Hatton Court Care Home

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.

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.

Hatton Court Care Home accommodates 60 older people some of whom were living with dementia. The provider also offered nursing care. On the days of our inspection 57 people were living in the home. The home is situated on one floor and was accessible to wheelchair users.

The home had a registered manager who was present on both days of our inspection visit. 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.

At the previous inspection in January 2017, the service was rated Requires Improvement. We found that people living with dementia did not have the same opportunities as others. Although the former registered manager was aware of this, they had not taken any action to ensure people living with dementia were treated fairly. At this inspection the new registered manager told us that the unit where people living with dementia resided had closed and had recently reopened as a reablement unit. The provider continued to offer a service to people living with dementia. We found that these people were now treated equally and were offered the same opportunities as others and had access to various stimulating social activities.

Since our last inspection visit the provider had appointed a new management team. People knew who the new registered manager was and found them approachable and told us they were happy with the management of the home. The provider had effective governance in place to assess, monitor and to drive improvements. People and staff were given the opportunity to be involved in the running of the home. People were supported to maintain links with their local community and the involvement of outside agencies assisted with promoting people’s wellbeing.

People could be confident that their complaints would be listened to, taken seriously and acted on. The registered manager informed us that no one in the home was currently receiving end of life care.

People told us they felt safe living in the home and staff were aware of their responsibilities of safeguarding people from potential abuse. The risk to people was assessed and action was taken to minimise the risk of harm. People were cared for and supported by sufficient numbers of staff who had been recruited safely. Appropriate systems and practices were in place to ensure the safe management of medicines. Staff practices made sure people were protected from the risk of avoidable infections. Incidents, accidents and nears misses were reviewed and action taken to reduce the risk of a recurrence.

The assessment of people's care, support and treatment needs were carried out to ensure they received the appropriate support. People were cared for by staff who were skilled and supported in their role. People were complimentary about the meals provided and staff were aware of people’s food preferences with regards to their health condition, religion, likes and dislikes. Access to relevant healthcare services promoted people's physical and mental health.

The environment was conducive to people's needs and they had access to relevant aids and adaptations to promote their independence. People were encouraged to make their own decisions and staff were aware of the importance of obtaining their consent before delivering care and support.

People were cared for by staff who were kind and attentive to their needs. People’s involvement in their care planning ensured their preferences were identified and met. People could be confident their right to privacy and dignity would be respected by staff.

Hatton Court Care Home provides accommodation and personal care for up to 60 older people and also provides a service for people living with dementia. On the day of our inspection there were 43 people living there.

The home had a registered manager who was present on the second day of the inspection. 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.

Prior to this inspection we had received information of concern by people who wish to remain anonymous. They alleged there were insufficient staffing levels provided to meet people’s needs especially during the weekend. Hence, the first day of this inspection was carried out on Sunday. People told us staff were available to support them when needed. People told us they felt safe living in the home and staff knew how to protect them from the risk of potential abuse. People were protected from the risk of harm because staff were aware of safe practices to reduce the risk of accidents. People were supported by skilled staff to take their prescribed medicines.

People living with dementia did not have the same opportunities as other people who lived in the home. People’s involvement in their care assessment ensured they received a service that met their preference. People could be confident their complaints would be listened to and acted on.

People had the opportunity to have a say in how the home was run and were supported to maintain contact with their local community. People received care and treatment from staff who were supported by the registered manager and nurses. The provider had systems in place to review and monitor the quality of service provided to people. However, these systems did not identify the difference in the quality of service provided to people living with dementia.

People were supported by skilled staff who received regular one to one [supervision] sessions. People could be assured their human rights would be protected because staff adapted the principles of the Mental Capacity Act 2015 in their work practice. People were provided with a choice of meals and had access to drinks at all times. People were supported by staff to access relevant healthcare services when needed.

People were supported and cared for by staff who were kind and compassionate and care was provided in a way that promoted their privacy and dignity. People’s involvement in their care planning ensured they received a service that was specific to their needs.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were treated with respect and dignity by the staff. Care plans were in the process of being developed to contain more person centred information. The new style care plans were clearer. They identified people's needs and were reviewed regularly. Staff demonstrated a good understanding of people's needs. People were given choices and supported to make decisions themselves. Individual risk assessments were in place for things such as moving and handling and trips and falls. Control measures were identified. This meant that people's needs were met and people were kept safe. People we spoke with confirmed they felt safe living at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Documented procedures were in place for The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. We saw records of recent DoLS applications. This was as a result of new guidance issued by the courts. This meant that systems were in place to safeguard people as required.

The service was safe, clean and hygienic. Vacant rooms were being redecorated and new carpet was waiting to be fitted. However, the dementia unit at the service was in need of redecoration. Curtains in the communal lounge area looked untidy and in need of a clean. People we spoke with told us their rooms were cleaned daily. One person said, 'The laundry is wonderful.' Another person told us they had moved rooms because of an odour. Their old room was currently vacant and was awaiting new carpet to be fitted. This meant that the provider took action to maintain a clean hygienic environment and reduce the risk of spread of infection.

Recruitment practice was safe and thorough. Disciplinary procedures had been used where necessary. This was to ensure people's safety was maintained. Professional registrations were maintained. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person said, 'I'm quite happy here, most staff are very good.' Another person said, 'The girls have been exceptional, very good.'

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. People had access to a copy of the complaints procedure. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People experienced care and support that met their needs. People were supported to participate in activities. Some people told us they preferred their own company but were asked if they would to participate in activities. One person said, 'We are going on a trip to a garden centre.' Some people told us they were involved in changes to their care. One person said, 'They always contact my relative if there are any concerns.' This meant that people were involved in decisions about their care.

People who were able to could move around the home freely and safely. Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people's needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. We saw people responded positively to staff. One person said, 'Most staff are caring.' Another person said, 'Staff give me choices, they know I would ask if I needed help.' Another person said, 'Staff ask what I want help with.' People were very positive about the staff and the care they received.

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. Religious services were available to people who wanted to participate. This meant people's diversity and individuality were promoted and respected.

Is the service responsive?

We saw staff that responded quickly to meet people's needs and ensured people's safety and dignity was maintained. For example, staff responded quickly reassure a person who was becoming distressed. We saw that people were supported to express their views and these were acted on. People had the opportunity to engage in activities both within the home and local community.

People we spoke with were aware of how to make a complaint. We spoke with a relative who had previously made a complaint. They told us they had been informed of their right to make a complaint to CQC. They said, 'I don't think you can fault the care.'

Is the service well-led?

On completion of a probationary period the current manager would be applying to become the registered manger. Staff told us that the provider invested in and supported the home and staff. This was for things such as new flooring, redecoration, new food trolley and thermo flasks. The service worked well with other agencies and services to make sure people received their care in a joined up way. All staff felt supported in their roles and felt their views were listened to. Staff we spoke with told us they were happy working at the home.

The service had a quality assurance system. A number of audits were undertaken monthly and annually. Action was taken as a result of audit findings. This meant the quality of the service was continually improving.

Everyone agreed they were happy to be living at the home and were satisfied with the care and support they received. People told us that their privacy and dignity was always promoted and respected. Our observations supported this and we saw numerous examples of good care.

People's needs were comprehensively assessed and care and treatment was planned and delivered in line with their individual care plan. People told us that their medical, personal and emotional care needs were met. They said they were supported by a knowledgeable and well trained staff team who knew people's care and support needs well.

Hatton Court had comprehensive quality monitoring tools in use to ensure that they maintained good quality and safe care. We saw they effectively sought people's views about their care and listened to them.