Archived: Hooklands Care Home with Nursing

Updated 30 November 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 and 20 October 2015 and was unannounced.

Three inspectors undertook this inspection.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed five previous inspection reports and notifications received from the registered manager before the inspection. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We looked at care records for 13 people, medication administration records (MAR), monitoring records of people’s food and fluid intake and weight. We also looked at three staff files, staff training and supervision records, staff rotas, quality feedback surveys, accident records, audits and minutes of meetings.

During our inspection, we spoke with nine people using the service, six relatives, the registered manager, one registered nurse, four care staff, the activity coordinator, two kitchen assistants and two of the housekeeping team. Following the inspection, we spoke with the acting clinical lead and contacted professionals to ask for their views and experiences. These included an agency that had supplied registered nurses to the service, a social worker, a district nurse, a Speech and Language Therapist (SALT), an optician, a chiropodist, a community admissions avoidance matron and a trainer from a local hospice. They consented to share their views in this report.

Updated 30 November 2015

The inspection took place on 19 and 20 October 2015 and was unannounced.

Following an inspection on 3 September 2015, we asked the provider to take action to improve the way that medicines were managed. The registered manager wrote to us in October 2014 to describe the action they would take to ensure that people received their medicines safely. At this visit, we found that the actions had been completed.

Hooklands Care Home with Nursing is registered to provide nursing care to up to 27 older people. The service is set over three floors and offers a variety of communal spaces, a garden and access to the beach. At the time of our visit there were 22 people living at the service.

The service has a registered manager. 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.

The registered manager had continued to improve and develop the service in response to concerns raised during our inspections in August and September 2014. A system of daily, weekly and monthly checks was in place to monitor and review the quality of care delivered. Staff felt that teamwork had improved and that they had a better understanding of person-centred care. The registered manager said, “It’s been a continuous learning experience”, and explained to us which actions were outstanding.

Most of the nursing staff had been recently recruited. We found that the team lacked knowledge in some areas of practice but that the acting clinical lead knew where to seek advice and, together with the nursing team, was pursing training opportunities to build on their knowledge and competence. We have made a recommendation around further training to ensure that people receive care and treatment in line with best practice guidance.

Records relating to assessments of people’s capacity did not show how their ability to make decisions relating to their care and treatment had been assessed. There was a risk that people could be deprived of their liberty without appropriate safeguards in place because the registered manager had not carried out assessments in line with the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS).

There was an open and friendly atmosphere at the home. People appeared relaxed and visitors were warmly welcomed. There were sufficient numbers of staff on duty to meet people’s needs, to provide them with one to one time and to encourage them to pursue their interests and hobbies. Staff responded quickly to people and provided support in a caring and respectful way.

People were involved in making decisions about their care and were supported to be as independent as they were able. Where there were changes in people’s needs, prompt action was taken to ensure that they received appropriate support.

People felt safe. Risks to people’s safety were assessed and reviewed. Any accidents or incidents were recorded and reviewed in order to minimise the risk in future. People received their medicines safely and at the right time. Staff understood local safeguarding procedures. They were able to speak about the action they would take if they were concerned that someone was at risk of abuse.

Staff received training and were supported by the registered manager through regular supervision. The registered manager had made arrangements to introduce appraisals for staff. Staff told us that the registered manager was approachable and that the home was well-led. Staff were clear on their roles and responsibilities and were kept up-to-date via handovers and regular staff meetings.

Mealtimes were a sociable experience. Staff were attentive to people’s needs and supported those who required assistance to eat or drink. People’s weight was monitored and action was taken if any concerns were identified.

The provider had made improvements to the home by redecorating, fitting new carpets and redesigning the garden area. There was a system for regular cleaning of the property and staff understood how to protect people from the risk of spreading infection.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.