Hatley Court

Hatley Court is a residential care home that provides personal care. It is registered to provide care and support for up to 35 older people. At the time of the inspection 33 people, some of who lived with dementia, were receiving personal care. Accommodation was provided over two floors accessible by a passenger lift and stairs.

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

People were safeguarded from harm by staff who were trained and knowledgeable about identifying and reporting any potential abuse. Medicines were administered and managed safely but some records had not been completed. Risks to people were identified and managed well. There were enough staff, who had been safely recruited and met people’s needs. Lessons were learned when things went wrong. There were mostly good systems in place to support good infection prevention and control practise.

The provider had ensured we were notified about events such as safeguarding. Audits in place were effective in identifying and driving improvements. The manager had identified and was addressing issues and had begun to build a supportive and positive staff team culture. One staff member said, “The manager is now managing the staff team as a manager should.” Staff, including the manager, were supported in their role via mentoring, team meetings and supervisions. However, not all supervisions, best interest decisions and medicines administration records had been recorded correctly. The provider and manager took action to address this before we completed our inspection. People were involved in how the service was run. The provider worked well with others involved in people's care and 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 15 May 2019).

Why we inspected

We undertook a focused inspection to review the key questions of safe and well led. This was because we received concerns in relation to the management of the service, staffing, medicines administration, management of risks, infection prevention and control. Several safeguarding concerns had been raised with the local authority in relation to poor care. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

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.

We found no evidence during this inspection that people were at risk of harm from these concerns. The provider had acted on safeguarding allegations and other concerns to help prevent the potential and risk of occurrences.

Please see the safe and well-led sections of this full report. The overall rating for the service has not changed from good overall but the safe domain has improved to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hatley Court on our website at www.cqc.org.uk.

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.

The accommodation is a purpose built building split over two floors.

This unannounced inspection was carried out on the 5 April 2018. At the previous inspection in August 2017 the home was given an overall rating of requirement improvement. During this inspection we found that Improvements had been made and the home now has an overall rating of good.

At the time of the 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 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.

Medicines were in the main managed safely. Staff received training and competency checks before administering medicines unsupervised. Medicines were stored securely. Records were not always an accurate reflection of medicines people had received. Not all protocols informing staff when to administer “when needed” medicines were available as guidance to staff.

Staff were aware of how to keep people safe from harm and what procedures they should follow to report any harm. Risk assessments identified risks to people and provided staff with the information they needed to reduce risks where possible. Action had been by staff taken to minimise these risks to people.

Staff were only employed after they had completed thorough recruitment checks in line with the providers procedure. There were enough staff employed to ensure that people had their needs met in a timely manner. Staff received the training that they required to meet people's needs and were supported in their roles.

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.

Staff were motivated to provide care that was kind and compassionate. They knew people well and

were aware of people’s history, preferences, likes and dislikes. People's privacy and dignity were respected.

People were supported to maintain good health. There was prompt access to external healthcare professionals when needed and in a timely manner.

People were provided with a choice of food and drink that they enjoyed. When needed staff supported people to eat and drink.

There was a wide range of activities for people to be involved in. These included activities held in the home, one-to-one activities and hobbies and interests.

Care plans provided staff with the information they required to meet people’s care and support needs. People received support that they needed in the way that they preferred it.

There was a complaints procedure in place. People and their relatives’ felt confident to raise any concerns either with the staff or registered manager. Complaints had been dealt with appropriately and in line with the providers guidance.

There was an effective quality assurance process in place which included obtaining the views of people that lived in the home, their relatives’ and the staff. Where needed, action had been taken to make improvements to the service being offered.

Further information is in the detailed findings below.

This comprehensive inspection took place on 3 August 2017 and was unannounced.

At the last inspection on 22 February 2017 we found there was a breach of one legal requirement. We found that improvements were needed to ensure that people were protected from harm because medicines were not always accurately managed or administered. The provider and registered manager were required to provide written evidence to the Commission that systems and processes were in place to ensure the proper and safe management of medicines at Hatley Court. They were also required to provide a monthly written report and evidence to show how the systems and processes for the proper and safe management of medicines were being monitored.

During this inspection we found that the provider had made some improvements in relation to the management and administration of medicines. However, people were at a continued risk of harm because staff had not safely administered medicines as prescribed. The provider's policy on administration and recording of medicines had not been followed by staff.

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. The registered manager was present during this inspection.

Risks to people who lived at the home had been assessed and identified and staff were aware of how to reduce risks to people. However, we found that changes to those risks to people had not always been updated.

Staff did not always treat people with care and respect. People’s privacy and dignity was not always respected.

There were sufficient numbers of staff to meet people’s needs. The provider had a robust recruitment process in place and staff were only employed after all essential safety checks had been satisfactorily completed. Staff had an induction when they started work and further training was available for all staff which provided them with the skills they needed to meet people’s requirements.

People had their needs assessed and reviewed. Staff knew how to support people and meet their requirements even though information had not always been recorded or updated in people’s care plans.

There was a system in place to record and investigate complaints. Where complaints had been upheld, there was a process in place to ensure that staff were aware of the outcome and used to reduce the risk of recurrence.

Staff understood the principles of the Mental Capacity Act 2005 (MCA) and could describe how people were supported to make decisions. Staff were aware of current information and regulations regarding people’s consent to care. Decisions, made on people's behalf by staff, would be in their best interest and as least restrictive as possible.

People and/or their relatives were appropriately involved in how their care and support was provided. Staff monitored people’s health and welfare needs and acted on issues identified. People accessed health care professionals when they needed them. People said they were provided with a choice of food and drink and were supported by staff when required.

People, relatives and staff were able to provide feedback and information about the service provided in the home. There were systems in place to monitor and audit the quality of the home.

Staff meetings, supervision and individual staff appraisals were completed. Staff were supported by the registered manager.

There has been enforcement action taken by CQC in relation to Hatley Court.

This unannounced inspection took place on 22 February 2017.

There was a registered manager in place. 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 last inspection on 26 and 28 September 2016 we required the provider to take action to make improvements to person centred care, the implementation of the Mental Capacity Act, risk assessments, monitoring the quality of the service and the recruitment process. The provider sent us an action plan detailing how these improvements would be made and during this inspection we found that the required improvements had been made.

At our previous inspection we also required the provider to take action to ensure that medicines were always administered safely. Although we received an action plan, during this inspection we found that the necessary improvements had not been achieved and there were still concerns about the administration of medication. 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.

People could still not be confident that they were receiving their medicines as prescribed. Staff were not accurately recording the administration of medicines and medicines were not always securely stored.

Action had been taken to ensure that risks to people were being assessed. Staff were provided with the information they needed to reduce risks to people where possible.

The provider’s recruitment procedures had been followed to ensure that new staff were only employed after the necessary checks were carried out. This meant that only the right people were employed. Staffing levels were adequate to meet people’s needs.

The registered manager had when needed assessed people’s capacity to make decisions. Where appropriate, decisions made in people’s “best interest” had been recorded. DoLS application had been made to the local authority when required. This meant that people’s rights were being respected.

Staff had received the training and support they required to meet people’s needs. Staff received regular supervisions with a member of the management team.

People had been referred to healthcare professionals when needed. People were provided with a choice of food and drink that they enjoyed.

Staff knew people well and supported them to maintain their interests. People were not always treated with dignity and respect.

Staff had detailed and current information about the action they needed to take to meet people’s individual needs. This meant that people received their care and support in the way that they preferred.

There was a complaints procedure in place and people and their relatives felt confident to raise any concerns either with the staff or the registered manager.

The registered manager had systems in place to assess the quality of the service being provided and had taken action when needed. However the improvements regarding the administration of medication had not been achieved.

This unannounced inspection took place on 26 and 28 September 2016.

There was not a registered manager in place. 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. A new manager had commenced working in the home in July 2016 and had applied to the Commission to become registered. Their application was being processed.

Action had not always been taken to minimise the risks to people. Risk assessments identified risks but didn’t always provide staff with the information they needed to reduce risks were possible.

People could not be confident that they received their medication as prescribed because staff were not always following the correct procedures when administrating and recording medication.

The provider’s recruitment procedure hadn’t always been followed. This meant that people were at risk of being cared for by staff that were not suitable.

The CQC is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager had completed a DoLS application. However, they had not completed the necessary capacity assessment to establish if the DoL was required. The staff demonstrated how they supported people to make decisions about their care but they did not have a good understanding of the principles of the MCA.

People’s care plans did not always give staff the information they required to meet people’s care and support needs. People did not always receive care that was person centred and met their needs.

There was a detailed action plan in place for the staff that identified and detailed some of the improvements that were needed. However the ongoing audits did not always identify all of the improvements that were required to ensure that people received the care and support they needed.

There were usually enough staff on shift to ensure that people had their needs met in a timely manner. However there had been occasions when short notice staff absence had affected the staffing levels.

Staff received the training they required to meet people’s needs and were supported in their roles.

Staff were aware of the procedures to follow if they thought anyone was at risk of harm from others. Staff were kind and caring when working with people. They knew people well and were aware of their history, preferences, likes and dislikes. People’s privacy and dignity were respected.

People had been referred to healthcare professionals when needed. People were provided with a choice of food and drink that they enjoyed. People were not always supported in the way they preferred to enable them to eat and drink.

There was a varied programme of activities including group activities, one-to-one activities, entertainers visiting the home and trips out. Staff supported people to maintain their interests.

There was a complaints procedure in place and people and their relatives felt confident to raise any concerns either with the staff or manager.

There were processes in place to obtain the views of people that lived in the home and their relatives. This had resulted in improvements being made as requested by people.

We found five 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 the report.