Royal Hampton

We found the following examples of good practice.

The home was clean. We observed staff using PPE safely. Relatives explained that checks and tests were carried out before they visited to help ensure everyone’s safety.

Staff told us that they had worked together as a team to help promote the wellbeing of people throughout the COVID-19 pandemic. People and relatives spoke positively about the staff and the support provided. Comments included, "The staff have been amazing" and "Mum has been looked after incredibly well."

Royal Hampton provides accommodation for up to 73 people with residential and nursing care needs in a purpose-built building. At the time of the inspection, 63 people were using the service. Some of the people were living with dementia.

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

People and their visitors told us the service kept them safe. People were protected from the risks of abuse and staff had received training to support this. Risks were generally well managed, and the provider learned from accidents and incidents. Staff provided people with kind and compassionate care and respected their privacy and dignity.

Systems were in place for the safe storage, ordering, administration, disposal and recording of medicines.

The service was clean and tidy and staff maintained good infection control procedures.

Regular assessments and reviews took place to ensure people’s needs were being met.

People received a good range of food and fluids to meet their dietary needs.

A range of activities were in place and a new activity coordinator had been recently employed to further enhance this, particularly for people living with dementia and those people nursed in bed.

Suitable recruitment procedures were in place and there were enough staff on duty to meet the needs of people. However, some staff were not always fulfilling their roles completely. The registered manager was aware of this and was addressing. A suitable induction and training programmes were in place to support staff in their roles. Staff received supervision and an annual appraisal, and the registered manager offered other opportunities to receive support and be involved in how the service was run.

People were supported with their healthcare needs and had access to healthcare professionals when required.

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.

Complaints procedures were available for people and their visitors and through conversations, it was confirmed everyone knew how to complain if they needed to. Feedback was encouraged via questionnaires and meetings.

The registered manager ensured a number of quality assurance checks were completed to monitor and help retain a good quality of care for people.

Positive feedback about the management of the service was received. The registered manager had recently reviewed her daily walkabouts to provide further opportunities for feedback about the service.

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

Rating at last inspection (and update)

The last rating for this service was good (published 25 January 2018). This was a focussed inspection in which the good rating from the previous full comprehensive inspection in May 2017 was retained.

Why we inspected

This was a planned inspection based on the previous rating.

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.

At this inspection, we concluded that people were safe, there were sufficient staff deployed, people’s dietary needs were met and the service continued to be well led.

The Royal Hampton accommodates up to 73 older people, some of whom have nursing needs and some who are living with dementia. There were 48 people living at the home at the time of the inspection.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

A local authority safeguarding officer and contracts officer had visited the service prior to our inspection. They found no major concerns and all minor shortfalls and omissions which they identified, had been addressed by the time of our visit.

People and their relatives told us the service was a safe place to live. There were safeguarding procedures and systems in place. Records of accidents and safeguarding incidents were completed. We noted that these were not always detailed and some of the language used by staff was ambiguous. The registered manager told us that this would be addressed.

People and most relatives told us there were sufficient staff deployed. Some staff and a relative informed us that more staff would be appreciated. We observed that staff carried out their duties in a calm unhurried manner.

There were safe systems in place to receive, store, administer and dispose of medicines.

Safe recruitment procedures were followed and staff had completed training in safe working practices and to meet the specific needs of people. An induction process was in place.

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 place supported this practice.

People were supported to receive a suitable and nutritious diet and access health care services.

Regular audits and checks were carried out to monitor all aspects of the service. There were various feedback mechanisms in place to obtain the views of people, their representatives and staff. Meetings and surveys were carried out. These systems meant that people, their representatives and staff were regularly involved with the service in a meaningful way to help drive continuous improvement.

We received mixed feedback from staff about the registered manager. Some staff told us they felt supported by the manager and enjoyed working at the service. Several staff told us however, that morale had dipped. They said that more support from the registered manager would be appreciated. We passed this information to the provider for their information.

During our inspection, we found the registered manager to be open and transparent. She was able to provide us with all the information we requested and immediately addressed any minor shortfalls and omissions we identified.

At our last inspection in September 2016, we found six breaches of the Health and Social Care Act 2008. These related to safe care and treatment, person-centred care, need for consent, safeguarding people from abuse and improper treatment, staffing and good governance. We placed conditions on the provider’s registration to minimise the risk of people being exposed to harm. We rated the service as requires improvement.

At this inspection we found that timely action had been taken to improve the areas of concern. The provider had met the conditions which we placed upon them and was compliant with all the regulations we inspected. They had also ensured good outcomes for people in each of the five key questions we reviewed.

The Royal Hampton accommodates up to 73 older people, some of whom have nursing needs and some who are living with dementia. There were 23 people living at the home at the time of the inspection.

A new manager was in post. She had commenced employment on 3 January 2017. People, relatives and staff spoke positively about her leadership. She had applied to become a registered manager. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. The local authority safeguarding team told us that the home was no longer in organisational safeguarding and the provider had been proactive in addressing all the concerns raised.

There were sufficient staff deployed. Staffing numbers had increased since our last inspection. Agency staff were still used at the service and the provider tried to ensure the same agency staff were requested for consistency. Safe recruitment procedures were followed and staff had completed training in safe working practices and to meet the specific needs of people. An effective induction process was now in place which was linked to the Care Certificate.

There were safe systems in place to receive, store, administer and dispose of medicines.

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 place supported this practice.

We observed that staff supported people with their dietary requirements. Permanent staff who worked at the home were knowledgeable about people’s needs. We observed positive interactions between people and staff. Several people told us that the quality of care provided by agency staff was sometimes not as good as the care delivered by the permanent staff.

There was an activities facilitator employed to help meet the social needs of people. A varied activities programme was in place.

A complaints procedure was available. No formal complaints had been received in 2017. Feedback systems were in place to obtain people and their representatives’ views.

Regular audits and checks were carried out to monitor all aspects of the service. Our observations and findings on the day of our inspection confirmed that the provider had an effective quality monitoring system in place.

People and relatives spoke positively about the home. One relative told us, “It’s a place whatever your age or limitations that you can come and enjoy life. It’s a positive experience, not the end of the road.”

All staff informed us they were happy working at the service and morale was now good. We observed that this positivity was reflected in the care and support which staff provided throughout the day.

The provider was meeting the conditions of their registration. They were submitting notifications in line with legal requirements and were displaying their previous CQC performance ratings at the service and on their website.

This home opened in January 2016 and this was our first inspection of the service. We brought forward our planned comprehensive inspection because we received information of concern related to staffing levels, safe care and treatment and the governance of the service.

Royal Hampton is a 73-bed home providing residential, nursing and dementia care. The facility includes a library with internet café, quiet lounge, social room and Shakespearean restaurant. There is also a treatment room where beauticians and therapists offer spa treatments, manicures, pedicures, massages and facials. Each of the single bedrooms has en-suite shower rooms and there are a number of suites with private lounges and kitchens. There were 17 people living at the home at the time of the inspection.

There was a manager in place during our inspection. They were not yet registered with the Care Quality Commission as a registered manager. A registered manager is a person who has registered with CQC 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 and associated Regulations about how the service is run. Following our inspection, the manager’s employment with the provider ended.

We found that systems and processes were not fully in place or operated effectively, to ensure compliance with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The manager carried out a number of audits and checks on aspects of the service. We noted however, that these did not always highlight the concerns which we found. We identified shortfalls with record keeping and confidentiality. There were gaps in the recording of some people’s care and treatment. In addition, care plans and risk assessments for one person had not been completed. We found confidential information regarding people’s care and treatment stored on the table in the open nurses’ station on the first floor.

People, relatives and staff told us there were insufficient staff deployed to meet people’s needs. There was a high use of agency staff. People and relatives raised concerns about continuity of care We identified issues with staff deployment and their skill mix and found there were insufficient suitably qualified, competent, skilled and experienced staff to meet people’s needs.

Most people told us they felt safe living at the home. However, some relatives informed us that due to the high use of agency staff; they considered there were times when their family members were not always as safe as they could be. One person had sustained an injury. This incident and subsequent injury had not been referred to Northumberland safeguarding adults team in line with protocols, or the Commission. This meant the person was not fully protected from the risk of abuse and improper treatment because the incident had not been referred to the correct authorities to check whether the appropriate action had been taken to safeguard the individual.

The manager explained that staff induction at the home had not been as thorough as they would have liked because of staffing issues. They told us that they were aware there were some gaps in training provision and explained that further training was planned. Documented induction and competency checks for agency staff were not always available. This meant it was not clear what clinical skills certain agency staff had to ensure that people’s needs were met by suitably qualified, competent, skilled and experienced staff. Checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining at least two written references and a Disclosure and Barring Service check [DBS].

There were gaps and omissions relating to medicines management, including the recording of controlled drugs. We found that a robust system for the receipt of medicines coming into the home was not fully in place and medicines had not always been administered as prescribed.

We checked the condition and suitability of the premises. The furnishings were luxurious and all areas of the building were well maintained.

The provider used a computerised care management system which was used to plan and review people’s care and support. This system flagged up when reviews were due for care plans and assessments. We found however, that people’s care records were not always accurate or up to date.

On the first day of our inspection, Deprivation of Liberty Safeguards [DoLS] applications had not been submitted to the local authority for authorisation where it was indicated that people’s plan of care amounted to a deprivation of liberty. On the third day of our inspection, the manager told us that two DoLS applications had been submitted.

People were complimentary about meals at the service. We saw that staff supported people with their nutritional needs.

Most of the interactions we saw between people and staff were positive. We found however, that staff sometimes overstepped professional boundaries and discussed work matters with people and relatives.

People told us that their social needs were met. There was an activities coordinator in place. On the second day of our inspection however, the activities coordinator was diverted from activities provision to help with care duties which the provider stated was due to an emergency situation at the home.

Two people had recently been admitted to the home. We noted that a preadmission assessment had not been carried out prior to them coming into the home. The provider informed us that preadmission assessments had always been carried out prior to people moving to the home except in relation to these two individuals, one of whom had been admitted as an emergency admission. They told us that in an emergency situation, a formal preadmission assessment may be completed on admission to the home.

There was a complaints procedure in place. People and relatives told us that they knew about the complaints process.

Staff told us that morale was very low which most staff informed us was due to the management of the service. We looked at staff rotas and noted that seven of the 32 staff had been off sick at various intervals over the two weeks prior to our inspection.

We referred all of our concerns about the service to the local authority and Northumberland Clinical Commissioning Group.

We found six breaches of the Health and Social Care Act 2008. These related to safe care and treatment, person-centred care, need for consent, safeguarding people from abuse and improper treatment, staffing and good governance. 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.