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CQC report explained · a residential care home

Hengoed Park

Hengoed, Oswestry, SY10 7EE

Requires improvementpublished 14 March 2024, 2 years ago

Rated Requires improvement: inspectors found the service was not performing as well as it should and told it what to change.

The five questions inspectors ask
Safe?
Requires improvement
Medicine records and stock counts were not always accurate, including for controlled drugs. Inspectors also found some environmental and recording risks, although there were enough staff and most people said they felt safe.
Effective?
Good
This question was not inspected during this focused visit. Its previous rating was carried over.
Caring?
Good
This question was not inspected during this focused visit. Its previous rating was carried over.
Responsive?
Good
This question was not inspected during this focused visit. Its previous rating was carried over.
Well-led?
Requires improvement
Management checks did not reliably identify problems with medicines, records, recruitment or staff training. The provider also failed to notify CQC about all reportable incidents.
The latest report, explained

What inspectors found, March 2024

Rated Requires Improvement; inspectors found medicine safety and management oversight were not reliable.

Inspectors visited the home without advance notice on 16, 18 and 30 January 2024. They spoke with 12 people living there, three visitors and 15 staff. They also checked care plans, medicine records, recruitment files and management records.

The home was rated Requires Improvement overall. Safe and Well-led were both rated Requires Improvement. Medicines were not always properly accounted for, some environmental risks remained, and records and quality checks did not reliably identify problems.

There were also positive findings. Staffing levels were enough during the inspection, people generally said they felt safe, and staff usually respected people's choices. The manager acted on some issues during the inspection, including putting catheter care plans in place and displaying the rating on the website.

This was a focused inspection of Safe and Well-led only. The other question ratings were carried over from the previous inspection, which was published on 2 February 2019 and rated the service Good.

What inspectors praised

  • Enough staff

    Inspectors saw enough staff to support people safely during the inspection. No one was seen waiting for support.

    “The provider ensured there were sufficient numbers of staff to safely support people.” from the report

  • Safety plans

    People's main safety risks were identified and plans told staff how to support them. Support plans were also in place for people who could become distressed.

    “People's care records provided staff with information on how to support people safely.” from the report

  • Respect for choices

    People said they could make decisions about daily life, and inspectors saw staff respecting those choices.

    “People told us they could make their own decisions about daily living tasks and activities, and we saw staff respected people's choices.” from the report
What inspectors were concerned about

  • Medicine records and stock

    serious

    Medicine balances did not always match the records. Inspectors also found two loose, unlabelled controlled drugs, and some administration records lacked staff signatures.

    “Medicines were not always correctly accounted for.” from the report

  • Management checks

    serious

    The provider's checks had not found several important problems. Managers also delayed checking medicine stock after inspectors raised concerns.

    “The provider's governance systems were not always effective as they had failed to identify the shortfalls we found at this inspection.” from the report

  • Reportable incidents

    serious

    The home did not notify CQC about some safeguarding concerns and authorised Deprivation of Liberty Safeguards applications as required.

    “The registered manager had failed to notify us of these.” from the report

  • Environmental risks

    needs fixing

    Inspectors found a fire door propped open, unsecured wardrobes and equipment stored under the main staircase. Refurbishment work had started, but risks remained.

    “On each day of inspection, we found equipment stored under this staircase.” from the report

  • People's views and engagement

    needs fixing

    Records did not show people's expectations and care goals clearly. Feedback was mixed, with some people saying they were bored or did not talk with staff about their goals.

    “Two people told us staff did not talk with them about what their expectations were for their care and goals.” from the report
Questions to ask them, based on this report
  1. 01What checks are now in place to make sure medicine balances, administration signatures and controlled drugs are correct?
  2. 02How are you checking that all safeguarding concerns and authorised Deprivation of Liberty Safeguards applications are notified to CQC?
  3. 03What has been done to secure wardrobes, keep the fire door closed and stop equipment being stored under the main staircase?
  4. 04How are staff training records being checked so they accurately show who has completed required training?
  5. 05How will you record people's care goals, expectations and views about life at the home?

This was a focused inspection of Safe and Well-led only; the other question ratings were carried over from the previous inspection in 2019. This explanation was written from the published report of 14 March 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.

The story over the years

Every inspection of Hengoed Park

3 rated inspections over 8 years: the service has slipped, from Good to Requires improvement.

  1. March 2024Requires improvementcurrent ratingdown from Good
    Safe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement

    Read what inspectors found at Hengoed Park →

  2. February 2019Goodstayed Good
    Safe: GoodWell-led: Good

    We are reading this report · the original is on cqc.org.uk

  3. July 2016Good
    Safe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good

    Read this report on cqc.org.uk

  4. October 2014

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  5. June 2014

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  6. September 2013

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  7. June 2012

    Report published without a new overall rating.

    Read this report on cqc.org.uk

  8. January 2011

    Registered with the Care Quality Commission on 10 January 2011.

Ratings and report dates from the Care Quality Commission. A service can also be visited without a new rating being published, so the timeline shows published inspections, not every contact the CQC has had with the service.

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