current needs. Visitors confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

We found people were treated with respect and dignity by the staff. During our inspection we observed staff speaking with people who used the service in a friendly and caring way. We observed care and support was provided to people when requested. Care workers we spoke with demonstrated a good understanding of the people’s needs and were able to give examples of how they promoted people’s independence.

People we spoke with told us staff were, "very nice" and "always patient." A relative said, “I visit my family member nearly every day and the staff are very good with everyone.”

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

Is the service responsive?

Staff and a relative told us the care and support provided was flexible to the person’s needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed. For example one person was requiring daily showers and this was being provided.

People completed a range of activities in and outside the service regularly. We observed staff treating people with kindness and helping them with their daily activities such as personal care and social activities. We saw staff spending time with people on a one to one basis and it was very evident that people enjoyed this.

People knew how to make a complaint if they were unhappy. One relative said, “I can say anything to the staff and they will listen and put it right."

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. We spoke with one visiting healthcare professional who told us, “We work well with the staff. They inform us of any concerns and we resolve them together. There are always staff around to assist us if needed.”

Staff had recorded supervision sessions with the manager and were kept updated about any information they needed to know about the service. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information.

The service carried out a yearly ‘Quality Assurance Survey’. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends and healthcare professionals. This showed people had the opportunity to put their views across.

The service had a quality assurance system. Monthly and/or weekly audits were completed regarding such things as medication, care plans, the environment, staffing and infection control. Records seen by us showed that any shortfalls identified in audits were addressed promptly.

We carried out this responsive inspection at Hunningley Grange Residential Home because we had received some information of concern regarding this service. This alleged that staff were working at the home without having a completed enhanced Disclosure and Barring Service (DBS) check, formally known as Criminal Records Bureau (CRB) check.

At the inspection we found there was no effective recruitment procedure in place to ensure people employed were of good character and had the skills and experience necessary for the work they performed. This meant the provider could not be assured people who used the service were provided with care and welfare that did not present a risk to people.

People that we were able to communicate with told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included, "it's great here, I have no worries," "the staff are lovely and I've got a nice room," and "everything is lovely, they (the staff) are lenient and reliable."

Records checked showed that before people received any care or treatment they were asked for their consent and the staff acted in accordance with their wishes.

During the inspection we spent time sitting with people in the communal areas of the home. We found that care and support was offered appropriately to people.

Each person living at the home had a care plan. We found that the information in these was detailed and complete.

We spoke with five relatives who were visiting the home and they confirmed that they were satisfied with the care provided.

Our discussions with staff confirmed that there were clear processes and actions in place to minimise and prevent abuse from occurring in the service. Conversations with people and relatives on the day of our inspection evidenced that people using the service felt 'safe' living in the home.

The provider had an appropriate system in place for gathering, recording and evaluating information about the quality and safety of care the service provided. People who used the service and their representatives were asked for their views about their care and treatment.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included, "I am happy here, things are OK," "It's okay here," "I'm comfortable" and "The staff are very good to me."

During the inspection we spent time sitting with people in the communal areas of the home. This meant we were able to observe people's experiences of living in the home. We found that care and support was offered appropriately to people. We found that inconsistencies occurred, in relation to people maintaining their dignity due to the differences in staff's skill and training.

Each person living at the home had a care plan. We found that the information in these was variable. This meant that the delivery of care to people may not be safe, effective and appropriate.

There were policies and procedures in place to prevent abuse from occurring. When we spoke with staff we found that they had not completed any updated or refresher training in safeguarding adults since 2010. This meant that they were unsure how to respond and raise concerns appropriately.

We found that staff had not received formal one to one supervision or a yearly appraisal, although staff told us they could go to the business development manager at any time for advice and support.

The home had an effective complaints system available. We found that comments and complaints people made were responded to appropriately.

In the main people that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. Their comments included:

"I am very happy here, things are OK".

"It's OK here".

"I'm comfortable".

"It's not home, I'd prefer to be somewhere quieter".

In the entrance hall there was a selection of cards that relatives had sent to the home. The comments that relatives and friends had written were all positive, thanking staff for their care and support.

People said they were pleased with the new manager and thought that she was making improvements at the home.

One visitor told us they were always made to feel welcome at the home.They said staff were always available to assist their relative when necessary and they saw that staff treated people well and had patience and empathy when dealing with people.

A number of people who live at Hunningley Grange have conditions that mean they have difficulty talking with people and therefore have varied methods of communication. Some people were able to express their views clearly, others were not able to verbally communicate with us. Due to people’s communication needs, during the site visit we sat with people in communal areas and observed them closely. This meant we were able to ascertain whether their needs were met.

People that were able told us that overall they were happy living at the home and satisfied with the care and support they were receiving. People’s comments included:

“I came here because I was depressed and they’re making me feel better”.

“I think I made a very good choice to come here”.

“There’s nothing wrong with the staff, they listen to you”.

“I am highly satisfied with my care”.

“There’s no doubt about it people are kind and caring”.

“The manager told me if there’s anything I want, I only need to ask”.

“I feel safe living here”.

Relatives interviewed said that, in the main, they were pleased with the care provided. Their comment’s included:

“Staff know (mum) very well and know her ways”.

“The environments not great but the care is 110%”.

“Staff do a good job and are kept busy”.

Health and social care professionals told us that they are generally satisfied with the level of care and support staff provide to people.

Some concerns were raised over people’s privacy and dignity being maintained and not all staff had received training in infection control.

One person told us that they were not able to take their prescribed medication when they needed it. This was because there was not always a trained member of staff on duty, during the night, to administer medication. We were also made aware that night staff were leaving the building unattended to go outside to smoke. These concerns were feedback to the area manager and business support manager on the day of the site visit. They confirmed that immediate action would be taken to resolve these concerns.

People, relatives and staff told us that the service would benefit greatly if there was a permanent manager in post.

Health care professionals, relatives and people all told us that they felt the environment at Hunningley Grange needed upgrading.