We carried out a review of the data available to us about Hartcliffe Nursing Home 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 Hartcliffe Nursing Home, you can give feedback on this service.
People's experience of using this service and what we found
There had been improvements made following the inspection of 30 and 31 May 2018. Food and fluid charts were fully completed along with positional charts. Where people had refused food and fluid this was clearly recorded. The amount of food and drink consumed was recorded by staff. The registered manager told us about some recent shortfalls identified during the CQC Dynamic Monitoring Activity which took place on 10 August 2022. The shortfalls were in relation to the recordings on food, fluid and positional charts. Since then audits of these records were taking place daily by the registered manager and deputy. Staff were being retrained in how to fill out the records fully. Audits helped to address any shortfalls within the home.
Staff received regular support to help them carry out their role. The annual training programme equipped staff with essential skills and knowledge. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. 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.
Staff were enthusiastic and happy in their work. The staff told us they felt supported within their roles. Staff described working together as a team, they provided person-centred care and helped people to achieve their potential.
Rating at last inspection
The last rating for this home was rated Good (published 27 March 2021). At a previous inspection carried out 30 and 31 May 2018, we rated the home requires improvement in the key question ‘effective’. We found further improvements needed to be made to people’s food and fluid records. Monitoring charts had not been fully completed. At this inspection we found improvements had been made.
Why we inspected
On the 10 August 2022 we carried out a direct monitoring activity (DMA) with the registered manager. Some shortfalls were identified in relation to people’s food and fluid charts, nutrition and the timings recorded on positional charts. This inspection was to follow up on the shortfalls we identified.
During this inspection we followed up on the outstanding improvements from the inspection carried out on the 30 and 31 May 2018.
The provider completed an action plan after this inspection to show what they would do and by when to improve safe care and treatment.
We undertook this focused inspection to check the provider 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 Effective and Well-led.
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 home has remained 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 Hartcliffe Nursing Home on our website at www.cqc.org.uk
About the service
Hartcliffe Nursing Home is a care home which provides personal and nursing care to up to 66 people. Thirty-nine people were living at the service at the time of our inspection.
People’s experience of using this service and what we found
We were assured that people were protected by the prevention and control of infection.
Systems and processes were in place to protect people from the risk of harm or abuse. Staff understood the importance of safeguarding people. When risks were identified, action was taken to protect people as necessary.
Staffing levels were regularly reviewed to ensure people’s needs could safely be met. There were enough staff in post to meet people’s needs and keep them safe. We received positive feedback from professionals and relatives about staff and the management team. Staff were passionate and committed to caring for people in a person centred and professional way.
Although a concern had been raised about the storage of some medicines, during our inspection, we did not find any medicines incorrectly stored. A policy was in place and regular audits carried out to ensure medicines were stored, managed and administered safely and in line with legal requirements.
Staff were committed to supporting people in a person-centred way to have a good quality of life. We were told about ways in which people’s individual needs were met which showed staff knew people well and treated them with respect. Some staff had worked at the service for many years and all the staff we spoke with were positive about the service.
The management team understood their responsibilities, and the service appeared organised and well run. The provider ensured systems were in place to monitor quality and performance and ensure people and staff were safe. Audits were carried out, and where shortfalls were identified, an action plan and follow up checks were in place. The management team and staff were open to feedback and keen to learn from this and develop the service further.
Rating at last inspection
The last rating for this service was good (published 11 July 2018).
Why we inspected
We received concerns in relation to staff and the care people received at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this 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 coronavirus and other infection outbreaks effectively.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.
The overall rating for the service remains 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 Hartcliffe Nursing 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.
At the last inspection on 28 and 29 March 2017 the service was rated Requires Improvement. We found a repeated breach of the regulation relating to Consent to Care and we issued a Warning Notice. We also found breaches of the regulation relating to safe care and treatment. Following the inspection, the provider sent us an action plan telling us how they would make the required improvements.
We carried out a comprehensive inspection on 30 and 31 May 2018. At this inspection, we found improvements had been made and the legal requirements had been met. We found further improvements were needed to make sure that care was always delivered and recorded in line with people’s assessed and changing needs.
Overall, the service has improved to Good.
There was a registered manager 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.
Sufficient numbers of staff were deployed at the time of our visit. Staff performance was monitored. Staff received supervision and training to ensure they could meet people’s needs.
Medicines management shortfalls were promptly acted upon and actions taken to make improvements.
Staff demonstrated a good understanding of safeguarding and whistle-blowing and knew how to report concerns.
People were helped to exercise support and control over their lives. People were supported to consent to care and make decisions. The principles of the Mental Capacity Act (MCA) 2005 had been followed.
Risk assessments and risk management plans were in place. Improvements were needed to make sure care was consistently delivered in line with assessed needs and that accurate monitoring records were maintained.
Incidents and accidents were recorded and showed that actions were taken to minimise the risk of reoccurrence.
People’s dietary requirements and preferences were recorded and people were provided with choices at mealtimes.
Staff were kind and caring. People were being treated with dignity and respect and people’s privacy was maintained.
A range of activities were offered and provided people with entertainment both in and out of the home.
Systems were in place for monitoring quality and safety. Where improvements were needed the provider took action to address identified shortfalls.
The inspection was unannounced. Hartcliffe Nursing Home provides nursing and personal care for up to 66 people. At the time of our inspection there were 62 people living in the home.
There was a registered manager in place at the time of our inspection. 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. However, the registered manager was leaving the care home during the week of our inspection. The provider had arranged for a registered manager from one of their other care homes to provide interim management cover, until a new manager was appointed.
People told us they felt safe in the home. They were cared for by staff that had been trained and understood their responsibilities with regard to keeping people safe from avoidable harm and abuse. Risk assessments were completed and risk management plans were in place. Overall, peoples’ medicines were safely managed.
Consent to care was not always sought in line with legal requirements and there was insufficient recording of best interest decisions made on behalf of people.
People‘s healthcare needs were not always met. When changes to care, such as frequency of positional changes had been identified and recorded, these were not always implemented. Staff had access to, and obtained support and guidance from, external health care professionals. People received the support they needed with eating and drinking.
Staff received training relevant to their roles. Staff confirmed they received supervision and were able to develop themselves through additional training.
Staff demonstrated a kind and caring approach and they treated people with dignity and respect. Staff knew people well and were able to tell us about people’s likes, dislikes and preferred routines which were reflected in their care records.
There was a wide range of activities that people could participate in and people were enjoying group activities on the days of our inspection. A team of volunteers provided additional support.
People, staff and relatives told us the home was well-managed. People and relatives told us the registered manager was readily accessible and available to them. Staff told us they were well-supported and described the home as a good place to work.
This inspection took place on 25 November 2014 and was unannounced. The service was last inspected in November 2013 and no breaches of regulation were found at this time.
The service provides care and nursing care for up to 66 older people. There is a registered manager in place. 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 in the home were safe. Staff received training in safeguarding adults, and demonstrated
knowledge about recognising the signs of potential abuse. Everyone that we spoke with was positive about the care they received.
There were sufficient numbers of suitably skilled staff to meet people’s needs and to ensure that people were cared for in a safe way. Staff were supported to care for people safely because there were risk assessments in place describing various aspects of people’s care.
The risks associated with medicines were minimised because they were stored appropriately and administered safely.
Staff had knowledge of the Mental Capacity Act 2005 (MCA), however the principles of this legislation were not yet fully embedded in to practice to protect people who lacked mental capacity. We saw that relatives were asked to sign their consent for bed rails to be used by people. Under the MCA, a next of kin does not have an automatic right to consent on behalf of their relative. Mental capacity assessments were not always carried out and the registered manager could not demonstrate whether less restrictive options had been considered or a best interests decision had been taken.
Staff received good support in their roles, including regular supervision and training to ensure that they were able to carry out their roles effectively. Staff were positive about the support they received.
People in the home were able to see other healthcare professionals when necessary, for example GPs and the tissue viability nurse. This ensured that people received effective care and specialist support when it was required.
People were protected against the risks associated with malnutrition because their weight was monitored and action taken to seek specialist advice if any concerns were identified. People were positive about the meals provided and we observed a meal time where people received the support they required.
We made observations of caring interactions between staff and people in the home. People and their relatives all reported that they were happy with the care, and some gave specific examples of how staff had made a positive difference to the health and wellbeing of their relative.
People were able to take part in a programme of activities if they wished to do so. and we made observations of this during our inspection. This included 1-1 support to make craft items if a person said that they wished to.
Staff understood the individual needs and preferences of people in the home and took action to ensure that these were met. Support plans were in place that supported staff in knowing the individual ways in which people preferred to be cared for.
People felt confident in being able to raise issues or concerns. There were systems in place to respond to formal complaints.
The home was well led. People were positive about the registered manager and we saw there was an open and transparent culture in the home. We heard about examples of where concerns had been raised and the registered manager had responded positively to resolve them. There were systems in place to monitor the quality and safety of the service and this included gathering feedback from people in the home.
People's care was planned and delivered in a person centred manner. Any risks with people's support were identified and measures put in place to help ensure that people were cared for safely. Where possible, people's consent was sought in relation to the care they received, for example through signing consent forms. If necessary, relatives were asked to sign paperwork on people's behalf.
Staff in the home went through a recruitment process that ensured they had the skills to carry out their roles. Checks were in place to ensure that they were suitable to work in the home, this included gathering references from previous employers. A system was in place to monitor the quality and safety of the home and this included gathering the views of people and their relatives.
We spoke with eight people who use the service and they told us 'It's a lovely home it's the best in the area', 'the staff are very good and helpful', 'I am very happy here the people are nice'.
Six relatives were also present in the home comments included;' excellent care provided by the staff',' Its friendly and homely and I can visit when I like", "I can't praise them enough", "they are very kind to me". Another person said 'They are considerate and welcoming here, the manager is always around if needed, and it's the best home in the district I think!'
Staff told us 'We serve a community here and the home has a real community feel'. 'I couldn't imagine working anywhere else
Care plans detailed how a person wanted to be supported including their preferences, likes and dislikes.
People spoken with during the visit confirmed that staff ask them how they wanted to be supported and decisions made by them were respected.
People have a varied and nutritional diet which meets their cultural and health care needs. Comments we received about the food were positive.
We spoke to five people, and four relatives and all commented positively about the cleanliness of the home. One person said 'it is home from home, my bedroom is cleaned regularly and I can find no fault'. One relative said that when they first visited and every time since they have found the home to always be clean and free from odour.
People spoken with during the visit said that the staff supported them with their medication and that if they were in pain, pain relief was offered appropriately.
We were told people were encouraged to personalise their rooms with their own furniture, furnishings and decor as far as is practicable. Great attention had been paid to make communal areas homely and a comfortable place to sit and relax.
We spoke to a number of people receiving a service and their relatives; generally the feedback about the staff was positive. Comments included 'the majority of the staff are professional, kind and caring' , 'All the staff are caring', 'the staff know me and quite often can tell how I am feeling without me saying anything especially if I am in pain', 'the staff are excellent I would recommend this home'. 'It is like home from home the staff are kind and caring and go the extra mile'.
We spoke to a number of people during the visit and it was evident that they were aware of how to complain and had confidence in the staff and the manager to deal responsively to the concerns raised.
Good systems were in place to review the quality of the service which included seeking the views of the people they support and their relatives.