New Milton House

Quaker House provides accommodation and personal care for up to 40 older people. The home is set in its own grounds close to local amenities and the town centre. At the time of our inspection there were 28 people using the service.

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

People and their relatives told us the home was very well managed. A person commented, “The quality of care is paramount in their minds.” There was a friendly atmosphere in the home and staff supported people in a kind and caring way that took account of their individual needs and preferences. People and their families were supported to express their views and be involved in making decisions about their care and support.

There were systems and processes in place to protect people from harm, including how medicines were managed. Staff were trained in how to recognise and respond to abuse and understood their responsibility to report any concerns. There were sufficient numbers of experienced staff to meet people’s needs. Safe recruitment practices were followed to make sure only suitable staff were employed to care for people in the home.

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.

The provider and registered manager were promoting an open, empowering and inclusive culture within the service. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving appropriate support.

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 26 January 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Follow up

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

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

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Medicines management had improved and people received their medicines as prescribed from staff who had been trained and were competent to do so.

Staff received guidance in how to keep people safe from harm and abuse and understood how to report any concerns.

Risks associated with people’s health, safety and welfare had been identified and assessed. Emergency evacuation procedures were in place and known to staff.

There were sufficient staff deployed on all shifts with the right skills to meet people’s needs and keep them safe. Recruitment procedures were in place to ensure only suitable staff were employed.

Improvements had been made to ensure staff received training and appraisal to provide them with the required skills, knowledge and competencies for their roles. Some staff had not received regular supervision but felt well supported and able to discuss any issues with the management team at any time.

People’s rights were protected because staff understood the principles of the Mental Capacity Act (MCA) 2005) and asked for their consent before providing any support. The registered manager understood their responsibility to submit applications for Deprivation of liberty safeguards to the local authority for authorisation when required.

The catering had improved at the home. People were offered a choice of fresh, home cooked food and a choice of drinks that met their preferences and dietary needs.

People were supported by staff to maintain their health and wellbeing and had access to a range of healthcare services when required.

Staff were kind and caring and treated people with dignity and respect. People were encouraged to make choices and retain their independence and maintain relationships with people who were important to them. Family and friends could visit at any time.

People and their relatives were involved in planning their support and care. Care plans had improved and were detailed and described how people wanted to receive their support.

People took part in a wide range of activities and events that met their preferences and needs.

The provider was working towards meeting the Accessible Information Standards. Staff used a variety of communication methods to communicate with people where required.

People and relatives were offered opportunities to feedback their views about their care and this was used to help improve the service.

There was a positive, supportive and open culture within the home. Staff felt supported and listened to by the manager and management team who were visible and approachable.

The provider had a complaints procedure and any complaints were investigated and responded to appropriately.

Quality assurance and auditing systems were in place to help drive continuous improvement. Record keeping had improved significantly although there was room for further improvement.

The registered manager understood their responsibilities under the Health and Social Care Act 2008, including submitting notifications of events as required to the commission.

We last inspected the service in October 2017 when we rated the service Requires Improvement with five breaches of regulations. The home has made significant improvements and now meets these regulations.

At our inspection in October 2016 we identified the provider was not meeting three regulations. Risk assessments were not always completed and regularly reviewed and actions were not taken to mitigate risks. Staff had not always followed safeguarding guidance to ensure people were protected from abuse or harm. Records in respect of people living at the home were not always accurate and up to date and the provider had not maintained appropriate oversight of the service. At this inspection we found that there was still some work to do to ensure risks to people were safely managed and the effectiveness of record keeping, which was sometimes out of date and did not reflect people’s current needs. We also found three new breaches of Regulations relating to people’s nutritional needs, the need for consent and person centred care.

The home had been through three management changes since our last inspection. At our inspection in October 2017 we found a new interim manager was in post until a new registered manager could be appointed. An advertisement went out for a registered manager the week after our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

Initial assessments were carried out before people moved into Quaker House to ensure their needs could be met. Care plans were not always up to date and did not always reflect their current care needs.

Individual risks relating to people’s health, safety and welfare had not always been completed or adequately reviewed to identify, assess and reduce those risks.

Although staff received training to administer medicines and were assessed for competency, people had not always received their medicines at the correct time, and in some cases, they had not received their medicines at all. The interim manager had requested to the Board of Trustees to change the medicines management system.

People were not always supported to eat an appropriate diet that met their assessed nutritional needs and people’s food preferences were not always supported.

Not all staff understood and followed the principles of the Mental Capacity Act 2005 designed to protect people’s rights and ensure decisions were made in their best interests.

Most people told us there was not enough to keep them occupied and they were often bored. Staff confirmed they were often too busy providing care and did not have time to provide regular social or physical activities. There were sufficient staff deployed to meet people’s care and support needs.

People and relatives told us they felt the home was safe. Staff understood how to identify abuse and explained the action they would take if they identified any concerns. However, not all staff knew how to report concerns to external agencies such as the Care Quality Commission.

Some recruitment checks required improvement to ensure that only suitable staff were employed.

Staff had not all received appropriate supervision, appraisal and training in line with the provider’s policy although actions had been taken to address this.

The manager had a good understanding of their responsibilities in relation to meeting the Health and Social Care Act 2008 regulations. They had notified us appropriately of events required by law.

Systems were in place to monitor and assess the quality and safety within the home although this was a work in progress and recent action plans had not yet been implemented.

Incidents and accidents had been investigated and learning shared with staff.

People were supported to maintain their health and well-being and had access to a range of healthcare services when they needed them.

Staff interacted with people with kindness and care. Staff treated people with dignity and respect and ensured their privacy and independence was promoted.

Friends and family were able to visit their loved ones at any time and felt welcomed by staff.

Residents meetings took place and enabled people to share their views about the service. People and relatives knew how to raise concerns and would do so if they needed to.

Staff felt supported by the interim manager who provided clear leadership and direction. Staff felt able to raise any issues or concerns with them and felt listened to and involved.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Quaker House is a purpose built residential care home for up to 40 older persons. It is located in a quiet residential area, close to the centre of New Milton. The registered provider is New Forest Quaker Home Limited who is also a registered charity run by a board of Trustees. The Trustees meet on a regular basis to discuss and decide on all issues concerning Quaker House. At the time of our inspection there were 29 people living at the home. The home provides both short and long term residential care and day services. It does not provide nursing care or specialist support for people living with dementia or those who might display behaviour which might challenge others.

The home is arranged over two floors which are accessed by stairs, a stair lift or a passenger lift. There are three communal lounges and a dining room. The 40 single rooms all have ensuite facilities. There are bathrooms and a shower room on each floor and kitchenettes with fridges where residents can make their own food and drinks. Many of the people living at the home were generally quite independent and only required minimal support with some aspects of personal care or support with their medicines management and the provision of meals. Some were able to use their mobility scooters to visit the town centre and storage for these was provided.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

Some areas required improvement. Staff displayed a commitment to protect people from harm and to protect them from abuse. However, potential safeguarding concerns had not been appropriately escalated to the local authority safeguarding teams.

The service did not have a structure to continuously monitor incidents, accidents or near misses for any trends or patterns that might allow actions to be taken to prevent similar incidents from happening again. Audits were not undertaken on a regular basis to measure the delivery of care, treatment and support given to people against current guidance.

Staff had not always taken appropriate steps to identify and mitigate risks to people’s wellbeing and safety and improvements were needed to ensure that all aspects of medicines were managed safely.

People and their relatives were positive about the care and support they received. Staff knew people well and understood how to meet their individual needs. However, some people’s care plans needed to be updated. Others needed to include more detailed and specific guidance about how to meet people’s needs.

There were sufficient numbers of experienced staff deployed to meet people’s needs at this time. The level of dependency of people using the service was increasing however, and so the registered manager would benefit from having a more systematic approach to determining staffing levels. We have made a recommendation about this.

Staff had received an induction and on-going training. However, the registered manager was not able to demonstrate that staff had received an annual appraisal. Supervision had also not been taking place on a regular basis. This was however, an improving picture.

Additional training was needed to help ensure that going forward staff fully understood the key principles of the MCA 2005 and how and when it might be appropriate to apply for a DoLS.

People were positive about the quality of food provided. They received a choice of meals and were supported to have a nutritious diet.

Staff had developed effective working relationships with local healthcare professionals to ensure that people received co-ordinated care, treatment and support.

People told us they were cared for by kind and caring staff who respected their choices, their privacy and dignity and encouraged them to retain their independence.

People received care that was responsive to their needs. Staff knew people well and had a good knowledge of their likes and dislikes.

People enjoyed the activities provided but felt further improvements could be made to ensure the activities remained relevant and were in keeping with their interests and wishes

People told us they were able to raise any issues or concerns and felt these would be dealt with promptly.

People spoke positively about the registered manager who had a good knowledge about the people being cared for within the service.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People's privacy dignity and independence was respected and promoted. People living at the home told us that they were fully involved in their care, that they were listened to and their choices and preferences respected.

People's care and welfare needs were being met. Assessments had been carried out and care plans put in place so that staff knew how to support people.

The home had robust recruitment procedures in place that were being followed to ensure that suitable members of staff were employed to work at the home.

The home had effective systems in place to monitor the quality of service provided to people living at Quaker house.

Records were maintained on behalf of people. These were up to date, accurate and stored confidentially.

People told us that they were consulted about their care and the way the home was run.

They told us their care needs were met by the staff team and that the home was well managed.

Staff we spoke with told us that they were felt supported by the management and that training was provided to make sure they were competent and knowledgeable.