Background to this inspection
Updated
6 September 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by three inspectors (one being a medicines inspector) and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Hothfield Manor is a care home with nursing care. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post. They were present during the inspection.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We reviewed information we had received about the service since the last inspection. We reviewed the information of concern we had received to ensure we focused on the appropriate areas during our inspection. We used all this information to plan our inspection.
During the inspection
We spoke with five people and five relatives of people using the service. We spoke with 10 staff including the registered manager, a senior manager, a nurse, activity staff, the chef, an occupational therapist, a physiotherapist and carers. We reviewed information held in seven people's care plans, three staff recruitment files, medicines records and other records related to the running of the service. This included minutes of meetings and audits. We received feedback from eight health and social care professionals and two independent advocates of people.
Updated
6 September 2022
About the service
Hothfield Manor Acquired Brain Injury Centre is registered as a care home with nursing and as a rehabilitation service for 32 older people, younger adults and people with a range of acquired brain injuries and neurological conditions.
The service was separated into two parts. People staying in the Neurological Rehabilitation Unit (NRU) were usually admitted directly from hospital after treatment for traumatic range of acquired brain injuries, along with some neurological conditions (non-degenerative) and spinal injuries. They generally stayed for 12 weeks when they worked intensively on developing their independence with support from nurses, physiotherapists, occupational therapists, psychologists and technicians.
People living in The Manor stayed for longer and some had made it their home. Others continued to progress their recovery from brain injuries with the intention of moving on.
At the time of the inspection 18 people were receiving care at the NRU and 10 people lived at The Manor.
People’s experience of using this service and what we found
Information to support staff with how and when to administer ‘when required’ (PRN) medicines was not always in place in The Manor. When staff were hand-writing medicines onto the administration records there was often no authorising signature or witness signature to ensure the prescriber’s, intentions were followed. We have made a recommendation around this. However, the service had systems and processes in place to safely store, administer and record medicines use. Staff were knowledgeable about people’s needs around medicines and worked to support independence where possible.
Staff contributed to the development of best practice and good leadership. Learning took place and changes were made to how care was delivered when needed. There were a whole range of
health care professionals who worked at the service that ensured staff were up to date with best practice and current guidance. Comprehensive training was provided to all staff.
Staff demonstrated a real empathy for people they cared for. Staff involved and treated people and relatives with compassion and kindness. People’s preferences likes and dislikes had been taken into consideration and support was provided in accordance with people's wishes. People's privacy and dignity were respected and promoted when personal care was undertaken.
People were able to alert staff when they needed to and there were sufficient numbers of staff available to support them. All the health care professionals had to ensure that they remained fit to practice. 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.
The service had a strong, visible person-centred culture and was helping people to express their views so they understand things from their points of view. People, relatives and staff were involved in the running of 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 24 February 2020).
Why we inspected
This was a planned inspection based on the previous rating and concerns we received about the management of medicines.
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.