Archived: High Hurlands Nursing Home

High Hurlands Nursing Home is a nursing home providing personal and nursing care for up to 22 people with a learning disability, autism and/or associated health needs in a small village on the outskirts of Liphook in Hampshire. At the time of the inspection there were 22 people living at the home.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People’s care was designed around meeting their health, medical and wellbeing needs. Management and staff displayed a positive ethos that focused on treating people with respect and promoting their choice through supporting people to follow their interests.

Relatives fed back positively about the quality of care their family members received. There was a positive culture at the service, where staff told us that management were approachable and supportive.

The provider had recognised where improvements could be made in the governance of the service. They had employed a new acting management team, who had reviewed the overall quality, safety and governance structure in the home.

Risks related to people’s health and medical conditions were assessed to reduce the risk of harm. Where people had complex health needs, professional input was sought to ensure staff followed best practice.

There were systems in place to ensure people were safely supported to take their medicines as prescribed.

There were systems in place to help ensure people did not suffer abuse or avoidable harm. When incidents took place, the provider investigated these thoroughly to ensure lessons were learnt.

The provider had systems in place to ensure the home was clean and hygienic. They had put additional infection control measures in place to mitigate the risks related to the COVID-19 pandemic.

There were enough staff in place, who were suitably qualified and trained in their role.

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 17 May 2018)

Why we inspected

We received concerns in relation to staffing, medicines management and the leadership at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

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.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for High Hurlands Nursing Home on our website at www.cqc.org.uk.

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.

High Hurlands Nursing Home is a care home for people who require nursing and personal care. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

High Hurlands Nursing Home provides care to a maximum of 22 people who live with a learning disability, autism and/or associated health needs in a small village on the outskirts of Liphook in Hampshire. At the time of the inspection there were 22 people living at the home.

The service had a registered manager in post. 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 was guidance in place to protect people from risks to their safety and welfare, this included the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely and where there were any short falls these were covered internally.

The provider had an effective recruitment process to make sure the staff they employed were suitable to work in a care setting.

Risks to people were assessed and action was taken to minimise any avoidable harm to people. Staff were trained to support people who experienced behaviour that may challenge others, in line with recognised best practice.

The provider used an electronic system to manage people's medicines. The system ordered, recorded the administration of and managed people's medicines stocks. Nurses had undertaken training to enable them to use the system and ensured that they administered people's medicines safely.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally, where required. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

People were supported by staff who had the required skills and training to meet their needs. Where required, staff completed additional training to meet individual’s complex needs. People were supported to have a balanced diet that promoted healthy eating and the correct nutrition.

Risks to people with complex needs were identified and managed to ensure they were supported to eat and drink safely. The registered manager ensured people were referred promptly to appropriate healthcare professionals whenever their needs changed.

The registered manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible.

People experienced good continuity and consistency of care from staff who were kind and compassionate. The registered manager had created an inclusive, family atmosphere at the home. People were relaxed and comfortable in the presence of staff who invested time to develop meaningful relationships with them.

People's independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.

Practical arrangements including staff rotas were organised so that staff had time to listen to people, answer their questions, provide information, and involve people in decisions.

The service was responsive and involved people in developing their support plans which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

People were supported by staff to maintain special relationships with friends and relatives to ensure people did not feel lonely and were protected from the risks associated with social isolation.

Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

The service was well managed and well-led by the registered manager who provided clear and direct leadership, which inspired staff to provide good quality care. The safety and quality of the support people received were effectively monitored and any identified shortfalls were acted upon to drive continuous improvement of the service.

High Hurlands Nursing Home had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The service is required by a condition of its registration to have a registered manager.

During the inspection we saw that there were sufficient staff to meet people’s needs. Where shortfalls were identified, for example, through sickness, the provider managed these internally by deploying staff flexibly across the nursing home and community homes.

The provider had not always ensured that all the relevant recruitment checks were carried out for newly employed staff. This meant that people were not always protected from the risk of receiving care from staff who were not suitable for their role.

Risks to people had been assessed and measures were in place to manage them. All incidents were recorded and reviewed in detail at monthly management meetings in order to identify any potential risks to people and in order to take any required actions to keep people safe.

Staff had undertaken training in safeguarding adults and understood their role in relation to keeping people safe from the risk of abuse. Where safeguarding incidents had occurred these had been dealt with appropriately, including being correctly reported to the relevant authorities and action taken to minimise the risk of re-occurrence.

The provider used an electronic system to manage people’s medicines. The system ordered, recorded the administration of, and managed the stock of people’s medicines. Nurses had undertaken training to enable them to use the system and ensure that they administered people’s medicines safely.

Staff received an appropriate induction and continued to receive regular supervision and relevant training in their role. People were cared for by well trained and well supported staff.

People’s records demonstrated they were supported by staff to see a range of health care professionals both on a routine basis and when they needed additional support.

Deprivation of Liberty Safeguards (DoLS) applications had been made for all people who lacked capacity to make decisions for themselves. Mental Capacity Assessments and Best Interest decisions had been carried out for people on some areas such as implementation of their care plans and use of specialist beds. We have made a recommendation that the provider ensures that appropriate mental capacity assessments and best interest decisions are clearly documented for some specific decisions taken on a person’s behalf, for example around other types of restraint, in order to demonstrate that the least restrictive outcomes for people were always in place.

People were supported to eat and drink enough to maintain a balanced diet. Meals were provided in the form of nutritionally balanced ready meals, cooked from frozen, which many people ate and enjoyed. However some staff and relatives told us they would prefer people to have freshly prepared meals. People’s mealtime experience varied on occasion. People didn’t tend to eat at the same time or together which sometimes impacted on the scope for mealtimes to be a social occasion. Some staff were very good at interacting with people while supporting them to eat while others were more focussed on the task.

People were supported to have choice in their daily decisions about their care such as what they wanted to wear or where they wanted to spend their time, and staff respected these. Staff described how they understood what choices people were making through their knowledge of the person.

Staff were able to discuss the importance of maintaining people's respect and privacy and describe how they ensured this. We saw that people’s privacy and dignity was promoted by staff.

There was a person-centred culture at the home and many of the staff knew the people they were looking after very well. There were warm and caring interactions between people and staff. Relatives described positive relationships that their loved ones had developed with the staff who worked closely with them.

People’s relatives were involved in the planning and reviewing of their care on their behalf. Staff had a good knowledge of each person’s care needs, interests and characteristics and ensured that people’s cultural and spiritual preferences were met. Staff supported people to attend a well organised and extensive programme of activities which enabled them to lead meaningful and fulfilled lives. People were supported and encouraged to maintain relationships with their relatives.

There was a complaints policy and procedure in place and relatives told us they would be confident in approaching the registered manager or provider if they had any concerns. We saw that where concerns had been recorded, these had been responded to and dealt with effectively by the registered manager.

The registered manager was friendly and approachable and promoted a culture which was open and transparent. Staff applied the provider’s values in their work with people. The registered manager had a good understanding of improvement and learning and identified opportunities for these. They gave clear direction and provided support to the staff team through a well-managed supervision and appraisal system.

Processes were in place to seek feedback on the quality of the service provided. The registered manager was enthusiastic and proactive in implementing systems to monitor and improve the quality of the service provided. They had implemented effective governance processes and procedures to ensure that people received high quality care.

People were protected against the risk of abuse because staff had been trained in adult protection procedures and were encouraged by the management team to express any concerns about people's wellbeing.

People were supported by sufficient numbers of well trained staff, most of whom knew them well. This helped to contribute to the high quality of interactions we witnessed.

The service was well led by an experienced manager and a competent and efficient senior management team who ensured that there were robust monitoring systems in place, to review all aspects of the service, for example infection control. This helped to maintain the high quality of the service.

There were very clear systems in place to ensure that staff acted appropriately in people's best interests when they assisted them with their health and care needs. Staff were given detailed guidance, which was regularly reviewed to help them to support people appropriately and consistently. Relatives were regularly informed about people's wellbeing. Healthcare professionals were consulted when the need arose and their advice was followed.

There were thorough processes in place to ensure that medicines were managed safely and regular audits took place to review medication procedures.

Effective recruitment procedures helped to ensure that staff employed were fit and appropriately qualified to do their job. People were supported by well trained staff who demonstrated a good understanding of people's needs.

Staff were regularly assessed to ensure that they had, and continued to have the necessary skills and knowledge .

There was a clear system in place to manage complaints and staff had a lot of guidance and knowledge about how to recognise when people were unhappy. Staff were encouraged to express their views during regular supervision sessions and said that managers were receptive to their opinions.