Hurstead House Nursing Home (referred to in this report as Hurstead House) 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 (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

This inspection took place on 22 and 23 August 2018 and the first day was unannounced. The home is registered with CQC to provide nursing and personal care for up to 30 older people. At the time of our inspection there were 25 people living at the home. Accommodation is provided over two floors, with a passenger lift providing access to the first floor.

There were two registered managers in place, one of whom was also the registered provider. A registered manager is a person who has registered with the CQC 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 last inspected on 30 October, 1 and 2 November 2017 when it was rated as Inadequate. This meant the service was in ‘special measures.’ At that time, we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These related to safe care and treatment; safeguarding people from abuse; premises and equipment, and the overall governance of the home. Following that inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘is the service safe?’, ‘is the service effective?’ ‘is the service caring?’ ‘is the service responsive?’ and ‘is the service well led?’ to at least good. At this inspection we found some improvement in these areas. The service is no longer rated “inadequate” and has moved out of special measures.

However, we found further improvements were required. We identified a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 as the governance arrangements for the service had not identified concerns regarding the safe management of the home. Issues included reviews of risk assessments which did not consider changes in need; faulty and dirty equipment in a shower room; the lack of hot running water and hand washing facilities in the laundry, and a smoke detector which had been temporarily rendered ineffective.

We also recommended that the service considers managerial arrangements to respond to risk and ensure the premises are safe and suitably maintained for the people who live and work at Hurstead House.

The service reported a low incidence of safeguarding concerns which reflected the safety of the people who used the service, and staff we spoke with demonstrated a good understanding of the signs of abuse, telling us they were encouraged to report any concerns.

Staff rotas reflected a good level of staff and robust recruitment policies ensured that staff recruited to work at Hurstead House had the right qualities to work with vulnerable people.

People's health was monitored by trained nurses and they had access to other healthcare professionals to meet their individual needs. People received their medicines safely.

Staff knew the people who lived at Hurstead House well, and had access to ongoing training to improve their knowledge. Some refresher training had not been completed by all staff, but had been scheduled for later in the year. This would provide staff with the opportunity to review and update their knowledge.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs. When we asked, people told us they enjoyed the food provided. One person told us, “The food is very good, tasty and plentiful”.

During our inspection we found the service reflected a caring ethos. We observed good examples of caring inter

This unannounced inspection took place on 30 October and 1 and 2 November 2017.

Hurstead House Nursing Home is situated in a suburban area of Rochdale close to local amenities and transport links. Nursing and personal care can be provided for up to 30 people in accommodation on the ground and first floor.

We last inspected Hurstead House Nursing Home in November 2014 and rated the service as Good. This inspection was carried out to ensure these standards were still being maintained, however we found standards had declined in several areas.

During the inspection we identified breaches of regulations with regards to safe care and treatment, safeguarding people from abuse, premises and equipment and good governance. You can see what action we have asked the service to take at the back of this report.

We found the home did not always assess and mitigate risks well. Flammable objects such as lighters were allowed to be held in bedrooms where oxygen was in use. Comprehensive risk assessments had not been carried out to mitigate these risks.

An electrical installation check was carried out at the home in May 2017 and several recommendations had been made which required both urgent and immediate action to ensure the electrics were safe. However at the time of the inspection this work had not yet been completed. These issues presented the risk of a fire at the home.

There were other environmental risks seen around the home such as a steep stair case leading to the attic which was left unlocked which presented a risk of people accessing it and falling. An upstairs sluice room was seen unlocked during each day of our inspection where cleaning products were stored, despite it being fitted with a key coded lock. A store room used to store the supplement, ‘Thick and easy’ was also left unlocked during the day. This presented the risk of people consuming these products in an unsafe manner, particularly people living with dementia who may not understand the presented risks.

We reviewed how medication was handled and overall, found this was given to people safely. However, we found there were no records kept for the application of topical creams, such as barrier creams to maintain good skin health. We also did not see any instructions for care staff about where the topical creams were to be applied. This meant we couldn’t be certain that the people using the service were receiving prescribed creams as required. We have made a recommendation about this within the detailed findings of the report.

We looked at systems in place with regards to infection control. The home was observed to be clean and tidy, with no malodours present. We did however observe some poor practice where a member of staff wiped a person’s nose with a tissue and then assisted a person to eat their lunch whilst holding the tissue in their hand. One bathroom/toilet was not fitted with a soap dispenser so that people could wash their hands if they had been to the toilet. This presented the risk of the spread of infections within the home.

We checked to see if the home were working within the requirement of the MCA (Mental Capacity Act) and were making appropriate DOLS (Deprivation of Liberty Safeguards) referrals to the local authority. We found DoLS applications were not always made in a timely manner where people lacked the capacity to make their own choices and decisions. The registered manager said if these people were to ask to leave the home then they would have to stop them due to it being unsafe for them. This presented the risk of people being detained without lawful authority.

Staff were not always discreet when taking people to the toilet and overheard staff saying this loudly in front of others living at the home. People also told us they often had to wait for assistance to be taken to the toilet. This could impact on people’s dignity.

The feedback we received from people living at the home and relatives was that there were not enough activities t

This was an unannounced inspection which took place on 19 November 2014.

We had previously carried out an inspection in June 2014 when we found the service had breached four of the regulations we reviewed. We made compliance actions that required the provider to make the necessary improvements in relation to: care and welfare of people; cleanliness and infection control; and staffing. In addition we issued a warning notice to the provider in relation to a breach of Regulation 10 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to the lack of quality assurance systems for the service. Following the inspection in June 2014 the provider sent us an action plan telling us what steps they were going to take to ensure compliance with the regulations.

We revisited the service on 15 September 2014 to check that the provider had taken the required action in relation to the warning notice. We judged the requirements of the warning notice had been met. This was because improvements had been made to the quality assurance processes in the service.

On this inspection we found the provider had made significant improvements to the service. This meant all legal requirements we reviewed were met, including those outstanding from our previous inspection.

Hurstead House Nursing Home is registered to provide accommodation for up to 30 people who require support with personal care or who have nursing needs. At the time of our inspection there were 17 people living at the home.

There was no registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 owner of the home had submitted an application to the CQC to register as manager of the service; this application was still being considered at the time of our inspection. This meant the owner was in the position of ‘acting manager’ at the time of our inspection.

We found some improvements needed to be made to the way medicines were administered in the service in order to ensure people always received their medicines safely.

Staff understood their responsibilities under the Mental Capacity Act (MCA) 2005. However improvements needed to be made to ensure people were not subject to restrictions which had not been authorised under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. Care records we reviewed included an assessment of individual’s capacity to make particular decisions. This should help ensure people’s rights were upheld.

At the time of our inspection we found work was underway to refurbish much of the home. However, we noted some improvements still needed to be made to the signage and lighting in the home, particularly to meet the needs of people with a dementia. We were told this had not previously been considered but, following our observations, would be included in the refurbishment programme.

Although we received conflicting information from some people who used the service and some relatives about staffing levels in the service, we found the numbers of staff on duty were appropriate to meet the needs of people who used the service at the time of our inspection. The increase in the number of domestic staff on duty in the service had led to an improvement in the cleanliness of the environment.

People who used the service told us they felt safe in Hurstead House. One person told us, “I feel safer here than at home. I have panic attacks and staff stay with me to calm me down. Staff will spend time with me.” Another person commented, “I feel safe here because of the presence of staff to help me.”

Staff had received safeguarding training and were able to tell us what action they would need to take if they had any concerns about the care people received in Hurstead House. All the staff we spoke with were confident that any concerns they might raise would be taken seriously and acted upon.

Care records we reviewed contained good information for staff to follow in order to help ensure people received the care they needed. All the care plans we looked at had been regularly reviewed and updated to record when people’s needs had changed.

There were systems in place to provide staff with support, induction, supervision and training. Staff told us they enjoyed working at Hurstead House and considered they received the training and support they needed to effectively carry out their role.

People’s health needs were assessed and staff ensured appropriate services were in place to meet these needs, including dieticians and speech and language therapists. Where necessary, staff provided support and monitoring to ensure people’s nutritional needs were met. All the people we spoke with made positive comments about the quality of food in Hurstead House.

We observed positive interactions between staff and people who used the service. People told us staff treated them with dignity and respect and were always kind and caring.

An activity coordinator had been employed to work in the service. People spoke positively about the events and activities which had been arranged for them. We found individualised activity plans were also in the process of being completed with people. This should help ensure people’s interests were reflected in the activities provided in the home.

There were processes in place to gather the views of people who used the service and their relatives regarding the care provided in Hurstead House. People told us when any concerns had been raised, these had been dealt with promptly by the acting manager.

People who used the service, relatives and staff spoke positively about the leadership displayed by the acting manager and the positive impact this had had on the atmosphere in the home. Quality assurance processes in the service were sufficiently robust to demonstrate that the acting manager was regularly reviewing how the service could be improved.

We carried out this inspection to check whether Sevaline Care Homes Ltd had taken action to comply with the Warning Notice served on them in July 2014.

During an inspection of the home in June 2014 we found the provider did not have an effective system to regularly assess and monitor the quality of service that people received. The provider also did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others.

Following the inspection in June 2014 we served a Warning Notice to ensure that improvements were made quickly in order to protect people.

During this inspection we found the Warning Notice had been complied with. The provider had introduced systems to monitor the effectiveness of the service provided. Systems were also now in place to assess and manage risks to the health, safety and welfare of people who used the service and others.

During our inspection visit we gathered evidence to help us answer the five questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs? Is the service well led?

Below is a summary of what we found. The summary is based on speaking with seven people who used the service and four relatives. We also spoke with the provider who was present on the day of the inspection, a professional visitor to the home, seven members of staff and looked at records.

Is the service safe?

All the people we spoke with told us they felt safe at Hurstead House.

Most care files we looked contained the necessary records to inform staff of the care people needed. An assessment had also been made of whether people were able to make their own decisions in relation to their care and treatment. However, in particular, people admitted on respite did not have a care plan in place.

People were not protected against the risk of acquiring infections. This was because the home was not kept clean and hygienic.

People were protected because an assessment had been undertaken of their capacity to make their own decisions. Relevant staff knew what actions to take if they considered a person needed to be deprived of their liberty in order to keep them safe.

Is the service caring?

People we spoke with were complimentary about the care provided. Comments they made to us included, "The care in really good", "This is one of the best homes I've been in for personal care" and "My relative is well cared for. There are other problems but the care is good".

It was clear from our observations and discussions with staff that they knew people well and had a good understanding of their care and support needs.

Is the service effective?

Not enough staff were in place to effectively meet people's needs. This was because the lack of domestic staff meant care and nursing staff were sometimes unable to spend quality time with people.

During our observations we saw people were sat for long periods without any stimulation or activities provided to meet their needs

Arrangements to clearly lead and support the staff team were not in place. This meant people did not always receive the care and support they needed.

Is the service responsive to people’s needs?

Staff had responded appropriately to a range of medical needs and we saw that medical professionals such as the G.P and district nurse were regularly involved in people’s care.

A relative told us, "The staff have always acted on any comments I have made".

Is the service well led?

We were aware there had been no registered manager at the home since 1 April 2014. In this report the name of the 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 the time.

Systems to monitor and review the quality of care and facilities, as well as opportunities for people to give their views about their experiences were not in place. This information would help to identify where improvements could be made within the home.

Staff and visitors told us they found it difficult to speak to the owner of the service in the absence of a registered manager. They commented, "When asked he says ‘talk to the manager’ and walks off” and "I don't think he takes enough responsibility".