Hatton Court Care Home

Updated 21 October 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors on the first day and two inspectors on our second day.

Service and service type

Hatton Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The registered manager was not present for this inspection.

Notice of inspection

This inspection was unannounced. We gave short notice from outside the home due to the risks associated with Covid-19. We needed to know of the Covid-19 status in the home and discuss the infection, prevention and control measures in place on our arrival.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we ask providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed information we had received about the service since the last inspection. We sought feedback from Healthwatch, the local authority and other professionals who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.

During the inspection

We spoke with eight people who used the service and nine visitors about their experience of the care provided. We spoke with two visiting health professionals. We spoke with 17 members of staff including care staff, nursing staff, housekeeping and maintenance staff, the operations manager, admissions manager, administrator and quality monitoring officer.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed a range of records. This included 13 people’s care records and multiple medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We contacted all relatives after our inspection and communicated with ten of them to obtain their feedback. We continued to seek clarification about our findings from inspection with the operations manager to validate evidence found.

Updated 21 October 2021

About the service

Hatton Court Care Home is a residential care home which provided personal and nursing care to 56 people at the time of our inspection.

The service can support up to 60 older people, younger people and people living with dementia in one building with a large central communal area. One unit at the home provides support for people living with dementia and has its own communal area. Another unit is a rehabilitation unit and provides support to people who have been discharged from hospital to enable them to go back to their own homes. This also has its own communal area with a kitchenette.

People’s experience of using this service and what we found

Relatives and staff told us they felt the service was good but also shared there had been some recent challenges and concerns. One staff member told us, “This is a really good home even though it might be having a bit of a rough patch. We [staff] are doing our best.”

Systems were in place to assess risks to people but were not always well managed or overseen to ensure people stayed safe. As a result people had been placed at risk of poor skin care and not having enough fluids.

Systems and processes had not been used effectively to learn from incidents, however improvement had recently been made to address this shortfall.

Staffing was stretched and their focus was on completing tasks. The shortfalls in staffing were covered by the use of agency staff. The provider was actively recruiting for staff and told us they had restricted admissions to the home until they were more stable.

The leadership and management of the home had not ensured the delivery of high quality care for all people. Although the provider had a governance framework in place this had not been used to focus on continuous learning and improvement. The oversight of agency staff and poor record keeping had not been considered as risks to people's health, safety and wellbeing.

A new management team was in place at the home which had started the process for improvement.

Overall, safe infection prevention and control procedures were followed and the management addressed issues with staff’s use of personal protective equipment (PPE) during our inspection. People and staff had access to COVID-19 testing and vaccination. All visitors were tested in line with government guidance.

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

Rating at last inspection

The last rating for this service was good (published 20 July 2018).

Why we inspected

We received concerns in relation to people receiving poor and unsafe care, poor fluid management and poor management of their skin. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hatton Court Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to governance and the management of risk at this inspection.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.