This inspection took place over two days on 30 August and 14 September 2016. The first day of the inspection was unannounced. We gave notice of our visit on the second day of the inspection so that the manager and other key personnel would be available to speak with us.
At our last inspection on 25 and 30 September 2014 the provider was meeting all the regulations that were assessed.
Hampden House is registered to provide nursing care to a maximum of 66 older people. Accommodation in the main part of the building is provided in three nursing and two residential wings set out over two floors. A link corridor on the first floor provides access to further residential accommodation for another nine people located in the adjacent building. On the first day of our inspection 61 people were living at Hampden House.
When we visited there was a new manager in post. The manager was registered as a ‘registered manager’ by the Care Quality Commission on 12 October 2016. 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 this inspection we found management systems and processes were not effective. We identified a breach of Regulation 18 of the Care Quality Commission Regulations 2009 because incidents and events had not always been notified as required to the Care Quality Commission.
Where risks had been identified staff had not always followed the agreed action, to reduce the identified risk. Medicines management was inconsistent increasing the likelihood of errors. Protocols for the use of medicines used on as ‘as required’ basis were not in place and people had not always received their prescribed medicines in a timely way. People’s care records did not always reflect people's health and care needs accurately. All of these matters placed people at potential risk of receiving inconsistent or unsafe care.
We found that there were not always enough care staff to respond quickly to people who needed assistance. Some people living in the residential part of the service required two people to attend to their personal care needs. This impacted the time staff had available to provide appropriate supervision and support for other people in a timely way.
Staff told us they felt they received the training they required. However training records showed significant gaps in training. Systems were in place to ensure staff received regular supervision and appraisals and staff told us this aspect was improving under the new management.
Good recruitment procedures were followed which made sure checks including checks for the nursing staff with the Nursing and Midwifery Council (NMC) had been completed before new staff started work.
Appropriate arrangements were in place to respond to safeguarding incidents.
The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA). However, records on MCA and DoLS were not well maintained. Information we received from staff suggested that they were not routinely using capacity assessments in their day to day decision making. We have made a recommendation to improve staff learning and understanding of the MCA.
People spoke positively about staff kindness and patience. We saw people had access to healthcare professionals such as GPs and district nurses. People told us they were treated with respect and this was confirmed in our observations. There was a relaxed and friendly atmosphere and we saw staff were attentive at the mealtime we observed. We saw mealtimes were a pleasant and sociable occasion with people being offered a choice of meals and drinks.
People could follow their own interests and pursuits. A range of activities were available and we were told of plans to increase the provision of these after consultation with people living there.
People were aware of how to make a complaint and we saw complaints dealt with by the service had been responded to appropriately. Two complaints were being investigated by head office and these were on-going when we visited. Not all of the issues people spoke to us about had been examined through the complaints procedure and these were referred back to the manager for investigation and resolution.
We found there was a willing and committed staff team. The new manager was enthusiastic and keen to make improvements. However, the effectiveness of some of the quality assurance systems required improvement, which is evident from the breaches we found at this inspection.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014: Regulation 12 (Safe care and treatment), Regulation 18 (Staffing), and Regulation 17 (Good governance). You can see what action we told the provider to take at the back of the full version of the report.