Hampton Grange Nursing Home

Hampton Grange Nursing Home is a residential care home providing personal and nursing care for up to 42 people within one large adapted building. It specialises in the care of people living with dementia and older people requiring general nursing care. At the time of our inspection, there were 29 people living at the home.

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

The provider’s quality assurance systems and processes were still not as effective as they needed to be. We found unexplained gaps in recording on people’s topical medicines application records, and incident records had not always been signed off by the registered manager to confirm all necessary actions had been taken. Most of the care staff we spoke with experienced a lack of clear leadership and direction on shift. People’s relatives continued to express mixed views about the management of the service.

Staff understood how to recognise and report potential abuse involving the people who lived at the home. The risks associated with people’s individual care needs were assessed and plans were in place to manage these. The provider carried out a range of checks to ensure the safety of the premises and the equipment within it. The provider checked the suitability of prospective staff before they were allowed to work with people at the home. They took steps to minimise the impact of agency staffing upon people’s care. Systems and procedures were in place designed to ensure people received their medicines safely and as prescribed. The provider had procedures in place enabling staff to record and report any accidents or incidents involving people who lived at the home. Domestic staff helped care staff maintain the hygiene and cleanliness of the home, and staff were provided with personal protective equipment to reduce the risk of cross-infection.

The registered manager sought to engage effectively with people’s relatives and staff through, for example, organising regular meetings with them. The majority of staff spoke positively about the support they received from the registered manager. The registered manager took steps to keep themselves up to date with legislative changes and current best practice guidelines. Staff and management worked with a wide range of community professionals to meet people’s individual care needs.

Rating at last inspection

The last rating for this service was Requires improvement (report published 17 April 2019) and there were breaches of regulation. An additional condition has been imposed on the service’s registration requiring the provider to supply us with a monthly report on how they were meeting Regulation 17 (Good governance). At this inspection enough improvement had not been made and the provider was still in breach of Regulation 17.

Why we inspected

We received concerns in relation to moving and handling practices, staffing, risk management and medicines. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

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 remained the same.

We have found evidence that the provider needs to make improvement. Please see the Well-led section of this full report.

Enforcement

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hampton Grange Nursing Home is a care home that provides nursing and personal care for up to 42 people within one large adapted building. It specialises in the care of people living with dementia and older people requiring general nursing care. At the time of our inspection, 32 people were living at the home.

People’s experience of using this service:

• Most people’s relatives and staff were concerned about the impact the lack of permanent staff and the current levels of, and changes in, agency staffing were having upon people's care.

• Some people’s relatives and staff were also concerned about staff shortages, when agency staff could not be booked, and the effectiveness of staff deployment. Concerns were raised regarding resulting delays and inconsistencies in people's care and support.

• Staff reported low morale amongst the staff team and did not feel their work was valued. People’s relatives expressed mixed views about the management of the service.

• Further improvement was needed in the provider’s governance and quality assurance systems to address concerns raised with us during our inspection.

• The provider had assessed, reviewed and put plans in place to manage the risks associated with the premises, the care equipment in use and people’s individual care and support needs.

• Staff understood their role in protecting people from any form of abuse.

• People’s medicines were administered safely by nurses and trained staff who maintain up-to-date medicines records.

• People were protected from the risk of infections by staff who made appropriate use of personal protective equipment.

• People’s needs were assessed and reviewed, and advice was sought on meeting these from relevant health and social care professionals.

• Staff received an induction and ongoing training to help them succeed in their roles.

• People were supported to make choices about what they ate and drank and to have an enjoyable mealtime experience.

• Staff sought people’s consent before carrying out their care, and supported their day-to-day decision-making.

• Staff adopted a caring approach to their work and promoted people's privacy and dignity.

• People’s communication needs had been assessed and guidance provided to staff on how to promote effective communication with individuals.

• People’s care plans were individualised, and staff understood the need to follow these.

• People had support to participate in social and recreational activities.

• The provider had a clear complaints procedure, and people’s relatives understood how to raise concerns.

• People’s needs and choices regarding their end of life care were assessed.

We found the service met the requirements for ‘Good’ in two areas, and ‘Requires improvement’ in three other areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection: At the last comprehensive inspection, the service was rated as 'Requires improvement' (inspection report published on 23 May 2018). At this inspection, the overall rating of the service remained the same. This service has been rated as 'Requires improvement' for the last three inspections.

Why we inspected: This was a planned inspection based on the service’s previous rating.

Enforcement: You can see what action we told the provider to take at the end of the full version of this report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any information of concern is received, we may inspect sooner.

We undertook this focused inspection to check the provider was complying with the requirements of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During our inspection, concerns were raised with us regarding the adequacy of staffing levels at the home. In view of this, we also inspected the service against the key question: is the service safe?

This report only covers our findings in relation to these requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hampton Grange Nursing Home on our website at www.cqc.org.uk.

This was an unannounced focused inspection carried out on the 2 October 2018, with a further announced visit on 8 October 2018.

Hampton Grange Nursing Home 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. The home accommodates up to 42 people within one adapted building, and specialises in the care of people living with dementia and older people requiring general nursing care. There were 34 people were living at the home when we inspected.

At the time of our inspection, there was no registered manager in post. We met with the care manager, who had commenced their duties in August 2018 and was in the process of applying to become registered manager of the service. 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.

The provider’s governance and quality assurance systems were still not sufficiently effective or robust. The audits and checks completed had not enabled the provider to ensure staff consistently maintained accurate and complete records in relation to people’s care, and exposed people to the risk of their care not being provided in line with their individual needs. The provider’s procedures for managing people’s medicines needed to improve, to ensure care staff consistently applied topical medication in accordance with the prescriber’s directions, and had clear guidance to follow. The risks associated with people’s individual care and support needs had been assessed and plans implemented to manage these. However, people’s care records did not always demonstrate staff were consistently adhering to agreed plans for minimising risks. People’s relatives continued to express mixed views about the adequacy of staffing levels at the home. Staff felt staffing levels were not sufficient, and that this had impacted negatively on their ability to work effectively. People’s relatives expressed mixed views about the management of the home and overall quality of care provided to their loved ones.

Procedures were in place to enable staff to record and report any accidents or incidents involving the people who lived at the home, which were monitored by the management team and provider on an ongoing basis. Staff understood their individual responsibilities to protect people from abuse, and were clear how to report any concerns of this nature. The provider had procedures in place for notifying and investigating any allegations of abuse brought to their attention. The provider undertook checks on prospective staff to ensure they were safe to work with people. Infection prevention and control procedures were in place to protect people, visitors and staff from the risk of infection. Most staff felt well-supported and valued in their work by an approachable management team. The provider encouraged feedback from people, their relatives and staff on the service, and worked with external health and social care professionals to promote joined-up care.

Hampton Grange Nursing Home is a ‘care home’. People in care homes received 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. Hampton Grange Nursing Home accommodates up to 42 people within one adapted building, and specialises in the care of people living with dementia and older people requiring general nursing care. At the time of our inspection, 31 people were living at the home.

A registered manager was in post and present during our 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.

At our last comprehensive inspection of the service on 1 February 2017, we found a breach of Regulation 17 of the Health and Social Care 2008 (Regulated Activities).Regulations 2014. We gave the service an overall rating of Requires Improvement. This breach related to the provider’s failure to assess, monitor and improve the quality and safety of the service provided. The provider sent us an action plan setting out the improvements they intended to make.

At this inspection, we found the provider was still not meeting the requirements of Regulation 17. Their quality assurance had not enabled them to effectively identify and address the significant shortfalls in quality we identified during our inspection, and they had not maintained accurate, up to date and complete records of people's care. We served the provider with a warning notice which required them to become compliant with Regulation 17 by 1 June 2018.

We also identified breaches of Regulations 9, 12 and 13 of the Health and Social Care 2008 (Regulated Activities) Regulations 2014. These related to the failure to provide consistent personalised care in line with people’s assessed needs and preferences, the failure of staff to consistently adhere to agreed plans to minimise the risks to people, and the lack of effective procedures for investigating allegations of abuse.

Communication between staff and procedures for sharing information on risks were not as effective as they needed to be. Staff did not always adhere to safe working practices. People did not always receive their medicines as prescribed and in line with the provider’s procedures. The procedures for monitoring accidents, incidents and unexplained injuries needed to be improved. The investigations conducted into potential safeguarding issues and associated decision-making were not always clearly recorded. People did not always have access to appropriate equipment and their involvement in decisions about what they ate and drank was not fully promoted.

Staff did not always maintain accurate records of people’s food intake in line with their care plans. Care planning and record-keeping in relation to people’s day-to-day health needs required improvement. People’s rights under the Mental Capacity Act 2005 were not always fully promoted. Staff did not always treat people with dignity and respect and people’s care plans were not always accurate, up-to-date and complete. The registered manager did not always work in unison with, or feel fully supported by, the provider. People, their relatives and staff found the registered manager approachable, but expressed mixed views about the overall management of the service.

The risks associated with people’s individual care and support needs had been assessed, recorded and reviewed. Staff understood their individual responsibility to protect people from abuse. Pre-employment checks were completed to ensure prospective staff were suitable to work with people. Measures were in place to protect people from the risk of infection.

Steps had been taken adapt the home’s environment for people living with dementia. People’s individual needs and requirements were assessed before they moved into the home. People had physical assistance and encouragement to eat and drink and the risks associated with their eating and drinking were assessed, with appropriate specialist input. Staff received an induction, ongoing training and regular supervisions to help them perform their duties. Staff helped people to access a range of healthcare services.

Staff responded promptly to people in distress and knew the people they supported well. People’s relatives were able to express their views on the service and to participate in care planning and reviews. People had support to participate in social and recreational activities, although the opportunities for them to do so were limited at present. The provider had procedures in place to ensure complaints were recorded, investigated and responded to. People receiving palliative care were supported to access a palliative care professional.

Hampton Grange Nursing Home provides accommodation, nursing and personal care to a maximum of 42 people, divided over two floors. At the time of our inspection there were 37 people living at the home. Some people were living with dementia.

Since our last inspection, there had been a change of provider and this was the first inspection since that change took place.

There was a registered manager in post at the time of our 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.

The provider had failed to effectively assess, monitor and improve the quality and safety of services provided. Though the provider had some systems in place to record and monitor the standards of care delivered within the home, these were not always effective. This followed our observed concerns about how some staff responded to the needs of people living with dementia during our visit. This also included that some staff had not received training to support people effectively at times, such as with a personal care needs. Whilst the home was very progressive in some area of dementia care, that was not always clearly demonstrated by staff. We also identified concerns about how some information was not always recorded accurately on both electronic and paper records. Individual concerns were not always effectively communicated at ‘staff handovers’ in addressing people’s needs. None of these issues had been identified by the registered manager through the provider's own quality audit checks, nor had steps been taken to address these issues.

We have made a recommendation about environments used by people with dementia.

Staff did not always effectively support people who were displaying behaviour that was challenging, which impacted on other people present. People's privacy and dignity was not always respected. Staff were overheard speaking indiscreetly about people's personal needs. White boards in people's bedrooms detailed confidential and personal information, which was visible to people walking along the corridor. People were unable to go to the bathroom when they wanted, as staff some staff lacked suitable training in supporting people.

Records were not always up to date and accurate such as re-positioning charts and fluid intake and output charts.

Risks to people's safety were assessed and minimised.

There were enough staff to support people safely at the home. People considered there were enough staff and did not feel they had to wait too long to receive support from staff.

We found appropriate Disclosure and Barring Service (DBS) checks had been undertaken and suitable references obtained, before staff started working at the home. Staff told us checks were made to make sure they were suitable to work with people before they started to work at the home, which included references, and a satisfactory DBS check.

The provider had appropriate arrangements in place to manage medicines safely. People were supported to take their medicines as prescribed.

Staff received regular supervision and training appropriate to their roles.

We found people’s mental capacity to make decisions had been assessed and appropriate Deprivation of Liberty Safeguards (DoLS) applications had been made. Care and support was provided in line with the recommendations within people's DOLS.

Individual nutritional needs were assessed and planned for by the home. We saw evidence that nutritional and hydration risk assessments had been undertaken by the service, which detailed any risks and level of support required by people. Relatives told us they had been involved in providing information for a 'Diet Notification Record,' which included any dietary restrictions, any assistance required or specialised crockery needed by the person and preferred foods and drinks. We looked at weight and fluid intake records for people, which reflected they were receiving the type of diet they required, together with plenty of fluids

The provider supported people to access a variety of health professionals to ensure they received effective treatment to meet their specific needs.

People were happy with the standard of support they received and spoke positively of their relationships with staff. People and relatives were actively involved in making decisions about their care and were listened to by the provider. The provider routinely and actively listened to people to address any concerns or complaints. Where complaints been received they been managed in line with the provider’s policy. Annual questionnaires were sent out to people to comment on the quality of services delivered.

People told us that both staff and the management team were very approachable. Staff told us the culture of the home was open and transparent and were confident that they would be listened to if they raised any concerns with a management about the service.

We found a breach 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 the report.