Hepscott Care Centre

Hepscott Care Centre is a residential care home providing accommodation for persons who require personal and nursing care to up to a maximum of 40 people. The service provides support to older people, including people who live with a dementia related condition. At the time of our inspection there were 30 people using the service. The care home accommodates people in one adapted building.

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

There were sufficient staff to support people safely. Staff had received safeguarding training and were clear on how and when to raise their concerns. Where appropriate, actions were taken to keep people safe.

Improvements had been made to medicines management. Staff followed effective processes to assess and provide the support people needed to take their medicines safely. Staff contacted health professionals when people’s health needs changed.

People and relatives were very positive about the caring nature of staff and had good relationships with them. They trusted the staff who supported them. People’s comments included, “I think the staff are really nice and are dedicated to doing their best for me” and, “It’s like home-from-home and the cooking is very good.”

Staff followed good infection control practices. The environment was showing signs of wear and tear and the provider provided an immediate action plan of refurbishment.

Records provided guidance to ensure people received safe, person-centred care and support from all staff members. A person told us, “I don’t think there’s a better home to be in. This is perfect, staff take time with you, they are really nice, and I think they are dedicated to their job.”

There was a welcoming, cheerful and friendly atmosphere at the service. A relative told us, “This home has been an absolute lifeline to me and our family. [Name] could no longer look after themselves. Since they got here, they have not had any time in hospital, and is well-looked after by staff.”

Staff spoke positively about working at the home and the people they cared for. They said communication was effective to ensure they were kept up-to-date about any changes in people’s care and support needs.

Staff respected people's diversity as unique individuals with their own needs. The staff team knew people well and provided support discreetly and with compassion.

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.

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 requires improvement (published 29 July 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 14 June 2021. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hepscott Care Centre on our website at www.cqc.org.uk.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hepscott Care Centre is a residential care home providing accommodation and personal care for up to 40 people. At the time of the inspection there were 26 older people living at the home.

The home is a converted and extended building with rooms over two floors, all of which have ensuite facilities. There are a number of communal lounge areas, a dining room and an activities room. People also have access to a garden area.

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

People’s medicines were not always managed safely. We found records relating to the safe storage of controlled medicines to be inaccurate. Infection control processes at the home had improved. Staff followed national guidance on the use of personal protective equipment (PPE) and practices to minimise infection risk. Processes to safeguard people from abuse were in place and risks related to both care and the running of the home were reviewed. Staff recruitment was undertaken safely and there were enough staff to support people’s care needs.

People choices and preferences were considered in determining and delivering their care. The home had worked hard to support people with activities during the current Covid-19 pandemic. Effective systems were in place to support relatives and friends to safely visit people in the home. Processes were in place to support people during the final period of their life.

Systems to monitor quality and safety at the home had improved but still needed to be made more robust. Check and audits had been established, with the exception of the safe management of medicines. People were supported to be involved in decisions about the running of the service, as much as possible. Staff said they were well supported by the acting manager and could raise any issues or concerns. The home worked closely with health and social care professionals.

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 requires improvement. (18 February 2021)

At this inspection we found improvements to the original breaches in regulations had been made and the provider was no longer in breach of these regulations. However, we found an additional breach of regulations relating to medicines.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 have found evidence that the provider needs to make some additional improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service remains requires improvement This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hepscott Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to how the service manages medicines safely. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme.

Hepscott Care Centre is a residential care home providing accommodation and personal care for up to 40 people. At the time of the inspection there were 25 people living at the home.

The home is a converted and extended building with rooms over two floors, all of which have ensuite facilities. There are a number of communal lounge areas, a dining room and an activities room. People also have access to a garden area.

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

Infection control processes at the home were not robust. Staff did not always follow the national guidance on the use of personal protective equipment (PPE) and practices to minimise infection risk. Medicines were managed safely, and records were up to date. Processes to safeguard people from abuse were in place and risks, other than infection control matters, were reviewed and maintained. Staff recruitment was undertaken safely and there were sufficient staff to support people’s care needs.

The home had worked hard to support people with activities during the current Covid-19 pandemic. A visiting pod had been installed to support people to have regular contact with their relatives.

Systems to monitor quality and safety at the home were not always robust. Specific checks and audits around infection control were limited. People were supported to be involved in care decisions as much as possible. Staff said they were well supported by the registered manager and could raise any issues or concerns. The home worked closely with health and social care professionals.

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. (31 May 2018)

Why we inspected

The inspection was prompted in part due to concerns received about the delivery of care, staff use of PPE and the safe management of medicines. A decision was made for us to inspect and examine those areas of risk.

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 coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hepscott Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the service response to infection control and the need to follow government guidance on the use of PPE. We have also identified that management processes to check staff at the home were working safely were not always detailed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hepscott Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. It accommodates up to 40 older people, some of whom are living with dementia. At the time of our visit 31 people were being cared for at the home.

The service was last inspected in October 2016 when we found five 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 and good governance. We requested actions plans from the provider outlining the action they would take to make the necessary improvements.

At this inspection we found improvements had been made and the provider was no longer in breach of these regulations.

A registered manager was 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.

At the last inspection we found not all aspects of the service were safe. People were not fully protected from abuse and risks to them and towards other people had not been fully assessed or mitigated. Storage for controlled drugs (CD’s) was not suitable.

At this inspection we found general and individual risk assessments had been carried out and staff had received training in the safeguarding of vulnerable adults and were aware of the procedures to follow in the event of any concerns. New CD storage cupboards had been installed which were suitably secure.

We checked the management of medicines and found a small number of gaps in records for non-medicated creams and lotions. Instructions about when to use some medicines as required lacked detail. We spoke with the registered manager about this who told us they would address this issue.

Medicine training and checks on the competency of staff to administer medicines had been carried out. An air conditioning unit had been ordered due to the treatment room becoming warmer than the recommended maximum temperature for the storage of medicines. The room temperatures were monitored closely in the meantime.

The home was generally clean and well maintained. We noted malodour on one floor on the first day of the inspection which had been addressed by our second visit. New flooring had been laid in one room and additional cleaning carried out.

Regular checks on the safety of the premises and equipment were carried out. This included checks of fire safety equipment, window restrictors, water temperatures and equipment used for the moving and handling of people.

There were suitable numbers of staff on duty who cared for people in a relaxed unhurried manner. Safe staff recruitment procedures were followed which helped to protect people from abuse.

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.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. At the last inspection we found decisions had been made in people’s best interests where they lacked capacity, but records did not demonstrate how people’s capacity and been assessed. At this inspection we found capacity assessments were recorded including information about every day decisions people were still able to make, and the amount of support they would need to make more complex decisions.

People were supported with eating and drinking and peoples likes, dislikes, needs and preferences were recorded. We received positive feedback about the quality of meals. The nutritional status of people was monitored to ensure any specific concerns about their health or diet could be addressed. Professional dietary advice was sought when required.

The health needs of people were supported. People told us they had access to a GP when necessary and care plans to address specific health needs were in place. Prior to the inspection concerns were raised that the service was not always keeping an up to date record of the resuscitation status of all people living in the home. At the inspection we found up to date records of whether people had a DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) order in place and these were audited regularly.

Staff received regular training, supervision and appraisals and felt well supported. Specialist training in supporting people exhibiting behavioural disturbance and distress was planned to ensure new staff felt confident in supporting people.

We observed kind and caring interactions between staff and people living in the home. People told us staff were courteous and respectful.

We received mixed feedback about the activities available to people. We observed a number of positive activities taking place and saw records of previous events that people had enjoyed. Some people told us they were bored. We passed this feedback to the registered manager and made a recommendation about this.

People and visiting professionals told us staff were responsive and sought timely support. Where specific instructions were issued, these were carried out by staff.

Care plans were in place and the provider had recently moved to electronic care plans (held on computer). Some care plans we read were very person centred and detailed, particularly those designed to support people when they became anxious. Other care plans contained generic phrases found on the computer system which meant they could be less personalised. The registered manager and deputy manager had picked up this issue and were in the process of reviewing all care plans at the time of the inspection to remove generic statements where required. We have made a recommendation to keep care plan content under review until use of the electronic record system is fully embedded.

Complaints were recorded and responded in line with the provider’s policy.

At the last inspection we found the provider’s governance systems had failed to pick up all the issues we identified. At this inspection we found improvements had been made and additional audits and checks were being carried out. Where we found minor gaps or areas for improvement, these had been identified by the registered manager and deputy. A new staff rewards scheme had also been introduced.

Hepscott Care Centre is a residential care home in Morpeth. It accommodates up to 40 older people, some of whom have dementia care needs. At the time of our visit 26 people were being cared for at the home.

The service was last inspected in July 2015 and at that time was in breach of Regulation 17 HSCA (RA) Regulations 2014 Good Governance. During this inspection we found that whilst some actions had been taken to improve the quality and monitoring systems, shortfalls in care remained. The provider had failed to implement a robust system to assess, monitor and improve the quality and safety of the services provided.

A registered manager was 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.

People had not been fully protected from the risk of abuse and improper treatment. Allegations of potential abuse had not been shared with all of the relevant authorities. Where people displayed behaviours that challenge, the risk they posed to other people had not always been assessed.

Accidents and incidents were monitored and reviewed by the registered manager. However actions had not always been taken to reduce the risk of them reoccurring. Assessments to limit the risk of people choking when eating had not been undertaken.

People, relatives and our observations confirmed there were enough staff to meet people’s needs. Records showed safe recruitment processes had been followed.

Staff had been trained to administer medicines and followed good practice, however appropriate storage systems were not in place for controlled drugs.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’.

We found decisions had been made on people’s behalf, however the provider could not demonstrate how the person’s capacity had been assessed or that they had considered the principles of MCA and ‘best interests’ in determining the decisions. Some people’s liberty was deprived because it was considered that they would not be able to keep themselves safe if they left the home alone. However the provider had not applied for the legal authorisation to do this.

Staff received training and supervision to ensure they had the skills and knowledge to meet people’s needs.

People spoke highly of the food available and there was a plentiful supply of fresh ingredients. We found people’s dietary requirements had not always been recorded appropriately within their care records or within the kitchen.

People and relatives told us the staff were warm and friendly. We observed staff were considerate of people’s privacy and dignity.

Relatives told us the home maintained good communication with them about their family member’s needs and told us they felt welcome to visit the home at any time.

Assessments of people’s needs and the care plans which described how they should be cared for did not always contain accurate information and were out of date, which put people at risk of receiving unsafe or inappropriate care.

At the time of the inspection there was not a dedicated activities staff member and care staff shared this role. One relative told us that people sometimes seemed ‘bored’. The manager advised that a member of staff was about to become activities coordinator, and they were going to utilise some unused space within the home as a place for activities to be held.

The provider did not have a robust system to monitor the quality of the service provided. We saw audits of care plans were carried out on a regular basis; however we found examples where they were not up to date or accurate. We found many of the issues which we had seen at our inspection in July 2015 remained at this inspection.

The provider visited the home regularly but did not carry out any formal assessments to monitor the quality of the service provided, or give written feedback to the manager.

We found five 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 and good governance. You can see what action we told the registered provider to take at the back of the full version of the report.

The provider had not sent us notifications which are a legal requirement of their registration. This meant they were in breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The provider had systems in place monitor care delivery and ensure the health, wealth and safety of people who used the service was maintained.

We confirmed the provider had a detailed and effective quality monitoring process in place.

We found that records contained accurate and appropriate information. People's care records were held securely in an office but were easily accessible for reference in an emergency.

We noted that care plans were in place for communication, personal hygiene and weight management and that they were regularly reviewed and information was entered and updated in a timely manner.

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One staff member said, “I feel really supported, there has been big improvements.”

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

We found that care records did not always contain accurate or appropriate information and documentation.

We found that people's needs were not always assessed and care and treatment was not always planned in line with people's individual needs.

As a result of our findings on the day we included the review of records. We found that care and records did not always contain accurate or appropriate information.

At this inspection there was an acting manager who had been in post for six weeks prior to our inspection. He was not registered with the Care Quality Commission. We have written to the provider to ascertain their plans for establishing a registered manager in place.

We spoke with six people and two relatives to find out their opinions of the service provided. People told us that they thought staff were, 'well trained.' We also talked with nine members of staff including a senior care worker, five care workers, housekeeper, the cook and maintenance man. All staff with whom we spoke were complementary about the changes that the acting manager had put in place with regards to training and support. One staff member informed us, 'It's getting much better now since [acting manager's name] has come.'

However, we found that suitable appraisal and supervision arrangements were still not fully in place at the time of our visit. We also identified shortfalls in staff training.

We concluded that people were made aware of the complaints system. This was provided in a format that met their needs.

We talked to three care staff employed by the service and looked at their records. We saw that staff provided person-centred care but found that individual staff supervision meetings were not taking place as often as required. We also found that the home's policy and procedures for managing complaints and gathering feedback about the service were inadequate.

We found that safeguarding arrangements were in place at the service and staff were aware of their responsibilities in this area.