Hebburn Court Nursing Home 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. Hebburn Court Nursing Home accommodates 55 people in one adapted building, across two floors. There were 38 people using the service at the time of our inspection, including some people living with dementia. This unannounced comprehensive inspection took place on 26 and 29 November 2017. This means that neither the provider nor the staff knew we would be visiting the home.
We last inspected this service in February 2016 and at that time we rated the service as 'good'. However, during this inspection we found some shortfalls at the service, and have now rated the service as 'requires improvement'.
A registered manager was not in post. The previous registered manager had formally de-registered with CQC in May 2017. A new manager had been employed but was absent at the time of our inspector. The deputy manager, with support from two managers from the provider's other services was responsible for the day to day management of the service whilst the manager was not at work. . 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.
There was a strong unpleasant smell around the home, including corridors, lounges and people's bedrooms. The provider was aware of this smell and was working to address it. We have made a recommendation about this. The décor of the home had not been well maintained, as paint was peeling and in bathrooms the woodwork was damaged. Maintenance staff were working through a list of improvement actions, however some absence meant they were running behind schedule. The home was clean and staff followed infection control procedures.
People who used the service and relatives told us staffing was adequate to run the service safely. During our inspection we found there were enough staff to respond to people's requests and meet their needs. However, staff expressed concern over staff numbers overnight. The provider's regional manager advised us that following a staffing review they were increasing the number of staff to cover the busier times of the night. The night before our inspection staffing numbers had fallen below the usual staffing levels, and the contingency protocol had not been followed leaving the service ‘short staffed’. The provider’s regional manager advised us they would ensure the contingency plan was followed in the future.
The systems in place to keep people safe had been maintained. Staff were knowledgeable about the safeguarding process. Accidents and incidents were well recorded and monitored to determine if any trends were occurring. Risks were managed. Safe recruitment processes, including pre-employment checks had been followed.
Medicines were administered by trained staff who had their competencies to administer medicines checked regularly. Medicine administration records were well completed. Health and safety checks on the building and equipment were regularly carried out.
Staff training was up to date. Staff received regular supervision and an annual appraisal. New staff were provided with an induction and opportunities to shadow more experienced staff.
Feedback about the food on offer was positive. People were usually provided with a visual choice so they could decide at the time what they would like to eat, based upon how it looked and smelled. Where people needed support to eat, this was given in a dignified way.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Applications had been made for Deprivation of Liberty Safeguards (DoLS), where it was considered that people would be unable to keep themselves safe if they were to leave the home unaccompanied.
People had access to a range of healthcare professionals to maintain their health and wellbeing. Referrals and appointments had been made with GPs, district nurses, specialist nurses and occupational therapists. Their advice had been incorporated into care records.
Most care plans in place were very person-centred and included details about people's life histories and what was important to them. People’s individual needs were assessed and an up to date plan of care was in place.
People told us staff were friendly and caring. They told us they were treated with dignity and respect. We saw that staff knew people well, and observed positive interactions where people and staff shared jokes and laughed together. Visitors told us they were welcome to visit at any time.
People spoke highly of the activities on offer. There were a wide variety of stimulating activities planned within the home. The wellbeing coordinator spent time with people on a one-to-one basis as well as planning group activities. We saw one person had been supported by the activities coordinator to reconnect with an old friend they hadn't seen for 20 years.
Complaints had been responded to in line with the provider's policy.
The quality assurance system included a range of audits carried out regularly by the manager, regional manager and the provider's quality assurance team. Whilst there was evidence that some of the shortfalls we identified had been highlighted through these audits we noted the issues were still on-going.
Feedback about the management team was very positive. Staff explained there had been a number of managers in a relatively short period of time, but described the current management team as stable and supportive. The service had built links with the local community and businesses and arranged a collection of food, donated by people, relatives and staff which was donated to a local food bank.
We found one breach of the Health and Social Care Act 2008 This related to Regulation 17: Good Governance. You can see what action we told the registered provider to take at the back of the full version of this report.