We carried out a review of the data available to us about Hartford Court on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hartford Court, you can give feedback on this service.
Hartford Court is a residential care home providing accommodation and personal care for up to 68 people, some of whom were living with dementia. At the time of our inspection there were 41 people using the service.
People’s experience of using this service and what we found
People said they received safe care. Since the last inspection systems to monitor people’s safety had improved and risks were documented, and work continued.
Staff knew people well and were able to respond to their individual needs in a timely manner.
Staff knew how to raise safeguarding concerns and lessons were learnt when things went wrong.
Robust recruitment procedures were in place and there were suitable staffing levels, although we have made a recommendation about this. Staff had the necessary skills to carry out their roles and felt supported.
Medicines were managed safely. People had access to healthcare services and staff worked proactively with other organisations. The home was clean and well maintained, including fire safety measures.
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.
People were supported with their dietary requirements and had drinks when required. A good range of activities took place, but more focused stimulation was needed for some people with complex needs. We have made a recommendation about this.
Quality assurance checks were in place to continually monitor the performance of the home.
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 19 May 2022) and there were breaches of regulation.
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.
At our last inspection we recommended that the provider strengthen their paperwork relating to the Mental Capacity Act, that staffing levels were closely monitored and visiting professionals guidance was reviewed. At this inspection we found the provider had acted on recommendations and had made improvements.
Why we inspected
We carried out an unannounced focused inspection of this service on 3 March 2022. Breaches of legal requirements were 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 and governance.
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, Effective 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 Hartford Court on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Hartford Court provides accommodation and residential care for up to 68 people, some of whom have a dementia related condition. At the time of our inspection there were 57 people using the service.
People’s experience of using this service and what we found
People had not always received their medicines in a safe and timely manner. The risk people faced in their day to day lives had not always been addressed.
People’s needs and choices were assessed but care plans lacked some important details. Records did not always accurately and fully reflect people’s care needs.
Quality assurance systems had not always been effective in finding the issues we had during the inspection. During feedback, the senior management team said they had fallen short of the providers expectations and would work to address issues raised.
People were helped to eat and drink and maintain a healthy diet. We received some mixed views about food and drinks from people and their relatives.
Communication within the service needed to be improved. This included within the staff team particularly in connection with record keeping and when communicating with health care professionals.
The service was clean and tidy, but staff had not always followed infection control guidance fully. We have made a recommendation about this.
The service needed some decoration and new carpeting; however, the provider had a refurbishment plan in place to rectify this.
Information around people’s capacity, consent to care and best interest decisions were in place in some care files but not others. We have made a recommendation about recording how staff are following the principles of the MCA.
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; however, the policies and systems in the service did not support always this practice.
People told us they felt safe. Staff understood their responsibilities to report any safeguarding concerns. People were complimentary about the kind nature of the staff team.
There were enough staff and staff were recruited appropriately. However, there had been some shortages from time to time due to the COVID-19 pandemic and there was still some use of agency staff. The provider was actively recruiting to fill vacant posts. Staff had received training, but further updates were required to better help staff support people living with dementia who had distressed behaviours.
We received mixed views about leadership within the home. Some staff felt they were not always supported effectively by management. During the inspection, the registered manager resigned.
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 18 January 2020). At this inspection we found the provider had deteriorated to requires improvement.
Why we inspected
The inspection was prompted in part due to concerns received about the care people received, including food quality, nutrition and medicines. A decision was made for us to inspect and examine those risks.
We undertook a focused inspection to review the key questions of safe and well-led but after further review of information, this was broadened to include effective.
For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating.
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 improvements. You can see what action we have asked the provider to take at the end of this full report.
The management team were responsive to our inspection feedback and had appointed a ‘turnaround’ manager to support the home.
You can read the report from our last inspection, by selecting the ‘all reports’ link for Hartford Court on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment and good governance at this inspection.
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 local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Hartford Court is a residential care home which provides older people with personal care. The home can accommodate up to 68 people. On the day of our inspection visit, 62 people were using the service.
People’s experience of using this service and what we found
People and their relatives told us the care was safe and they were happy at Hartford Court. Medicines were managed safely, there were enough staff on duty and staff were recruited safely. People were protected from abuse by staff who understood how to identify and report any concerns. People were protected from harm as risks had been assessed and plans put in place to mitigate these.
The registered manager carried out detailed assessments of need and people's preferences to ensure the home could effectively support any new admissions. People were supported to have enough to eat and drink and staff were trained to support people who had different dietary needs. Staff told us they were well trained, and they were well supported and supervised by the management team. The service worked well with community healthcare partners to ensure people received healthcare support where needed.
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.
Interactions we saw between people and the staff team were positive and relatives also said they were made very welcome at the home. People were treated with kindness, dignity and respect.
People received personalised care that was responsive to their needs and preferences. They were involved in reviews of their care where they were able. People were supported to engage in activities to reduce their risk of social isolation.
There had been a lot of manager changes at the home since our last inspection. This had impacted on the quality of service provided and staff morale. The registered manager who had been in post for a year had driven improvements and provided stability. People's feedback was sought regularly and acted upon. We received very positive feedback from people, relatives and staff about how the service was now managed. There were effective systems in place to monitor the quality of the care provided.
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 26 April 2017).
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hartford Court 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.
At our last inspection of the service in April 2015 we rated the service as good. A new provider HC- One Beamish Limited took over the provision of the service on 10 January 2017. This was our first inspection of the service since the new provider had acquired the home.
Hartford Court is a purpose built care home for older people, some of whom have a dementia related condition. Accommodation was organised over three floors. The Grace Suite for people living with dementia was situated on the third floor. Grace represents the philosophy of caring for people with a dementia related condition - Graciousness, Respect, Acceptance, Communication and Empowerment. There were 62 people living at the home at the time of the inspection.
There was a registered manager in place. She had commenced employment in April 2016 and registered with CQC as a registered manager in November 2016. 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.
We found that staff were exceptionally caring. We observed kind, caring and thoughtful interactions between staff and people. Staff were highly motivated, committed and spoke with pride about the importance of ensuring people’s needs were held in the forefront of everything they did. Staff used inclusive methods of communication which were tailored to the needs of the people who lived at the home. The service had a strong, visible, person centred culture which was evident through the actions of the manager and staff.
People told us that they felt safe living at the home. There were no ongoing safeguarding concerns. A new electronic medicines system had been introduced. We found there was a safe and effective system in place for the receipt, storage, administration and disposal of medicines.
Checks were carried out to ensure that applicants were suitable to work with vulnerable people. This included obtaining written references and a Disclosure and Barring Service check [DBS]. There were sufficient staff deployed. Staff carried out their duties in a calm unhurried manner.
Staff told us, and records confirmed that training was completed regularly. There was an appraisal and supervision system in place. Staff followed the principles of the Mental Capacity Act 2005 when carrying out their roles.
People’s nutritional needs were met and they had access to a range of healthcare services. An activities programme was in place to help meet people's social needs. There was a complaints procedure in place. None of the people or relatives with whom we spoke during the inspection raised any concerns or complaints about the service.
Audits and checks were carried out to monitor the service. Our observations and findings on the days of our inspection visits confirmed that the provider had an effective quality monitoring system in place.
Staff told us that the service had been through a period of change following the appointment of the manager and the sale of the home to HC- One Beamish Limited. They were positive about the changes and about working at the home. We observed that this positivity was reflected in the care and support which staff provided.
Hartford Court provides personal accommodation and personal care and support for up to 68 older persons, some of whom are living with dementia. At the time of our inspection there were 64 people living at the home.
This inspection took place on the 29 and 30 April 2015 and was unannounced. We last inspected this service in August 2013 and found no breaches of legal requirements.
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.
Systems were in place to protect people from abuse and all of the staff we spoke with recognised their own personal responsibility to report any instances of abuse that they may have witnessed or suspected. None of the staff we spoke with raised any safeguarding concerns.
Most of the risks that people were exposed to in their daily lives had been assessed. We found one case where the risks a person faced had not been fully assessed but we fed this back to the nominated individual and registered manager who rectified this. Environmental risks within the home had been assessed and measures put in place to protect the health and wellbeing of people, staff and visitors. Health and safety checks such as those related to fire and equipment were carried out regularly.
The ordering, storage, administration, disposal, recording and overall management of medicines was safe. Staffing levels were sufficient to meet people’s needs and staff had been vetted through the provider’s recruitment procedures to ensure they were both of suitable character, and mentally and physically fit, to work with vulnerable adults. Records showed that staff were trained in key areas such as moving and handling and the safe handling of medicines. In addition, staff had received training in areas specific to the needs of the people they supported, such as training in Parkinson’s disease awareness. Staff told us they felt supported by the registered manager and the wider organisation and they received regular supervision and appraisal.
The Mental Capacity Act 2005 (MCA) was appropriately applied and the best interests decision making process had been followed where necessary. Some records related to people’s capacity and any best interests decisions that may have been made, did not fully reflect who was involved in the decision making process and how the decision was reached. In addition, where people’s families held lasting power of attorney related to health and welfare decisions, copies of these documents were not obtained by the provider so they could satisfy themselves that they were acting within the law. Documents related to care decisions made about actions for staff to take should a person stop breathing needed to be reviewed and the nominated individual told us that this would be addressed.
People told us, and records confirmed that their general healthcare needs were met. General practitioners were called where there were concerns about people’s health and welfare as were other healthcare professionals such as occupational therapists. People told us the food they were served was of a high standard and that they could ask for anything they liked and it was accommodated. People’s nutritional needs were met and specialist advice was sought when needed.
Our observations confirmed people experienced care and treatment that protected and promoted their privacy and dignity. Staff displayed caring and compassionate attitudes towards people, and people spoke highly of the staff team. Staff were aware of people’s individual needs. People told us that they were supported to engage in activities within the home if they so wished, and the provider arranged excursions for them at various intervals.
Staff were very knowledgeable about people’s needs and care records overall were well maintained. Some records needed further detail so that information about people’s conditions and needs could be clearer. Staff provided person-centred care and on the upper floor the service was piloting a project linked to the Dementia Care Matters organisation, designed to enhance outcomes for people with cognitive impairments. The environment of this unit aided people with dementia care needs, by orientating them and there were tactile objects to occupy them.
The provider gathered feedback about the service from people, their relatives and staff via meetings and surveys. There was a complaints policy and procedure in place and records showed that complaints were handled appropriately and documentation retained.
Quality assurance systems were in place and these were used to monitor care delivery and the overall operation of the service. For example, audits related to medicines management and health and safety within the building were carried out regularly. Checks on the building and equipment used in care delivery were undertaken in line with recommended time frames.
Staff told us they felt supported by the registered manager who acted on any concerns that they raised. The provider had a staff reward scheme in place where staff could enjoy discounts with large organisations and a bi-annual recognition awards ceremony was held, where staff could be nominated by colleagues, people and visitors for their attitude and good practice.
The provider had a clear vision for the service they delivered to people, and we saw they achieved this at Hartford Court.
We found people's needs were assessed and care was planned in line with their needs. One relative told us, "It is great here, they know what X needs and get them the help and support needed."
Care plans were regularly updated and contained clear information about individuals' care.
People were protected from the risks of inadequate nutrition and dehydration. People told us, "The food is lovely."
People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.
At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Staff responded promptly to requests for assistance. One person told us, "The lasses are magic, lovely and helpful."
People were asked their views about the service provided and these were taken account of. People were aware of the complaints procedure. We saw the provider had a complaints policy and procedure in place and people told us they would confidently raise any concerns they had with the manager. People told us, "I can say if anything isn't right" and "The staff listen and help."
People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. People told us they had confidence in the service, comments included, 'I have nothing but good things to say about living here", "They (staff) are simply wonderful", "I have a lovely room with a great view" and "Everything is top notch."
People said they could receive medical and specialist attention when they needed it and were helped to fulfil their social needs within the home and community. People we spoke with said, "There is always something happening" and "There is plenty to do and we are always laughing."
People told us their home was clean, comfortable and warm. They said, "I have a beautiful room, which I love." They said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was good.
People said they received enough to eat and drink. They said "the food is really nice", "I enjoy my cooked breakfast", "there is always something tasty" and "you always have a choice".
People confirmed they could receive medical and specialist attention when they
needed it and were helped to fulfil their social needs within the home and community.
People we spoke with said "there plenty to do", "we sometimes don't have enough to do", "I enjoy getting out and about" and "I can join in or spend time in my room".
People told us their home was clean, comfortable and warm. They said "I have a lovely room with my things around me", "it is always so clean" and "there is always somewhere you can go to have a rest".
They said staff were kind and caring and seemed to be well trained. People confirmed they were given the opportunity to comment on the service, change routine or raise complaints. They said their visitors were made to feel welcome and information sharing was good.