Hampton Court Care Home

Hampton Court is a residential care home providing personal and nursing care to up to 80 people. The service provides support to older people, some of whom are living with dementia, or have mental health needs. At the time of our inspection there were 51 people using the service.

Hampton Court accommodates people across 2 separate units, each of which has separate adapted facilities. The smaller unit, known as The Lodge, specialises in providing care to people living with advanced dementia.

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

Systems used to review and monitor the quality of care provided were not always effective at identifying concerns.

People told us they felt safe. Staff knew how to identify possible signs of abuse and how to escalate concerns for people’s safety. People received their medicines as prescribed and there were enough staff to support people safely and respond to their needs. Staff had been safely recruited and there were systems in place to monitor the risk of infection. Where things went wrong action was taken to reduce the risk of reoccurrence and learn for the future.

People’s needs had been assessed and care plans contained details of their wishes and preferences. Staff knew people well and understood their likes and dislikes. Staff had received training in the roles and felt supported by the wider staff team and the management team. People received enough to eat and drink, and any dietary needs were known by staff so people could receive appropriate support. People’s health needs were managed with the support of external agencies. Improvements had been made to the home environment and were suitable for the needs of people living with dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us staff were kind and caring. There was a friendly, relaxed atmosphere within the home and people were comfortable to approach staff for care and support. People were involved in decisions about their care. Support was dignified and people’s independence was promoted where possible.

People’s care was planned with their involvement where possible. Staff understood people’s individual preferences and provided care tailored to each person. People’s communication needs had been considered to give people the best opportunity to understand information presented to them. People were encouraged to take part in activities which interested them. There was a system in place for the management of complaints. People’s end of life wishes were considered and staff worked alongside external agencies to ensure people received dignified care.

People, relatives and staff spoke positively about the management of the home. Feedback reflected there had been numerous positive comments and compliments made about staff and the care people received. There were established governance systems in place used to monitor the quality of care people received. There was a positive approach to learning at the home and any learning identified was shared with staff to raise the standard of care provided. Staff worked in partnership with other agencies to meet people’s needs. People, relatives and staff had been asked for their feedback about the home and responses were reviewed to ensure action could be taken to drive improvements in people’s care.

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

Rating at last inspection and update

The last rating for the service under the previous provider was requires improvement, published on 5 December 2019.

Why we inspected

The inspection was prompted in part due to concerns received about safety. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe section of this full report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Newlyn Court is a residential care home providing personal and nursing care to 58 people at the time of the inspection. The service can support up to 80 people in one adapted building.

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

Improvements had been made since the last inspection. The serious concerns identified relating to health and safety had been addressed and further improvements had been made throughout the service. The management and monitoring of fire safety, water temperatures, evacuation plans and electrical testing had improved and the provider was no longer in breach of the regulations.

However, we identified further improvements were still required. Improvements were required to the standard of some documentation and care records. We found some care planning documents required review to ensure they were up to date, and improvements were needed to the documentation relating to the use of covert medicines and end of life care planning.

People told us they felt safe and staff knew how to identify and report concerns relating to people's safety. Risks were assessed and managed to reduce the risk of avoidable harm. People received support to take their medicines safely. There were enough staff available to meet people's needs. Staff were safely recruited.

Staff received training and had the skills required to effectively support people. People received enough food and drink to maintain their health. Staff worked with external healthcare agencies to ensure people’s health needs were met. People were asked for their consent before care was provided. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were supported by a compassionate staff team who knew people well. People were supported to maintain their independence where possible and their dignity was valued and respected. People were encouraged to make daily living decisions and staff supported them to make their own choices where possible.

People were supported by a staff team who knew their life histories and understood their needs and preferences. People and their relatives were involved in the assessment and planning of their care. People were supported to participate in activities and pastimes. People and relatives knew how to raise a concern if they were unhappy about the service they received.

People, relatives and staff felt the service was well managed. The registered manager and provider had made improvements since the last inspection. Relatives and staff were given opportunities to share feedback about the service. The registered manager had implemented new systems to improve communication and the quality of care. Staff worked well with other partner agencies to ensure people's needs were met. Both the registered manager and provider had been open and honest about the failings identified at the last inspection and were keen to raise standards at Newlyn Court.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 15 October 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when, to improve. Following the inspection we applied conditions to the provider’s registration. They have complied with those conditions. They submitted monthly reports to us to demonstrate people were no longer at risk due to poor health and safety management.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 18 June 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

The provider has shared with us an action plan to explain what they will do to improve standards of quality and safety and to ensure they improve their rating to at least good. We will work with the local authority and clinical commissioning group to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

¿ Actions taken to always ensure risks to promote people’s safety in the home environment were not always effective.

¿ Action required by the Fire Authority was not fully actioned prior to our inspection.

¿ No action had been taken when checks had identified people could be exposed to a risk of scalding from hot water.

¿ There was a lack of evidence to demonstrate all portable electrical appliances were tested to ensure their safety.

¿ Items of potential risk were found unsecured within communal bathrooms and toilets.

¿ The providers quality checks were not fully effective in identifying potential risks to people living at the service.

¿ The registered provider had not achieved a rating above Requires Improvement for the fourth consecutive inspection.

¿ People confirmed they received their medicines however improvement was needed in areas of recording people’s medicines.

¿ People did not always receive the support they needed at meal times.

¿ Improvements were needed to ensure people’s personal care records were completed showing the care provided.

¿ Care records needed to be secured to prevent unauthorised access.

¿ Risks to people’s personal care needs were assessed, reviewed and equipment was in place.

¿ People felt safe and relatives believed their family member to be safe living at the home.

¿ Staff were aware of their responsibilities regarding safeguarding of people.

¿ People were supported by staff who were kind and caring.

¿ People had their privacy and dignity respected.

¿ Staff received training and support to ensure they had the skills and knowledge to perform their role effectively.

¿ People could make choices about their daily living.

¿ Relatives and staff spoke highly of the registered manager and the work they had done since becoming manager.

We found the service met the requirements for ‘Inadequate’ in two areas and ‘Requires Improvement’ in the remaining three area. The overall raring of the service was ‘Inadequate’. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement (report published 21 September 2017)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: The overall rating for this service is ‘Inadequate’ and the service has therefore been placed in ‘Special Measure’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within his timeframe.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Newlyn Court is registered to provide accommodation with nursing and personal care for up to 80 people including older people, people living with dementia and people with mental health needs. On the day of the inspection there were 64 people living at the home.

There was a registered manager in post. 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.

Although we found there were sufficient numbers of staff to meet people’s care needs, improvements were required to the way in which staff were deployed, to ensure people received timely support at mealtimes. People living at Newlyn Court told us they felt safe.

The provider had not always carried out assessments of people’s capacity to make specific decisions. Some people who required staff support during mealtimes experienced delays which meant their lunchtime experience was not a positive one. Staff did not always ensure people had the appropriate equipment to support them with the meals.

Staff were aware of their responsibility to report any concerns about people’s safety and knew how to escalate any concerns to the relevant authorities. People were supported to manage their risks by staff who were aware of the need to protect people from avoidable harm. The provider carried out safe recruitment practice to ensure staff who supported people were safe to work with vulnerable adults. People received their medicines as prescribed and there were systems in place to ensure medicines were managed and stored safely.

People were asked for their consent before care was provided. People were supported by staff who received training to ensure they had the skills and knowledge to meet people’s care and support needs. Staff told us training benefited their understanding and knowledge of people’s needs. People were happy with the food and drink they received and were supported to maintain a healthy diet. People received support to access relevant healthcare professionals where required which helped them maintain their health and wellbeing.

People received support from staff who were caring. People were supported to make their own decisions where possible. People were encouraged to maintain their independence and staff supported people in a way that respected their privacy and dignity.

People and relatives were involved in the planning and review of their care and support. Staff were aware of people’s individual care needs and supported them according to their personal preferences. Information about changes to people’s care was shared with staff to ensure people received up to date and relevant support. People and their relatives were aware of who they could contact if they were dissatisfied about the service they received. There was a system in place to manage complaints and where improvements had been identified changes had been made to reduce the likelihood of events reoccurring.

Although some improvements had been made since the last inspection, further action was needed to address the issues identified during this inspection. Action needed to be taken to ensure the quality of mental capacity assessments and the effective deployment of staff during mealtimes. People and their relatives told us they were happy with the support they received. Staff expressed confidence in the management team and provider and told us they could share any issues or concerns. People, relatives and staff felt able to share their views on the service, and the registered manager used these responses to drive improvements across the service. The registered manager and provider were aware of their responsibilities in relation to their roles and had notified us of incidents and events as required by law.

Newlyn Court is registered to provide care and accommodation for up to 80 older persons, some of whom may be living with dementia or have poor mental health. There were 65 people living at the service when we carried out our inspection.

The service had a registered manager. 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 felt safe and staff were aware of how to protect them from the risk of harm and escalate any concerns. Risks to individual people were identified and minimised. Visitors were not always confident there was sufficient staff. We saw occasions where staff were busy, meaning people had to wait for assistance. People received their medicine when needed and in a safe way. The provider checked prospective staff to ensure they were safe to work with people.

People were supported by staff who had the appropriate skills and knowledge to meet their needs. People’s health was promoted through timely access to a range of healthcare professionals. People had limited choices of food or drink, as they were not always given access to available options. People did have enough food and drink though, and it was presented in a way that met their specialist dietary requirements. People’s mental capacity was assessed; however assessments and best interest decisions were not specific about the decisions people may need support with.

People did not always receive consistent kind and compassionate care. People received care that was often task orientated and staff did not always listen to, or respond to people at the point care was delivered. Staff understood people’s needs and cared for people in a manner that respected people’s privacy and dignity. People were supported to maintain their independence.

People were involved in the planning of the care and support they received. People were involved in appropriate pastimes which reflected their preferences and gave them enjoyment. The provider took action in respect of people’s complaints but did not pro-actively encourage complaints or record outcomes from complaints to help capture learning or improvements the service may have made.

There was still scope for improvement in respect of some aspects of the service in respect of ensuring people received consistent person centred care. The registered manager expressed a wish to improve so the service was providing high quality care and was able to tell us of plans they had to help them achieve this. Staff told us they were well supported and able to approach managers, who listened to them. There were systems in place to monitor and provide an oversight of risks to people and the service, so these risks could be minimised.

During this inspection we spoke with the registered manager, the provider, three care staff, one nurse and two visiting relatives. The people who used the service lacked capacity and were unable to tell us about their experiences of using the service, so we observed how staff interacted with people.

We saw that there were sufficient staffing levels with various skills and experience to meet people's assessed needs. One visiting relative said, 'There seems to be enough staff and the staffing levels are consistent during the weekend as well." One care staff told us, 'The staffing arrangements are better. Staff are appropriately deployed during mealtimes.'

We observed that people's right to privacy was respected.

We found that care plans provided information about people's care needs and how to meet them. One visiting relative said, 'I am quite content with the care and X is kept nice and clean.' Another relative told us, 'They look after X very well.'

The care plans we looked at provided information about people's dietary needs and the support required to ensure they had sufficient food and drink. One visiting relative said, 'If X does not like their lunch the staff will give them something else.'

The layout and design of the property was suitable to meet people's needs but some areas were sparse and nonstimulating.

We found that there were insufficient staffing levels to assist people at mealtimes and to engage in social activities.

People who used the service and visitors had access to a complaints procedure.

We saw times when staff engaged positively with people as well as times when they didn't. We observed times when people's dignity was not always being respected by the way staff supported them with meals, and by the way people were supported with their mobility. This means that people did not always receive support that was respectful and promoted their dignity.

We saw that people's needs were assessed, and care plans were in place. Staff spoken to were able to tell us about people's needs. This ensures they receive support is a way they prefer.

Relatives we spoke with were happy with the care provided. One relative told us 'I think my relative is well looked after'. Another relative told us 'The care is good and the staff work hard'.

We found that staff were clear about the action to take should they become aware of an allegation of abuse in the home. This ensures people are safeguarded from harm.

We found that the medication systems in place ensured people received their medication as required.

Staff spoken with told us they felt supported by the manager, and have regular training opportunities.

We found that there were some systems in place to monitor the quality of the services, and make improvements where required.