Hampton Care Home

Hampton Care Home is a residential service providing personal and nursing care to 55 older people at the time of this inspection. Most people residing at the care home are living with dementia. The service can support up to a maximum of 76 people. The premises is divided into three separate units/floors, each of which has their own adapted facilities.

People’s experience of using this service

People were supported to stay safe and be protected against the risk of avoidable harm and abuse. People were supported by enough competent staff who knew them well and had been safely recruited. The environment was clean and followed current best practice guidelines regarding the prevention and control of infection (IPC), including those associated with COVID-19. Medicines were well-organised and staff helped people take their prescribed medicines in a safe way.

The newly registered manager was competent and clear about their roles and responsibilities. They understood regulatory requirements and how to ensure people received high-quality, person-centred, safe care. This was achieved by routinely monitoring and analysing the safety and quality of the care people received. The registered manager also recognised the importance of learning lessons when things went wrong and was keen to continuously improve the service. They promoted an open and inclusive culture, and worked in close partnership with other health and social care professionals and agencies to plan and deliver positive outcomes for people.

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

Rating at the last inspection

The last rating for this service was good (published 18 September 2020).

Why we inspected

We received multiple concerns recently in relation to the management of the care home and how people were safeguarded from the risk of abuse there. We were also notified about an outbreak of COVID-19 amongst people living and working at the care home.

As a result, we undertook a focused inspection to review the key questions of safe and well-led. We also looked at infection prevention and control measures under the safe key question to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

No areas of concern were identified in the other key questions of effective, caring and responsive. 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 these concerns. The overall rating for the service therefore remains good. This is based on the findings at this inspection.

Please see the safe and well-led key question sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hampton 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 inspection programme. If we receive any concerning information, we may inspect sooner.

Hampton Care Limited is a care home providing nursing and personal care to 51 older people at the time of our inspection. The service can support up to a maximum of 76 people. The premises is divided into three separate units, each of which has their own adapted facilities. Most people using the service are living with dementia.

People’s experience of using this service

People using the service, their relatives and staff spoke positively about the care home and the relatively new managers, who most felt had significantly improved Hampton Care Limited in recent months. Typical comments we received included, “It’s been so frustrating having so many different managers in recent years, but the new managers seem very good and hopefully they’ll stay”, “The home is a lot more stable since the new managers took over and have done well to reduce the number of agency staff they use” and “All this place needs is a bit of continuity, which hopefully the latest managers will bring.”

At our last two consecutive inspections we found staff did not have enough opportunities to reflect on their working practices and professional development because the formal support they received from their line managers was sporadic. The previous manager sent us an action plan setting out how they would address this ongoing staff support issue. At this inspection we found the provider had followed their action plan and made enough improvement to ensure the service was no longer in breach of the regulations.

At our last two inspections we found the provider had failed to ensure the service was consistently managed by a suitably fit person who had been registered with us. In addition, we found the way the provider operated their governance systems to assure the quality and safety of the service people received was not always effective. At this inspection we found the provider had followed the action plan they sent us and improved the way the care home was now led and how they operated their oversight and scrutiny arrangements. The provider had also appointed a new permanent manager who has now applied to be registered with us.

The new managers consulted people, their relatives and staff as part of their on-going programme of improving the service they provided. For example, when things had gone wrong, there were systems in place to learn lessons from this and prevent similar incidents from reoccurring. The provider continued to work in close partnership with other health and social care professionals and agencies to plan and deliver positive outcomes for people using the service.

We found people were still cared for by staff who knew how to protect them from avoidable harm and keep them safe. The care home was adequately staffed. Staff continued to undergo all the relevant pre-employment checks to ensure their suitability and fitness for the role. People received their medicines safely and as prescribed. The provider had effective systems in place to assess and respond to risks regarding infection prevention and control, including those associated with COVID-19.

Rating at last inspection and update.

The last rating for this service was requires improvement (published 4 March 2020) and there was a breach of regulation in relation to staff support. 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 enough improvement had been made and the provider was no longer in breach of regulations. This report only covers our findings in relation to the Key Questions; Is the service Safe, Effective and Well-led? The overall rating for the service has now improved to good.

Why we inspected

This inspection was prompted in part due to ongoing concerns received about the service’s high turnover of managers and the safe management of medicines. A decision was made for us to inspect and examine the risks associated with these issues.

Care Quality Commission (CQC) has introduced focused/targeted inspections to follow up on previous breaches and to check specific concerns.

We used the targeted inspection approach to look at a specific concern we had about staff support associated with the key question, Is the service effective? As we only looked at part of this key question, we cannot change the rating from the previous inspection. Therefore, the key question for is the service effective remains rated as requires improvement.

We undertook a focused inspection approach to review the key questions of Safe and Well-led where we had specific concerns about medicines management and how the service was managed.

As no concerns were identified in relation to the key questions is the service Caring and Responsive, we decided not to inspect them. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

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

Hampton Care Limited is a care home that at the time of our inspection was providing accommodation, nursing and/or personal care to 65 older people. The service can support up to a maximum of 76 older people. The care home is divided into three separate units, each of which has their own adapted facilities. The units tend to specialise in providing people with either nursing care needs, end of life care or supporting people living with dementia. Most people using the service are living with dementia.

People’s experience of using this service

The last rating for this service was good with no breaches of regulation, although we rated them requires improvement for the key question well-led because the care home had been inconsistently managed and was over-reliant on temporary agency staff who might not be so familiar with people’s needs, wishes and daily routines.

At this inspection we found the service had continued to experience high rates of manager turnover, although we saw the relatively new interim manager and new permanent manager had brought much needed stability and continuity to the care home in recent months. This was confirmed by people using the service, their relatives and community professionals who told us they felt the care home had begun to improve under the guidance and leadership of the new management team.

In addition, as recommended last time we saw the provider had now taken appropriate action to implement their improvement plan and reduce the number of temporary agency staff they used. The new management team had achieved this by filling almost half of the services staff vacancies within the last four months. This helped drive up the standard of care provided because most of the staff were now permanent and were therefore more familiar with the needs, wishes and daily routines of people living at the care home.

However, these positive comments described above notwithstanding; we found further improvements needed to be achieved over a sustained period of time. This was because at our last inspection we recommended the provider develop an action to improve the way they supported, supervised and appraised staff. At this inspection we found not enough had been done to address this ongoing staff support/development issue. This meant staff did not have sufficient opportunities to reflect on their working practices.

Furthermore, although we saw people continued to live in a suitably adapted and reasonably well-decorated care home, the environment was not particularly ‘dementia friendly’. This was because most communal areas lacked any easy to understand pictorial signage, colour contrasting doors and walls or memory boxes near people’s bedroom doors for people living with dementia.

We discussed this matter with the new permanent manager who confirmed they were in the process of developing an action plan to make the care home’s communal areas more suitable for people living with dementia. Progress made by the provider to achieve these stated aims will be assessed at their next inspection.

These negative points notwithstanding, we found at this inspection people were still cared for by staff who knew how to protect them from avoidable harm. Staff continued to undergo all the relevant pre-employment checks to ensure their suitability and fitness for the role. The premises remained clean and staff followed relevant national guidelines regarding the prevention and control of infection.

People were still 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 continued to be offered well-balanced meals that meet their dietary needs and wishes and were supported to stay healthy and well.

People continued to be treated equally and had their human rights, diversity and privacy respected. People were encouraged to make decisions about the care and support they received and were involved in the running of the care home. People were supported to be as independent as they could and wanted to be.

People had their own individualised care plan for staff to follow. People’s communication needs and preferences continued to be respected and met. People were aware of the providers’ complaints policy and how to raise any concerns or complaints they may have. When people were nearing the end of their life, they continued to receive compassionate and supportive palliative care.

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

Rating at the last inspection

The last rating for this service was good (published 27 June 2017).

Why we inspected

The inspection was prompted in part due to concerns we had received about this service in the last 12 months in relation to the way it was managed, overreliance on temporary agency staff, and the number of safeguarding incidents and complaints we received. We were also aware the local authority had decided to place a temporary embargo on people being admitted to the home following a serious provider concerns meetings held in the last quarter of 2019. A decision was therefore made for us to bring the services next inspection forward by approximately 18 months and examine those risks.

Enforcement

We have identified a breach of regulation that relates to ongoing issues regarding staff support, supervision and appraisals. 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found that some improvements could be made with regard to the service being well-led and have made a recommendation in this area. However, no breaches in regulations were found.

We found that much emphasis was being given to senior manager oversight and forward planning. This in turn sometimes had the negative effect of missing the pressure that staff sometimes worked under and was heavily reliant on agency staff.

The senior managers of the home acknowledged this and confirmed they had plans in place to address it. We have made a recommendation about the need for the provider to develop a specific plan for reducing the dependency on agency staff.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Hampton Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 76 people across three separate units, each of which have separate facilities. There were 69 people living at Hampton Care Home at the time of inspection. People living in the service may have complex physical or health needs or are living with dementia and they need the support of trained nurses.

The home was in the process of recruiting a suitably qualified and experienced registered manager who had both a nursing and social care background. The previous registered manager had left the organisation. 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.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and spoke to us about how they would identify any issues and report them appropriately. Risk assessments and risk management plans supported people well.

Good arrangements were in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults.

The acting manager and her senior team kept staffing rosters under review as people's needs changed. We judged that the service employed enough nurses and care staff by day and night. There were suitable numbers of ancillary staff employed in the home.

Staff were appropriately inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles. Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. Any issues were dealt with promptly and appropriately.

People in the home saw their GP and health specialists whenever necessary. Where necessary nurses in the home would liaise with external specialist nurses and consultants. The staff team had good working relationships with the local health and social care teams in the area.

People had their needs assessed and the staff team reviewed the delivery of care for effectiveness. They worked with health and social care professionals to ensure that assessment and review of support needed was suitable and up to date.

People told us they were satisfied with the food provided and we saw suitably prepared meals being served. Nutritional planning was in place and special diets catered for appropriately.

Hampton Care Home had suitable adaptations to ensure people were safe and had enough personal and shared space. The home was warm, clean and comfortable on the day we visited. Suitable equipment was available.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

The staff team were aware of their responsibilities under the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People who lived in the home told us that the staff were caring. We also observed kind and compassionate support being provided. Staff supported people in a respectful way. They made sure that confidentiality, privacy and dignity were maintained.

Risk assessments, nursing plans and care plans provided detailed guidance for staff in the home. People and relatives were aware of their care plans and were involved in their development. Staff took people out locally and encouraged people to follow their own interests and hobbies. We saw evidence of regular activities for people and visitors were made welcome.

The service had a comprehensive quality monitoring system in place and people were asked their views in a number of different ways, from direct conversations to questionnaires. Quality assurance was used to support future planning. The home had a large presence of support from the wider organisation who were supporting the home to improve on its leadership and quality assurance. This had resulted from a variety of factors relating to incidents and accidents which had occurred over the previous 12 months. The management were working with the local authority in improving the way it monitored and managed these areas.

The acting manager and the operations manager responded to concerns or complaints appropriately and records were well organised, easy to access and stored securely.

Further information is in the detailed findings below.

There was a registered manager at the home. 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 the last inspection on 17 and 20 April 2015 we found that the staff supervision and training in place was insufficient. We also found that the quality assurance systems in place were not sufficient and did not take into account the views and experiences of people living in the home. We asked the provider to submit an action plan detailing the improvements to be made.

These actions have been completed and on this inspection we found that the relevant requirements were being met.

People’s feedback about the safety of the service described it as good and that they felt safe.

People were safe because the service had provided training to staff and had systems in place to protect them from bullying, harassment, avoidable harm and potential abuse.

Staff protected people’s dignity and rights through their interaction with people and by following the policies and procedures of the service Feedback from people and their relatives was that staff were caring in their attitude and responsive to people’s needs. A caring attitude was observed during the inspection and personalised care, dignity and respect formed part of staff training.

Staff training and supervision had improved since the previous inspection. There was a structure and system in place for regular staff supervision and each member of staff had a training record which was relevant to their role.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene. Medicines were well managed, with staff displaying a sound understanding of the medicines administration systems, recording and auditing systems.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were understood by the manager and acted on appropriately.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

Care, treatment and support plans were seen as fundamental to providing good person centred care. The service had moved to a new computerised system which meant that all staff would be able to access and update these plans at any time. Care planning was focussed upon the person’s whole life, including their goals, skills, abilities and how they prefer to manage their health.

The service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and companionship. The service enabled people to carry out person-centred activities within the service or in the community and encouraged them to maintain hobbies and interests.

This was supported by policies and procedures which emphasised the rights of people and developments in care planning which included people’s life histories written from their own perspective, which enabled staff to work in a person-centred way.

People described the responsiveness of the service as good. People received personalised care, treatment and support and were involved in identifying their needs, choices and preferences and how they are met. People’s care, treatment and support was set out in a written plan that described what staff needed to do to make sure personalised care was provided.

Improvements had been made to quality assurance systems to ensure that people’s views were sought and that quality audits take account of the experience of people living at the home. The roles of deputy manager and matron had been introduced and meetings with relatives and residents been held.

Records and personal information were kept in a secure and confidential manner.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure.

The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We saw that the home was clean and well maintained. People we spoke to told us that they were happy with the cleanliness of the home. Equipment was well maintained and regularly serviced and all health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

We inspected the staff rotas which showed that there were sufficient staff on duty to meet people's needs throughout the day. However, some people told us that they often had to wait for a long time for staff to respond to calls. The provider may wish to review how staff levels are calculated and linked to current dependencies of people as uncertainty about how quickly a call for help will be answered could lead to a person feeling unsafe.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Recruitment procedures were rigorous and thorough.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although the registered manager told us that no DoLS applications had been made, they were able to describe the circumstances when an application should be made and knew how to submit one

Is the service effective?

People all had an individual care plan which set out their care needs. Care records showed that people had been consulted with and information was presented from the perspective of the individual. However, some people we spoke with seemed unfamiliar with the concepts of "care plan" and "key worker" and could not recall their involvement in assessments and care decisions. This may therefore be an area for reflection by the provider.

People had access to a range of health care professionals including palliative care and GPs who visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. However, there was evidence that some staff demonstrated better awareness and skills than others, particularly in the areas of personal care assistance. We saw examples of excellent care during mealtimes. At other times, such as when people were using their call bells for help, some calls were not answered for some time.

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is The Service Responsive?

The home had developed good links with other agencies, including palliative care services in order to ensure people received appropriate care. The home had activities co-ordinators who offered a range of activities. However, several comments from people indicated that activities may need to be reviewed. Whilst the home offered in-house activities such as singing and manicures, comments from some people were that they wanted more opportunities to go out of the home. There was an adapted minibus which was used by the adjacent day centre.

Some people were unfamiliar with some of the staff and concepts such as "care plans". However, they told us that they were pleased that the new manager took the time to visit them on an individual basis and talk to them.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed in the past but due to staff changes this had lapsed somewhat in the last month or so. The manager was able to describe a plan which included regular review of the quality of the service and increased supervision for staff.

People's personal care records, and other records kept in the home, were accurate and complete. There was a general atmosphere in the home of teamwork and good communication between staff and manager.

During our unannounced visit on the 3 July 2013 we saw improvements had been made. We spoke to staff and reviewed daily records, current care plans and archived care plans.

People we spoke with described receiving attention and good care from staff working at the home. One person told us, "they are all very kind". Relatives we spoke with described staff as "caring" and "helpful".

Four people living at the home said that staff were particularly busy in the afternoons, evenings and at weekends. The staff we spoke with gave similar accounts. The manager sent us details, which we checked, relating to qualified nurses who had been booked using a long term placement agency. This was to cover staff shortage until the current recruitment process was successfully completed.

We looked at the records and a number of care related documents and found that some records were not always accurate or being fully maintained. Written entries in some records were not clearly dated and it was difficult to ascertain precisely when care provided had been administered. There were inconsistencies in how records were written and how care was recorded.