Hastings Court

Hastings Court provides accommodation and nursing care for up to 80 people, who have nursing needs, including poor mobility and diabetes, as well as those living with various stages of dementia. Accommodation was provided over three floors and split into four units. Peony unit provided nursing care, Poppy and Sunflower units provided care and support for people who lived with dementia and Bluebell unit provided 13 residential beds. There were 74 people living in the home during our inspection.

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

People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I’m very content here, feel safer than I did at home.” Care plans and risk assessments meant peoples’ safety and well-being were promoted and protected. 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. We observed medicines being given safely to people by appropriately trained staff, who had been assessed as competent. The home was clean, well-maintained and comfortable. There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service.

The provider’s governance systems were being used consistently to improve the service. There had been improvements made, to areas identified from audits, such as adjustments made to the meal service and the introduction of hospitality staff, who worked alongside the care team.

The manager and staff team were committed to continuously improve and had plans to develop the service and improve their care delivery to a good standard. Feedback from staff about the leadership was positive, “We are a strong and supportive team, who want to deliver the best care we can.”

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 03 March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and delivery of care. A decision was made for us to inspect and examine those risks. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 Hastings Court 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.

Hastings Court provides accommodation and nursing care for up to 80 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. Hastings Court also provides ten short term care beds purchased by the Local Authority for people who were not ready to go home from hospital. There were 63 people living in the home during our inspection.

We found the following examples of good practice.

Visitors to the service were met by the receptionist who took their details, checking their vaccine status and Lateral flow device result. They were asked to take their temperature and record it on the electronic system and were given a bag of personal protective equipment (PPE) to wear on entry to the home.

People were supported by staff to have visits from their friends and family in various ways throughout the pandemic. When face to face visits had not been possible, people had window/door visits and visits in a quiet room now a visitors room which had a glass partition and speech panel/hole to enable clear communication. The visitors room was able to be accessed through the garden. People receiving end of life support or whose well-being was at risk were able to have essential visitors throughout the pandemic. People also used phone and video calls to keep in touch with their loved ones. The staff have a booking system to ensure people received their visitors safely and each person had named visitors, supported by a risk assessment .

Staff provided people and their relatives with updates to keep them informed of what’s happening at the home and any changes to visiting. These are also highlighted on the website for the service.

The layout of the home meant that in the event of an outbreak, people could be supported to safely isolate in small zones around their bedrooms. Risk assessments demonstrated how staff supported people to safely access quiet areas or the garden to promote their mental well being.

The home was clean and hygienic. The head house keeper explained that they completed daily cleaning schedules which included hourly contact areas, such as key pads and lifts. Audits were completed regularly.

PPE stations had been placed throughout the home for staff to access easily. People who have tested positive have individual PPE stations outside their room. Disposal of used PPE in the en-suite of individual rooms. Laundry was managed safely and one passenger lift was specifically designated as a ‘dirty ‘lift to reduce risk of transmission.

Staff had received specific COVID-19 training from the provider, and this included guidance for staff about how to put on and take off PPE safely. Updates and refresher training took place to ensure all staff followed the latest good practice guidance. They were seen to be following

correct infection prevention and control practices (IPC). Hand sanitiser was readily available

throughout the home.

Regular testing for people and staff was taking place. All staff have a weekly PCR and three lateral flow device test (LFD) weekly.

The premises has a variety of communal rooms on each of the three floors and people who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been arranged to allow more space between people. The corridors were also wide enough to facilitate social distancing.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, caring, responsive and well led to at least good. This inspection found significant improvements had been made and the breaches of regulation met.

Hastings Court 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. Hastings Court provides accommodation and nursing care for up to 80 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. Hastings Court also provides ten short term care beds purchased by the Local Authority for people who were not ready to go home from hospital. There were 58 people living in the home during our inspection.

The service had 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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service now met legal requirements. We found improvements had been made in the required areas.

The overall rating for Hastings Court has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Nurses and community leads (senior care staff) were involved in developing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The registered manager said all staff were being supported to do this and additional training was given if identified as required. A new computerised care plan system with staff was to be introduced in February 2018. People were supported to eat a healthy and nutritious diet. Food and fluid charts were completed when risk of poor eating and drinking had been identified and showed people were supported to eat and drink.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health and mental health needs such as diabetes, dementia and Parkinson’s disease. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. Staff were supported to become ‘champions’ in areas of care delivery such as infection control, medicines and tissue viability. People were supported to make decisions in their best interests. The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles. People previously isolated in their rooms were seen in communal lounges for activities, meetings and meal times and enjoyed the atmosphere and stimulation.

A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the day, seven days a week and were developed in line with people's preferences and interests. Further ideas for the prevention of social isolation were being discussed by the management team, such as sensory table equipment that will promote engagement with individual people. Technology was used to keep families up to date if they lived away via protected internet access to they can see events and activities taking place at Hastings Court. Staff had received training in end of life care supported by the Local Hospice team. There were systems for the management of medicines and people received their medicines in a safe way. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals.

The provider had progressed quality assurance systems to review the support and care provided. A number of audits had been developed, including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and they would be happy to talk to them if they had any concerns.

The home was purpose built to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over three floors and split into four units. Peony unit provided nursing care, Poppy and Sunflower units provided care and support for people who lived with dementia and Bluebell unit provided 10 blocked beds for those who had left hospital and needed care and support before either going home or on to a long term placement.

Hastings Court is owned by Hastings Court Ltd and the organisation has one other care home in Essex.

This comprehensive inspection was brought forward by six months due to a large number of concerns raised by families, friends and staff.

Due to a high number of concerns raised about the safety of people, care delivery, deployment of staff and staffing levels we brought forward the scheduled inspection to the April 2017, so we could ensure that people were receiving safe care from sufficient numbers of suitably qualified staff.

At this inspection, people’s safety was being compromised in a number of areas. Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic. We found that people with specific health problems such as breathing irregularities, diabetes and skin conditions did not have sufficient guidance in place for staff to deliver safe treatment. We also found that not all care plans reflected people’s health needs such as care of people post-surgery, catheters and breathing issues. The deployment of staff impacted on the care delivery and staff were under pressure to deliver care in a timely fashion. Shortcuts in care delivery were identified in that person care was not delivered in the way people needed. We also found the provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not following the principles of the MCA. We found there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves, as required under the MCA Code of Practice.

The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes and dislikes. Information in respect of people’s lifestyle choices was not readily available for staff. The lack of meaningful activities at this time impacted negatively on people’s well-being.

Quality assurance systems were in place but had not identified the shortfalls in care delivery and record keeping. Incidents and accidents were recorded but there was no overview available that identified actions taken and plans to prevent a re-occurrence. We could not be assured that accidents and incidents were consistently investigated with a robust action plan to prevent a re-occurrence.

People’s medicines were stored safely and in line with legal regulations. However people did not always receive their medicines as prescribed. There were missing signatures for medicines. These had not been followed up to ensure that people received their prescribed medicines. We also found poor recording of topical creams, dietary supplements and ‘as required’ medication.

People and visitors we spoke with were complimentary about the caring nature of some of the staff, but said that the changes to staff, use of agency staff and staff leaving had impacted on how the home was run. Some people were supported with little verbal interaction, and some spent time isolated in their rooms. Peoples’ dignity and independence was not always promoted.

Feedback had been sought from people, relatives and staff in 2017 but had not been undertaken since changes to the running of the home were implemented and the new management team had been introduced. ‘Residents’ and staff meetings had been held on a regular basis which provided a forum for people to raise concerns and discuss ideas.

Staff told us they thought that communication systems needed to be improved and they required more support to deliver good care. Their comments included “It’s been a bad time for us, but we are committed to improve.”

People had a choice as to where they ate and they and their relatives were positive about the food provided. People told us they felt listened to in regard to their comments and suggestions about food and mealtimes.

People and their relatives were positive about the physical environment and aspects of the care they received such as their rooms and the support they received to dress the way they chose. The provider had established an organisational system whereby the registered manager was provided with practical support and guidance from area and regional managers along with head office support in regard to areas such as HR.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Hastings Court and bank nurses all had registration with the nursing midwifery council (NMC), which was up to date.

We found a number of breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The home was purpose built to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over three floors and split into three units. One unit provided nursing care with the second and third units providing care and support to people living with dementia.

Hastings Court is owned by Hastings Court Ltd and the organisation has one other care home in Essex.

We last inspected Hastings Court in October 2015 where the overall rating was good. We received multiple concerns in September 2016 from whistleblowers in relation to people’s safety. As a result we undertook an unannounced focused inspection on the 18 and 21 September 2016 to look into those concerns and be assured of people’s safety. This report only covers our findings in relation to the key question of whether the service is safe.

The service did not have a registered manager. The registered manager resigned from post in August 2016. 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. There is an acting manager in post who has a good knowledge of the home and the people who live there. Interviews are currently being held to recruit a manager.

Before this inspection we received concerns that medicines were not always dispensed and handled by appropriately qualified staff. We found all staff that dispensed and handled medicines had received training and been assessed as being competent. However the handling of medicines was not always safe and some people did not always receive their prescribed medicines. The staff in Hastings Court had identified the errors and taken immediate action to mitigate risk to people’s safety. We found that there were sufficient appropriate and qualified staff to meet people’s needs. Clarity to staff role and duty rotas was an area that required improvement as it was unclear of staffs’ qualifications and experience to take responsibility for safe care delivery.

People said they were happy and well looked after. We found people were comfortable and happy moving around the home and spending time where they wanted to. The provider ensured a thorough recruitment procedure was followed when new staff were employed. Staff understood how to recognise any possible abuse and how to respond to any suspicion or allegation of abuse to safeguard people.