Archived: Humphry Repton House

Humphry Repton House is residential care home providing personal and nursing care to people living with dementia. The service can support up to 45 people. At the time of the inspection there were 28 people living in the home.

The home was divided in to four wings, one of which was not currently being used for permanent accommodation but was available for people to isolate should it be necessary in line with pandemic guidance.

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

People using the service were not able to speak with us directly about their experience of living in the home. Through observation we saw that people responded positively to staff with smiles and vocalisation.

There were clear plans and risks assessments in place to support people safely. These outlined the measures in place that were required to manage specific risks. Staff worked with relevant healthcare professionals when necessary and followed their advice and guidance. For example, staff liaised with the speech and language therapist in relation to a person at risk of choking.

The home were following their own action plan in relation to medicines. Some areas for improvement had been identified through the home’s own audit procedures and these were being addressed.

The home was well led. There was no registered manager at the time of inspection; however, the provider was actively recruiting. The provider was in the process of working through an improvement plan for the home. This had involved changes in the staffing structure to support nurses in having more time to concentrate on clinical tasks. There were team leaders and assistant team leaders in each wing.

There was a person centred culture within the home; we heard examples of support where staff had taken time to meet people’s individual needs and this had led to a better quality of life for them. For example, by eating better or by engaging with staff in going out shopping. People and their representatives were involved in the running of the home. Their views were listened to and actively sought through regular family meetings.

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 (3 December 2020).

Why we inspected

The inspection was prompted in part due to concerns received about medicines and the safety and wellbeing of people using 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 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.

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

We found the following examples of good practice.

• There was clear signage at the entrance to the home advising on social distancing and the use of masks. There was further signage and guidance available to staff and visitors throughout the home.

• There were facilities in place to take people’s temperature on arrival and record contact details for test and tracing purposes.

• Extra cleaning shifts had been implemented to ensure a high standard of cleanliness, paying particular attention to high touch areas such as door handles.

• There was a designated isolation area for people who had tested positive or who were symptomatic. There were donning and doffing stations located outside the entrance to this area and facilities to safely dispose of PPE.

• Consideration was given to people’s wellbeing and how visits could be managed safely, taking in to consideration current guidance. In the warmer months outside areas were utilised to support family visits. Zoom and video calling facilities were also available.

• Wherever possible, the movement of staff between different areas of the home was minimised. The provider took steps to ensure that bank and agency staff were working in a maximum of two locations.

Further information is in the detailed findings below.

Humphry Repton provides nursing care and accommodation for up to 44 people. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 42 people living at the home. The home is split in to two areas. The ‘Green Wing’ has space for 13 people. The remaining rooms are in the main building. People who used the service had dementia.

There was 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 and their relatives were all happy with the service they received. Family told us they were informed and involved in decisions about their loved ones care. Our observations showed that staff were kind and caring in their approach and understood the needs of people they supported.

The service had experienced some difficulties recently in relation to staff vacancies and this had led to a high reliance on agency staff. However, the situation had been managed through using regular agency staff so that as far as possible people received continuity of care from staff who understood their needs. The service had also successfully recruited to carer roles through targeted local recruitment such as advertising in local shops.

People received safe support with their medicines. Medicines were stored safely and the temperatures of these areas were checked regularly. If people needed to have their medicines crushed in order to be able to take them safely, this was done following advice from the GP and pharmacist.

People received effective care that met their needs. Staff worked with community healthcare professionals such as speech and language therapists, occupational therapists, psychiatric nurses and GPs to ensure that people had the right health support in place.

People’s rights were protected in line with the mental capacity act 2005 (MCA). If people did not have capacity to make decisions, family were consulted and involved in making decisions about their care and support. As a result of findings at our last inspection, new systems had been implemented to ensure that the conditions on people’s DoLS authorisations were being met.

People received their meals in accordance with their needs. People were able to be seated where they wished at mealtimes. Some chose to be at the table and others chose to be in armchairs around the room. Meal textures were modified for those people that required it in order to be able to eat safely.

All staff were positive about the training and support they received. On the day of our inspection, staff were receiving dementia training. Staff also received regular supervision as a means of monitoring their performance and development. All staff were positive about working in the home and told us morale was good amongst the team.

Staff were responsive to people’s individual needs and preferences. A pre admission assessment was carried out which helped staff create person centred care plans. There was a range of activities in place for people to be involved in if they wished. This included visits from outside organisations and entertainers. During our inspection we saw that an organisation bringing animals for people to explore were at the home. Other activities included craft sessions and musical entertainment.

The home was well led. Staff and relatives were positive about the management of the home and felt able to raise any issues or concerns they had. There were quality assurance systems in place to monitor the safety and quality of the service provided.

Humphry Repton House provides nursing and personal care for up to 45 older people. At the time of our inspection there were 33 people living at the home.

A registered manager was in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.

The home was not always safe as medicines were not always stored or administered safely. Systems to check that medicines were safe were not always effective and documentation in regards to people’s medicines had not always been fully completed. Risk assessments were in place and had guidance in place for staff on how to support people in a way that minimised risks. Staff were knowledgeable in how to protect people from abuse. Incident and accidents were reported.

Staffing levels were at the home’s assessed level but still depended on a high number of non permanent staff members. This impacted on the individual care and support that was needed and the ability of the home to implement effective changes. Staff were supported through regular supervisions and a formal induction programme had been introduced. Staff had training specific to the needs of people. However, we found that not all necessary training was completed regularly.

The home was not always effective as consent to care and treatment was not always sought in line with the Mental Capacity Act (MCA) 2005. Mental capacity assessments and best interest decisions had not always been completed where appropriate. The registered manager was aware of their responsibilities in regards to (DoLS). DoLS is a framework to assess if the deprivation of liberty for a person when they lack the capacity to consent to care or treatment or need protecting from harm is required. The registered manager kept clear records of the steps taken in the DoLS process. However, we found that conditions attached to the authorisations of people’s DoLS were not always being met.

The home was caring as people were supported by staff that were kind and respectful. We observed positive interactions and relationships between staff and people living at the home. Staff knew people well and their personal preferences. Staff responded to people’s changing needs and were flexible in their approach.

The home was responsive. Care plans were person centred and gave clear guidance to staff as to how people wished for their care and support to be delivered. People were supported to engage in activities and outings. The environment , décor and items within it had been considered in response to people’s care and support needs.

The home was not always well-led. There were systems in place to monitor and review the quality of care and support. However, the systems in place were not always effective in identifying areas that required improvement or instigating the necessary changes. We received positive feedback in regards to the registered manager and the changes being made to improve the home. Staff told us they felt valued supported and involved. Information was communicated effectively to staff and relatives. Staff could contribute their feedback and ideas through meetings.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made one recommendation in relation to improving the effectiveness of audits. You can see what action we told the provider to take at the back of this report.

We had also found that people were supported by staff who had a varied understanding of the Mental Capacity Act 2005. Some staff clearly understood what their legal responsibilities were while other staff were not sure. The provider had a quality monitoring system in place to ensure checks were undertaken on the service people received. However, audits and checks that the registered manager was required to do were not done as often as the provider’s policy required. This meant there were risks that people could receive unsafe and unsuitable care.

After the comprehensive inspection, the provider wrote to us to say what they would do to improve the service. We undertook a focused inspection on 4 March 2016 to check that they had followed their plan and to confirm that they had taken action to improve the service.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Humphry Repton House’ on our website at www.cqc.org.uk.

At our focused inspection on 4 March 2016, we found that the provider had not fully implemented their plan which they had told us would be completed by October 2015.

The way that staffing was deployed across the home did not always fully meet people’s needs. This meant there was not enough competent staff on duty at all times who knew people well to meet their needs.

People were still supported by staff who had a varied understanding of the Mental Capacity Act 2005. Some staff knew what their legal responsibilities were while other staff did not have the same level of understanding.

The management audits and checks were not done as often as the provider’s policy required. This meant there were risks that people could receive unsafe and unsuitable care.

We had also found that the provider had not responded appropriately to incidents of possible abuse. There were a number of incidents of aggression between people at the home. Some of these incidents had not been responded to in a way that aimed to keep people safe.

The staffing levels were inadequate to ensure that people received the care and support they needed.

We also found that quality checks on the suitability of staffing arrangements were not in place. This had meant that people were at risk of receiving unsafe care.

Humphry Repton House is registered for up to 44 people. When we carried out our inspection there were 36 people in the home.

At this inspection we saw that action had been taken that demonstrated that the provider responded appropriately to incidents of possible abuse. We saw that when there were incidents of aggression between people at the home there were risk assessments and strategies in place. These were to support staff to respond in a way that aimed to keep people safe.

The provider had put in place a quality checking system on the effectiveness of the staffing arrangements to ensure there were enough staff on duty to meet people's needs.

We observed staff were friendly when they assisted people with their needs. When people were not able to make their views known we saw that the staff communicated by facial expressions, body language, and gentle humour.

People had positive views of the meals at the home. People who used the service were provided with a varied and nutritious diet. Where needed the advice of dieticians was sought to support people with nutritional needs.

We found that staffing levels were inadequate to ensure that people received the care and support they needed. For example, people who needed supervision were not receiving this; and certain people's care needs were not being met because they were not getting sufficient support. Also a person was not being helped to have a shower on a weekly basis as their care plan stated they required.

The quality of care was monitored however quality checks of the suitability of staffing arrangements were not in place. There was evidence that some shortfalls in the service were acted upon. For example a carer's' support group had given feedback about shortfalls in staffing and an excessive use of agency staff. A consultant had been employed to implement a staff recruitment and retention strategy for the home.

During our inspection we were unable to speak to people living in the home as the people had complex needs and were living with dementia. However, we spoke with staff and relatives of people living at the home. We also observed people living at the home to gain an insight into people's experiences of living at the home.

People's needs were assessed and care plans developed and agreed with people or their representatives. We saw that when a risk was identified a care plan was put in place which contained guidance for staff on how to ensure that these needs were met.

Staff were knowledgeable about the needs of people in relation to eating and drinking. We observed staff assisting people with eating and drinking, respectfully and appropriately. We saw that where people had been assessed as at risk of becoming dehydrated or malnourished priority measures had been taken.

We found that the people living on green wing did not have regular input from qualified nursing staff. The home did not have formal procedures in place for when staff working on green wing should contact the nursing staff for advice on people's health needs.

We found that staff at the home received support appropriate to their role.