Archived: Hooklands Care Home with Nursing

We also considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This summary is based on our observations during the inspection, discussions with six people who lived at the service, two relatives, the manager, one nurse and two care staff. We also reviewed four people's care and health records and records that related to the management of the service. These included maintenance records, audit reports, policies and procedures and staff training records.

As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff. At the time of our inspection there were 24 people living at the service. The majority of people required high levels of nursing care. The manager informed us that some people lived with dementia, that most people had continence needs and that many needed assistance with moving and handling. Other needs included maintaining skin integrity and pressure area care. We were also informed that six people had pressure ulcers .

Is the service safe?

Action had been taken to ensure that management of people's pressure areas and wounds was safe.

Improvements to cleanliness and the environment had taken place to ensure they did not pose a risk to people. Stained carpets in communal areas had been replaced and people confirmed their satisfaction with the improvements made at the service. One person said, 'Lovely home, nice new carpet'.

Systems had been introduced to make sure that the manager and staff learned from adverse events such as accidents and incidents. This decreased the risk of harm to people and helped prevent such incidents happening again.

Is the service effective?

Changes had been made to assessment and care planning systems which helped ensure the safe management of people's pressure areas and wound care.

Audits had been introduced that helped the manager to identify and then ensure action was taken to address shortfalls in service provision.

Is the service caring?

People that we spoke with told us that they were happy and well and our observations confirmed this.

Is the service responsive?

A residents' meeting had taken place in order that people's views and wishes were sought in relation to the quality of service provided and actions were taken as a result of issues raised.

Is the service well-led?

The manager had introduced systems to monitor and manage risks to the health, safety and welfare of people who used the service and others. These included audits of complaints, accidents and falls that helped to mitigate the risk of reoccurrence.

We also considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This summary is based on our observations during the inspection, discussions with four people who lived at the service, the manager, two nurses and two care staff. We also reviewed nine people's care and health records and records that related to the management of the service. These included policies and procedures and staff training records. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff.

At the time of our inspection there were 24 people living at the service. The majority of people required nursing care. The manager informed us that some people had dementia, that most people had continence needs and that many needed assistance with moving and handling. Other needs included skin integrity and pressure care, end of life care and nutritional care. We were also informed that five people had pressure wounds and one person had a dressing on their PEG site.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Since our last inspection the service has been supported by West Sussex County Council (WSCC) adult services safeguarding team to improve the management of people's pressure wounds. This has resulted in new care planning documentation having been introduced and further training provided to staff. At this inspection we found that, despite the support given by WSCC, the management of pressure areas and wounds was still not robust and placed people at risk of harm. People with pressure wounds were not having their wound dressings changed at the required frequencies and this had led to further deterioration of wounds for some people. This is being followed up and we will report on any action when it is complete.

Information about the use of bedrails had been obtained and considered to ensure they were compatible and safe to use with pressure relieving mattresses.

Is the service effective?

The service had introduced new documentation for the management of people's pressure areas and wounds. This was not effective as it did not ensure that people got the correct level of nursing intervention at the required frequency. This is being followed up and we will report on any action when it is complete.

During this inspection process three relatives made contact with us to share their views on the service provided to their family members. Two people expressed the view that the care that their family members received was 'excellent'. One expressed the view that the care provided was inconsistent.

Since our last inspection the service had obtained information from the manufacturers of pressure relieving mattresses. Staff at the service used this information to ensure equipment was now used correctly when they cared for people. This meant that people were not a risk of unnecessary pain and discomfort.

The service had obtained advice from a dietician and implemented new routines for the management of PEG. This was effective as it had reduced periods of nausea for one person who had a PEG.

Is the service caring?

During this inspection we visited 15 people who were either confined to bed due to their frailty and nursing needs or who had chosen to remain in their room. We observed that staff had ensured everyone was appropriately dressed or covered to preserve their dignity. People that we spoke with told us that staff were caring. One person explained, 'Staff are alright. They do their best'.

Is the service responsive?

Since our last inspection the manager had obtained a nationally recognised pain assessment tool. This would help ensure that people who may not be able to verbalise if they were in pain receive the necessary relief when required.

Is the service well-led?

The manager was not aware of some of the issues we identified at this inspection in relation to the management of people's pressure areas and wounds. This impacted on the safety of service delivered to people. This is being followed up and we will report on any action when it is complete.

This summary is based on our observations during the inspection, discussions with five people who lived at the service, one relative, the manager, the nurse on duty, three ancillary workers and two care staff. We also reviewed four people's care and health records and records that related to the management of the service. These included audits, accident and incident records, policies and procedures and staff training records.

At the time of our inspection there were 26 people living at the service. The majority of people required nursing care. The manager informed us that some people had dementia, that most people had continence needs and that many needed assistance with moving and handling. Other needs included skin integrity and pressure care, end of life care and nutritional care. As some people could not talk with us about their experiences of living at the service we spent time observing how they were cared for and treated by staff.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager told us that no one who currently lived at the service was subject to a DoLS authorisation. The manager demonstrated some understanding of DoLS and there were policies and procedures in place that the manager and staff could refer to if needed.

Whilst people's care needs had been assessed at the time of their admission to the service, we found that management of pressure areas and wounds was not robust and placed people at risk of harm. This is being followed up and we will report on any action when it is complete.

The systems in place to make sure that the manager and staff learned from adverse events such as accidents and incidents were not effective. This increased the risk of harm to people and failed to prevent such incidents happening again. This is being followed up and we will report on any action when it is complete.

We found that areas of the environment and some equipment were in a poor state of repair. Appropriate measures were not in place to prevent the risk of infection. Prompt action had not been taken by the provider to address these areas and to reduce the risks posed to people's safety and welfare. For example, the emergency call bell system was not fully operational and had not been since April 2014. This meant that some people were unable to summon assistance if they needed to. This is being followed up and we will report on any action when it is complete.

Is the service effective?

We found that people's nutritional needs were met. People were provided with a choice of meals and snacks and we observed that the lunchtime experience in the lounge and dining area was relaxed and inclusive. Care staff who assisted people to eat their meal ensured the pace was dictated by the person. Encouragement was given where needed.

Assessment and care planning systems were not effective as they did not help ensure the safe management of people's pressure areas and wound care.

The provider's involvement at the service had not ensured timely action had been taken to address environmental issues. There was evidence that the manager had repeatedly raised concerns about repairs that were required that needed approval or action by the providers. Some had not been acted upon for weeks or months and some were still outstanding at the time of our inspection.

The quality monitoring systems at the service were not effective as they did not identify and then ensure action was taken to address shortfalls in service provision.

Is the service caring?

People that we spoke with told us that they were happy and well. As one person told us, 'It's home from home' and another, 'I love it here, it's so nice'. We observed that staff were patient with people and treated them warmly.

Is the service responsive?

People's views and wishes were not routinely sought in relation to the quality of service provided, nor were the views of their representatives.

The service had not taken action to involve other agencies to help meet changes in people's care needs. For example, when people fell they did not seek advice from the Falls Prevention Team. When people developed pressure areas they did not make referrals to the Tissue Viability Nurse.

The service did not take sufficient action to reduce medication errors.

Is the service well-led?

The provider did not have effective systems in place to manage the risks to the health, safety and welfare of people who used the service and others. The quality of the service that people received had not been monitored. When incidents and accidents occurred the service had not looked into these in sufficient detail in order to reduce the risk of reoccurrence. We found that gaps in care planning and incidents and accidents sustained by people who lived at the service were not known by the manager. This impacted on the safety of service delivered to people. This is being followed up and we will report on any action when it is complete.

The service was not well led. Management was fragmented and this impacted on all areas of service provision. For example, the clinical coordinator had been given responsibility for management and clinical oversight of the nurses and nursing practices. The provider's had not ensured the clinical coordinator had undertaken this role effectively despite knowing that the manager of the service was not qualified to do this. There were no structured communication systems in place that involved both provider's and the manager that formed part of the quality monitoring systems at the service.

A pharmacist inspector inspected the service on 3 September 2014 and gathered evidence against the relevant outcome we were inspecting.

Our judgement is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

We found that people's medicines were not handled safely. We found that the procedure used during administration followed poor practice. The service did not have effective systems for assessing and responding to poor practice.

We gathered evidence by spending time watching how people spent their time, the support they received from staff and whether or not they had positive experiences.

We saw that staff addressed people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

All of the people that we spoke with told us that they were happy living at the home and that they felt that their care needs were being met. One person said, 'I really am happy living here, the staff will do anything for you, nothing is too much trouble'. Another person said, 'I just couldn't look after myself anymore. I am happy here and safe, everyone is so kind to me'.

We found that people had planned care that met with their needs. We also found that people's consent had been obtained prior to treatment where appropriate.

We saw that medications were being stored and administered safely in the home.

We also found that staff were trained in line with the provider's policy, and were supported by the home's manager to develop within their roles.

We found that people's complaints were taken seriously by the service, and that the manager was following the home's complaints procedure when dealing with people's concerns.