Archived: Hampshire Court

We carried out an unannounced comprehensive inspection of this service on 12 and 13 November 2014. At which a breach of legal requirements was found.

The registered person had not ensured people were protected against the risks of unsafe or inappropriate care and treatment arising from a lack of proper information about them by means of keeping accurate records for each person.

After the comprehensive inspection the provider wrote to us to say what they would do to meet the legal requirements in relation to the breach. As a result we completed a focused inspection on 12 May 2015 to check that they had followed their plan and to confirm that they now met the legal requirements.

Shortly after the comprehensive inspection in November 2014 we received concerns in relation to the hot water system and the level of staffing. As a result we looked into those concerns during this focused inspection.

This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Hampshire Court on our website at www.cqc.org.uk.

Hampshire Court provided residential care for up to 50 people, some of whom were living with dementia. At the time of our inspection there were 12 people living at the home, all of them located on the ground floor. The upper floor of the home remained not in use due to on-going maintenance work.

The service had a manager, who had been in post since 20 April 2015. The manager had not yet begun their application to register with us. 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 focused inspection on 12 May 2015, we found that the provider had completed some of their plan which they told us would be completed by 23 February 2015.

Care plans and risk assessments had been updated since the comprehensive inspection but many of the same issues remained. We found the provider continued to breach regulation.

Risk assessments had not been completed in full and many had information missing, including dates and signatures. Information in relation to the monitoring of control measures was often not recorded. Risk ratings had not always been accurately calculated so people had been assessed as being at a lower risk than they actually were. One person had a risk assessment for dehydration with the risk recorded as medium but, when following the instructions to calculate the rating it should have been high. This was the case on several other risk assessments.

Some people had two versions of the same document in place, often with conflicting and confusing information recorded. One person had two falls risk assessments, one rated the risk as very high the other as a medium risk.

We found care plans contained confusing and at times contradictory information. Some care plans didn’t always direct staff as to specific strategies to use for example for using hoists and slings or for supporting people when they were anxious or distressed.

We saw no evidence of specific care plans in relation to medicines. One person had a care plan in relation to inhalers but it was not clear from the plan whether the person self-administered or whether the medicine was managed by staff.

The manager told us work was ongoing in relation to the hot water system. New boilers had been fitted and workmen were due on the day of the inspection as two toilets still had excessively hot water when the hot water outlets were turned on and one toilet had no hot water at all. The manager added that they had spoken to environmental health who were happy that work was now almost complete.

The manager confirmed that they had sufficient staff to meet people’s needs. Staffing during the day was two carers and a senior and during the night one senior and a carer. An additional domestic role had now been filled and we found the service to be clean and tidy with no malodours.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection took place on 12 and 13 November 2014. This was an unannounced inspection. At the last inspection carried out on 3, 4, and 15 July 2014 we found that the provider was not meeting two of the regulations inspected.

At the previous inspection we found the home was failing to take proper steps to protect people from the risks associated with unsafe premises and failing to take appropriate steps to provide adequate maintenance for the proper operation of the premises. We found in relation to cleanliness and infection control that the provider was failing to take proper steps to maintain appropriate standards of cleanliness and infection control because people were not protected from the risk of infection and were not cared for in a clean, hygienic environment.

Following our inspection on the 3, 4 and 15 July 2014, the provider sent us an action plan telling us about the improvements they were going to make. During this inspection we found the provider had taken action to address these issues, although unforeseen additional damage to a shower room had prolonged work in this area. We took that into account when preparing this report.

Hampshire Court provided residential care for up to 52 people, some of whom were living with dementia. At the time of our inspection there were 19 people living at the home, all of them located on the ground floor. The upper floor of the home was not in use due to on-going maintenance work. The provider was in the process of making a decision to reduce the total number of registered beds available at the home, to coincide with the number useable on the ground floor. While the provider was making the decision, they had agreed with us not to take in any more people.

The home had a manager appointed in July 2014 and who was in the process of applying to be the registered manager of the home. 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.

People’s risk assessments were not always completed accurately, which meant people were not kept as safe as they could have been. Care records were not always reviewed regularly and clear which meant people were at risk of receiving inappropriate care and treatment.

These matters were in breach of regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People were respected and cared for individually. People told us they felt safe. One person told us, “I have no worries here about safety.”

People received their medicine correctly and staff had received training to administer medicine in the correct way. Any new staff were not allowed to complete this task until assessed as competent.

We found the home to be clean, tidy and odour free and new cleaning rotas had been put into place to monitor this.

Staff understood safeguarding procedures and told us about what they would do if an incident of concern happened. From what we were told, we felt staff would have no hesitation in reporting any safeguarding issues that may arise at the home.

Staff followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). MCA assessments and ‘best interests’ decisions had been made where there were doubts about a person’s capacity to make decision. The manager had also made three DoLS applications to the local authority when that had been required.

Staff knew the people who lived at the home. We asked staff about behaviours that challenged the service. They were able to explain how they managed those behaviours with different strategies they had put in place.

People told us they felt there was enough staff to look after them. The manager monitored staffing levels to ensure enough trained staff were available to meet people’s needs. The manager had procedures in place to ensure any staff recruited were suitable to work within the home.

There was a training programme in place. Staff development was monitored by the manager to ensure they had up to date knowledge and any training needs were met.

The home had recently employed a new maintenance person. Part of their role was to complete regular checks on the building and maintain a suitable environment for people. We saw the manager had emergency procedures in place so that if there was any incident, staff would know what to do to protect people.

People were offered a selection of food types and told us they enjoyed what was offered. We saw homemade food being prepared. People told us they had a choice and we saw evidence of that on the day we inspected. One person told us, “It’s lovely food, just right.” The kitchen staff were dedicated to making sure people were happy with the food they made for them.

We saw people being offered support if it was required and carers did this in a way which retained the dignity of the people they were caring for. Care staff were seen to be kind, warm and considerate. They also respected the views of the people they cared for. One person told us,

“Staff are very nice, very caring and can’t do enough for you.” A relative told us, “You just need to ask, they [staff] will do anything for you.” We found a positive attitude to caring from all the staff we had contact with during our inspection.

People told us they had choice. People had chosen to decorate their bedrooms with their own personal items and staff had helped them to do this. We saw people choosing what meals and drinks they would like. One person told us, “Staff ask me how I want things done, if that is what you mean.”

People were able to participate in activities, although the manager told us this was being reviewed with the two new activity coordinators recently employed.

People, who told us they had complained, said the staff dealt with the matter effectively and to their satisfaction. People and their relatives were able to meet with the manager and staff, at various times and be able to give feedback about the home. People and relatives thought the staff in the home listened to them and helped bring about positive change.

The manager had put in place a number of systems to monitor the quality of the service provided. When issues were identified, we saw actions had been taken.