Hankham Lodge Residential Care Home

Hankham Lodge Residential Care Home is a residential care home providing accommodation and personal care to up to 20 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 20 people using the service.

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

Risks to people's safety were not always assessed and managed. People's care plans and risk assessments were not up to date and did not always contain enough guidance for staff to keep people safe. The provider had begun working with an external consultant to make improvements to care plans and risk assessments.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People that may lack capacity did not have capacity assessments in place to see if the person was able to make their own decisions, and no best interest decisions had been recorded. DoLS (Deprivation of Liberty Safeguards) applications had not been made when required.

People did not always receive person-centred care. People's care plans did not contain information about people's individual wishes and interests. People did not always have enough meaningful activity to keep them occupied.

Governance and oversight of the service needed improvement. Audits to identify shortfalls at the service were not always in place, for example for medicines and care plans.

People were supported by staff that knew people well. Staff spoke about people warmly and enjoyed supporting people. People told us they were happy at the home. Staff were recruited safely and there were enough staff to support people. The home was clean and hygienic.

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 overall rating for this service was requires improvement (published 1 August 2020). This was a focused inspection to review Safe and Well Led.

At the last comprehensive inspection (Published 25 January 2020) we identified breaches of regulations around the need for consent, staffing and person-centred care. The provider completed an action plan after this inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider check the environment was maintained and decorated to a good standard. At this inspection we found that improvements had been made.

At our last inspection we recommended that people should have access to drinks throughout the day. At this inspection we found people were provided with drinks throughout the day.

At our last inspection we recommended that the provider ensure staff have sufficient time to spend with people and that people have choices around their delivery of care. At this inspection we found that improvements had been made.

At our last inspection we recommended that the provider make a record of complaints and evidence how complaints had been investigated and resolved. At this inspection we found that the provider kept a record of complaints and actions taken.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 November 2019. 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 person centred care and need for consent.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. During the inspection, we found evidence to suggest we needed to look at the safe key question. This meant we opened up the inspection to a five key question 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hankham Lodge Residential Home 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 monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, person-centred care, need for consent and governance.

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

Hankham Lodge Residential Care Home is a residential care home providing care and support for 17 older people. The service can support up to 20 people. People were living with a range of needs associated with the frailties of old age and some people were living with dementia.

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

Following the previous inspection, the provider sent us their Provider Information Return on 2 April 2020. This included information about the steps they had taken to make improvements at the home including working with external professionals and consultants to develop and improve the home. However, due to COVID-19 and the subsequent lockdown on visitors, their priorities had to change. The provider and staff worked hard to ensure the appropriate infection control procedures for the pandemic were in place to keep people safe. This included increased cleaning and ensuring adequate supplies of PPE were available. Staff completed training in relation to COVID-19. The impact on COVID-19 meant that some improvements will need further time to be fully introduced and embedded into every day practice.

The provider and staff team had worked hard to address the areas for improvement following the last inspection. Further time was needed to fully embed these changes into day to day practice.

Quality assurance systems had been introduced and were continuing to be developed and improved. This included audits of medicines, falls, and the environment. Some changes had been made to record keeping and this was ongoing.

People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns. There were enough staff working to provide the support people needed. Recruitment procedures ensured only suitable staff worked at the service. Staff understood the risks associated with the people they supported. Risk assessments provided some guidance for staff about individual and environmental risks. People received their medicines safely, when they needed them.

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 Inadequate (published 27 January 2020). There were multiple breaches of regulation. We served warning notices in relation to the safe care and treatment of people and the governance of the home and told the provider to make these improvements. At this inspection we found improvements had been made and the warning notices were met.

This service has been in Special Measures since 27 January 2020. The provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 November 2019. Breaches of legal requirements were found. We issued warning notices to the provider about safe care and treatment and governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check whether the warning notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. Therefore, this report covers our findings in relation to the Key Questions Is it Safe? and Is it Well-led? only.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate 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 Hankham Lodge Residential Care 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.

Hankham Lodge Residential Care Home is registered to provide accommodation and personal care for up to 20 people who may have a disability or may be living with dementia. There were 19 people living at the service at the time of our inspection.

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

There were not always enough staff deployed at the service which left people at risk particularly at night. This also meant that staff were not always able to spend meaningful time with people. Risks associated with people’s care were not always being managed in a safe way including the management of medicines and aspects of infection control. Incidents and accidents were not always followed up on or analysed to avoid the risk of reoccurrence.

Staff had not always received training and supervision to ensure best practice within the service. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. There was a lack of meaningful activities for people and people fed back they would like to go out on trips. We saw from surveys from people and relatives that the provider had been aware of this.

Quality assurance was not always effective. Where shortfalls in care had been identified with staff this had not been addressed robustly.

Pre-assessments of care were detailed with information about people’s care and staff understood people’s needs. People and relatives knew how to complain and were comfortable doing so. People had access to health care professionals to support them with their care. People and relatives told us that staff were caring and respectful and we saw examples of this throughout the day. Relatives and visitors were welcomed as often as they wanted. People enjoyed the meals on offer at the service.

Previous Inspection

The last rating for this service was Good (Report published 6 May 2017.)

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Caring, Responsive 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.

Follow up

We will request an action plan for 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The registered manager, although on maternity leave at the time of the inspection, continued to oversee the service and staff said they were available for advice and support if needed. The registered manager was one of the home’s two providers; the other provider was available during the inspection and informed us they had been managing the home since August 2016 and had send in a notification to inform us of this, but was not yet registered. 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.

This inspection took place on the 10 and 13 April 2017 and was unannounced.

At our inspection on 8 and 16 December 2015 we found the provider was not meeting the regulations with regard to record keeping and the quality monitoring system was not always effective; as it did not enable the provider to identify where quality and safety were being compromised. At this inspection we found improvements had been made and the provider met the regulation.

However, we found that additional work was needed to ensure the improvements were embedded into practice. For example, the quality assurance and monitoring system had been reviewed and a number of audits had been completed. However, the system had not identified areas of concern that we found during the inspection, such as gaps in the care plans.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. The management and staff had attended training and had an understanding of their responsibilities with regard to Deprivation of Liberty Safeguards (DoLS). The provider had followed current guidance by contacting the local authority for DoLS assessments when required.

Relevant training was provided; staff were supported to understand people’s needs and develop the skills to provide the support people wanted. Staff had attended training and had an understanding of the Mental Capacity Act 2005 and, people who did not have capacity to make some decisions were supported to make choices about all aspects of their day to day lives. People chose where they spent their time, in their own rooms or the communal areas. They were very positive about the food and told us activities were available for them to join in if they wanted to. Staff were kind and caring and treated people with respect.

Staff had attended safeguarding training; safeguarding and whistleblowing policies were in place and staff demonstrated an understanding of abuse and how to protect people. The atmosphere in the home was calm and people said they were very comfortable living there and felt safe and well cared for.

There were systems in place for the management of medicines. Staff had attended training and completed records as they gave people their medicines.

The recruitment process was robust, it ensured only suitable people worked at the home and there were enough staff working in the home to provide the support people wanted.

Complaints procedures were in place. The provider encouraged people, relatives and staff to be involved in decisions about how they improved the service and, people and staff were positive about the management of the home.

We recommend the provider seeks appropriate advice and training, with regard to record keeping and monitoring/auditing of records; to ensure they reflect people’s needs and provide clear guidance for staff.

We spoke to four people who used the service in depth, one visitor, and two staff working in the home. We spoke with the registered manager and the provider. We spent time with people using the service and observed interaction they had with each other and with the staff.

We saw staff asked for people's consent before they provided any care or treatment. People told us they were never made to do anything and they were free to make choices about their life. One person told us, 'I like to have my meals in my own room, and this is respected.' People told us that they received good care and were well treated.

We reviewed the premises and saw that the home was well maintained with safety issues taken into account.

We reviewed the recruitment practice and associated documentation. We found the home followed robust recruitment processes for the recruitment of new staff.

We looked at a number of records and found that these had been managed and completed in a consistent manner.

A person told us that staff were all friendly and helpful. 'Staff are fantastic. If I need them, I use my call bell and they come really quickly'.

We spoke with one relative. She told us that staff were generally very helpful and friendly. However, she had concerns about some of the care that her mother received, and the way a complaint she made last year had been dealt with.

This was largely a positive inspection. People living in the home stated that they were highly satisfied with the care they were provided with. A relative expressed satisfaction with the staff of the service. However, she thought that personal care could sometimes be better: that hot water always needed to be available for washing and that complaints needed to be handled in a more positive way.

The main issues we identified were to ensure that care fully meet people's needs, fire precautions were always fully in place, that hot water was always available to people and staff, and that complaints are always positively handled, in line with the stated complaints procedure of the home.