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Archived: Hatherley Grange Nursing Home

Overall: Requires improvement read more about inspection ratings

26 St Stephens Road, Tivoli, Cheltenham, Gloucestershire, GL51 3AA (01242) 251321

Provided and run by:
Almondsbury Care Limited

All Inspections

30 September 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 20 October 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements to gain consent of people in relation to their care and support and ensuring staff were trained to carry out regulated activities.

On 29 June 2015, we undertook a focused inspection to check that they had followed their plan. We found some improvements had been made however not all staff had been trained and there was insufficient evidence that people’s consent to their care had been gained lawfully. We told the provider that these shortfalls should be addressed by 31st August 2015.

On 30 September 2015, we carried out this focused inspection to check that the provider now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hatherley Grange Nursing Home on our website at www.cqc.org.uk.

At this inspection we found that improvements had been made in staff development and gaining people’s consent to their care and treatment lawfully.

Most staff had received update training in mandatory courses such as mental capacity act and moving and handling. Systems were in place to plan further training and support staff development.

People in the home lived with advanced dementia. Their mental capacity to make decisions about their care and support had been lawfully obtained. Staff understood their responsibility to work with in the code of practices of the Mental Capacity Act and ensure people were cared for in the least restrictive way. Best interest decisions had been made on behalf of people when specific decisions about their care and support had to be made.

The home had been without a registered manager for several months however at the time of our inspection the acting manager had been working with the provider to address the shortfalls of the service.

29 June 2015

During an inspection looking at part of the service

We carried out an unannounced comprehensive inspection of this service on 20 October 2014. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements to gain consent of people in relation to their care and support and ensuring staff were trained to carry out regulated activities.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hatherley Grange Nursing Home on our website at www.cqc.org.uk.

At this inspection we found that some improvements had been made in staff development and gaining people’s consent to their care and treatment. However there were still some shortfalls in staff training and support and gaining and recording people’s consent.

Most staff had received update training in mandatory courses such as fire safety however there were no plans to address the training needs or evidence the competency of bank staff who mainly worked at the weekends. Whilst qualified nurses had carried some additional clinical training, they had not all completed and up dated their knowledge on the home’s mandatory training such as safeguarding people.

People in the home lived with advanced dementia. Their care records did not specify which decisions about their care and treatment that they could make for themselves. Best interest decisions had been made on behalf of people however there was no evidence that people had been consulted in the process.

The home had been without a registered manager for several months however a new manager had recently been appointed and had been in post for six days at the time of our inspection. The new manager had started to assess and review the quality of the service and was aware that further improvement was required.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

20 October 2014

During a routine inspection

This inspection took place on 20 October 2014 and was unannounced.

Hatherley Grange Nursing Home provides accommodation and nursing care for up to 25 people who have nursing or dementia care needs. At the time of our inspection there were 22 people who lived in the home. The home had 25 bedrooms over 4 floors. People had complex health needs and lived with advanced stages of dementia. Most people spent their day in the lounge and adjacent dining room.

A registered manager was in place as required by their conditions of registration. 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 our previous inspection on 3 June 2014, the provider did not meet all the legal requirements in relation to the management of medicines and supporting and training staff. Following this inspection, the provider sent us an action plan to tell us the improvements they were going to make. During this inspection we looked to see if these improvements had been made. We found that improvements had been made in systems to manage and record people’s medicines. However staff training as stated in the action plan had only been partially carried out. Not all staff had received relevant training in caring for people living with dementia to ensure their care practices were up to date.

People’s mental capacity for specific decisions had not been thoroughly assessed or recorded although staff knew people well enough to understand their preferences. Records of best interest decisions made on behalf of people were not in place.

People who spent the day in their bedrooms due to their health needs were not always effectively monitored to ensure their safety and wellbeing. The provider’s safeguarding policy and some training provided to new staff did not always give staff clear guidance on where they could report any allegations of abuse or poor care practices to outside agencies. Recruitment processes and employment checks had been carried out by an agency.

Care records gave staff guidance so they could deliver care and support which was focused around the person. Activities provided for people were limited and not always personalised, especially for those people who had advanced dementia. People were not always provided with activities that were meaningful to them.

Although people were well cared for, there was a sense that the provider and registered manager did not have a vision of how the service provided could continually improve. The registered manager and staff were not fully aware of changes in the latest care practices and legislation. Although the provider supported the registered manager in implementing changes there was no record or action plan to drive improvement in the quality of the service provided.

People had access to health care services such as chiropodists and mental health teams to meet their specific needs. Staff implemented the recommendations made by the professionals to ensure people’s changing needs were being met. People enjoyed the well balanced meals that were provided and staff supported them respectfully to eat their meals.

We observed people were well cared for. Staff were compassionate and kind when supporting people. People looked relaxed and content at the home. Relatives were positive about the care their loved ones received at the home.

Relatives told us they had confidence in the registered manager and staff. The registered manager knew people individually and how they preferred to be supported. They had formed strong links with health care services to ensure people received additional care or treatment in a timely manner.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

3 June 2014

During a routine inspection

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with the registered manager, four members of staff and two relatives who both spent a lot of time at the home. We observed staff interacting with people who lived in the home. We reviewed the care records relating to the management of the home which included five care plans, daily care records, accident and incident records and quality assurance systems.

Below is a summary of what we found. The summary describes what relatives of people who lived in the home and staff told us, what we observed and the records we looked at.

Is the service safe?

People were safe because staff understood the needs of the people who lived in the home. Care was delivered as planned in people's care records. The home was cleaned and maintained. Equipment was regularly checked and serviced. The registered manager and staff were aware of their role to prevent people who lived in the home from coming to harm. Emergency procedures were in place should they be needed. However we found the provider did not have appropriate arrangements in place for the recording and safe keeping of some medicines. This told us people were at risk of being given the wrong medication.

Is the service effective?

People received an effective service because staff had a good understanding of people's needs. Relatives told us that "Staff are wonderful here, very patient". We saw staff supporting people who got upset in an appropriate manner. However not all staff were supported and the development and skills of new staff had not been verified. We asked a relative about the meals that were served in the home. We were told 'the food is excellent; my wife has put on weight'.

Is the service caring?

People received a service which was caring because people's wishes were acknowledged and respected. As people's needs changed, staff knew how to manage and adapt their care effectively. Staff were observed communicating with people in a kind and sensitive way. A member of staff told us, "I enjoy working here; we are caring and work as a good team'.

Is the service responsive?

This service was responsive because people received support and care when they needed it. A visitor said, "Staff are always busy but they are always happy to help". The registered manager managed complaints in line with the provider's policies and procedures. Relatives told us they could always speak to the registered manager if there was a problem.

People's health was regularly monitored and reviewed by the local GPs. Referrals were quickly made to health services when people's needs changed. The care records of people who lived in the home were reviewed monthly.

Is the service well-led?

The service was well led as there were effective arrangements in place to review and monitor care practices in the home. The management team understood the principles of quality assurance to improve the service and quality of life for people who lived in the home.

11 December 2013

During an inspection looking at part of the service

At our last visit on the 18 July 2013 we found the provider was not compliant with two outcomes. We found the care records showed limited information about the life histories of people who used the service. We saw that power of attorney information had not been recorded appropriately. We found key principles of assessing people's mental capacity and applying the Mental Capacity Act 2005 had not been completed. We found that staff had not referred to the Mental Capacity Act (2005) Code of Practice when necessary. The provider sent us an action plan which showed what actions the provider would take to achieve compliance. We did not talk to people who used the service during this follow-up inspection.

During this inspection we found compliance had been achieved and the provider had applied the principles of the Mental Capacity Act 2005. We also saw that the code of practice was available for staff to refer to as necessary. Mental capacity assessments and best interests assessments had been completed by the registered manager in conjunction with people's GPs.

Concerns had been raised with us about the recruitment practices within the home. We asked the registered manager about this and we were told that it had been difficult to recruit staff in the six months before our visit. We were told that a specialist recruitment agency was used and most of the new staff had been recruited from abroad. We found effective recruitment procedures were in place.

18 July 2013

During an inspection looking at part of the service

We did not speak to people who used the service this time as this was a follow up inspection to look at records where one compliance action had been made at the previous visit. We found that there were some improvements to record keeping for assessing people's capacity to consent to care and treatment. There remained additional work to complete to ensure that there was suitable arrangements to gain and review consent from people and effectively record it.

18 April 2013

During a routine inspection

We planned an inspection visit to follow up compliance actions made at the previous inspection and look at concerns raised with us. We spoke with three visitors and observed how people using the service engaged with the staff. We spoke briefly to people about the activity they had taken part in that day. One person told us that they liked to dance to the music and other people agreed they had enjoyed the music duo entertaining them. The relatives we spoke to had been healthcare professionals and told us, "I can't fault the care, he loves music and staff look at his canal books with him" and "I can't praise the staff highly enough".

We found that people were generally engaged with the entertainment provided and that the staff spoke to them with respect and kindness. People were free to wander as far as possible and the staff knew their usual preferences, which were recorded.

Records regarding people's capacity to make decisions were incomplete and decisions made in people's best interest were not recorded.

11 September 2012

During a themed inspection looking at Dignity and Nutrition

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. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective).

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke to relatives who were visiting the home and they were very positive. Comments included, 'They're like gold those girls, can't do enough for them', 'They go above and beyond what they have to do because they love all the residents. It's like a family'.

Another person told us 'They've looked after my relative for six and half years and I come in every day, what impresses me is the individual care they give them. They know all their likes and dislikes. They're always polite and address them by name, I'd say they really do treat them with dignity, that goes without saying.'

All the relatives we spoke with were very satisfied with the care provided at the home. They commented positively on the family atmosphere and all felt that their relatives were treated well. Throughout our inspection visitors came and went, spending varying amounts of time in the home. Visitors appeared to feel very relaxed and at home there.

We saw that people's nutritional needs were well assessed and monitored and arrangements were in place to ensure they had sufficient nutrition and hydration. We saw that people's dignity was respected at meal times.

Staff told us that activities were available but this was not confirmed by the visitors we spoke to. We noted there was a lack of stimulation for some people during our inspection. We did see staff sitting and spending time talking with some people who lived at the home.

10 August 2011

During an inspection looking at part of the service

We did not speak to people directly about their care as they have a diagnosis of dementia. We did speak to staff about the care people receive. As part of this inspection we undertook two visits to the service, one of these was at night to follow up on some information we had received and the other was to follow up on the compliance actions we issued at the last inspection.

5 April and 5 May 2011

During a routine inspection

People who live at Hatherley Grange Nursing Home have a diagnosis of dementia and therefore we did not ask them direct questions about their care.

We heard people speaking to each other following the lunchtime meal and saying how much they had enjoyed it.

Relatives of people who use this service told us how they had chosen this home on behalf of their relative. This was from information they had been told by external health and social care professionals and from visiting the service. One relative told us that they had visited many other care homes but this was by far the best. Another relative said 'this is the next best place to our own home'.

People were observed to be wearing clean and tidy clothes and they all looked well cared for. Staff had made sure that people looked respectable.

People were able to walk freely around the communal rooms and music was playing in the main lounge.

Relatives praised the staff for their caring nature and they all felt that the registered manager and team leader develop good relationships with people and their relatives. One relative commented on how supported the management of the home had been to them during a bereavement and from their experience they felt this would not happen at another care home.

We observed the lunchtime meal to a social event with people where able were sitting with staff who very also eating the meal or their own food. One person was telling one member of staff about their outing that morning and what they had done.

Mealtimes are arranged so that people who need assistance have their meals first because this allows staff to spend as much time as needed helping people.