All inspections: Hatherleigh - Care Quality Commission

This inspection took place on 21, 23 and 29 December 2015. The first two visits were unannounced.

Hatherleigh provides personal and nursing care to a maximum of 53 people in the rural community. The home has one unit providing care for people with dementia and one unit, over two floors, providing general nursing care. There were 50 people resident at the time of this inspection.

Our inspection in December 2014 found six breaches of the regulations. These related to care and welfare, staffing, medicine management, safeguarding people from abuse, consent and quality monitoring. The provider sent us a comprehensive action plan. We inspected the service again in December 2015, specifically to check whether people’s care and welfare needs were being met, and found that they were.

The home is required to have a registered manager. 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.

Medicine management was well organised and there were checks in place to make sure people’s medicines were provided in a safe way.

People’s needs were met by sufficient numbers of staff, who were recruited following checks on their background and suitability to work in a care home environment. Staff received training, supervision and support in their roles.

The premises was well maintained and upgrading improvements had increased people’s comfort.

Risk to individuals was assessed and any identified risk was managed for their safety.

Staff had a good understanding of how to protect people from abuse and respond should they had any concerns. People’s legal rights were upheld.

There was a varied menu and people’s dietary needs were met. One said, “Food is quite nice. I get enough to eat, it is tasty and well cooked”.

Health care needs were met through consultation with community professionals and support to attend hospital and other health care visits.

People received kind and compassionate care. One person said, “Nothing is too much trouble for them. I am very lucky.” Staff engaged with people in a respectful way, promoting their dignity.

People received care which was individual to them, taking into account their needs, preferences and wishes. There were regular activities for people should they wish to be involved and the home environment had benefitted from adaptations, such as raised vegetable beds and posters to trigger memories from people’s past.

Complaints were used as a way to improve the service. Where necessary staff had received additional training and an apology had been given where things could have been done better.

There were comprehensive systems in place to ensure the service was well run, such as audits, staff meetings, and consulting with people about how the home is run.

We carried out an unannounced comprehensive inspection of this service on 9 and 18 December 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 in relation to those breaches.

We undertook this focused inspection to check that they had followed their plan with regard to the breach of Care and welfare of people who use services, and to confirm that they now met that legal requirement. This report only covers our findings in relation to that requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hatherleigh on our website at www.cqc.org.uk

The inspection visit took place on 31 March 2015 and was unannounced.

At the December 2014 inspection people’s care needs were not always responded to in a timely manner. We found the required improvement has now been made.

The service has a registered manager. 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 and associated Regulations about how the service is run.

Hatherleigh provides residential and nursing care for a maximum of 53 people. The first floor provides accommodation for people living with dementia. The ground and lower ground floors accommodate people with other nursing or residential needs. There were 53 people resident the day of our visit.

People were receiving the care they needed to maintain their hygiene and safety.

Changes in staffing arrangements had led to a more relaxed atmosphere and staff were able to respond to people’s needs and preferences in a timely manner. For example, helping people move safely, engaging with people with friendship and providing the assistance needed with eating, bathing and toileting needs.

Most people and their family members spoke positively about the care provided. One said, “Staff are very good. They don’t intrude but help with personal care; they keep a watching eye, they know us and we know them”.

Where people had complex needs staff understood those needs and how to meet them. However, some care plans lacked the detail which should be available to staff for reference. Monitoring records were sufficiently detailed so any concerns about people’s health and care needs could be identified quickly.

The unannounced inspection took place on 9 and 18 December 2014 and included an evening visit.

The service has a registered manager. 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 and associated Regulations about how the service is run.

Hatherleigh provides residential and nursing care for a maximum of 53 people. There were 52 people resident the day of our first visit.

We previously inspected this service on 4 and 12 June 2014 and found the home was meeting the required standards.

People’s hygiene needs were not always met. This included the changing of soiled continence pads and washing/bathing to a standard acceptable to people. Staff had been told that where they needed to prioritise their work people could stay in bed, or be dressed and put back to bed, to give staff time to ensure people received other care, such as receiving enough fluids.

The staffing arrangements did not ensure people’s needs were met in a timely manner, such as receiving personal care or meals at a reasonable time. Inadequate staffing numbers put people at risk; one to one support was not always available when planned and sometimes there were no staff in the area which left some people without physical and emotional support.

Some aspects of medicine management put people at risk. For example, an inhaler was in use which was out of date.

People were not protected by the principles which underline the Mental Capacity Act 2005. There was no evidence of supporting people to make decisions or that people’s capacity to make time and decision specific decisions was assessed. There was little evidence that people had been involved in planning their care although some families said they were consulted on people’s behalf.

Most staff were unaware of the local authority safeguarding adult’s team or the legislation which protects staff if they whistle blow concerns although they were informed on their pay slip they could contact the local authority if they had concerns about abuse. Less than half of the staff had received training in the safeguarding of adults, in the last two years. Some staff were worried about talking to the CQC.

Some people were isolated from company, stimulation and activities of interest to them, such as watching the television or listening to music. Activities staff were requested to direct their efforts to people who showed most need, which sometimes meant meeting their everyday routine support needs.

There was diverse opinion of the helpfulness of the registered manager and senior staff in responding to concerns people raised. Some people were very satisfied and some were very dissatisfied. Formal complaints were responded to and improvements made where possible. There was insufficient overview of the organisation to ensure policies were adhered to, risks managed and the safety and welfare of people promoted.

Staff showed a commitment to providing care which was kind, patient and individual to the person. Staff had good knowledge of people’s individual needs although this detail was not always reflected in the plan of how their care was to be delivered.

There was a range of opinions about the quality of the meals provided, but people’s nutritional needs were met.

People’s health care needs were well met. People were supported to receive treatment and health care advice and support. Staff received training and support in their work although induction training was taking considerably longer than the home’s policy said it should. Staff recruitment was robust.

We found breaches of the regulations 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 the report.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service caring?

Is the service effective?

Is the service responsive?

Is the service well led?

This is a summary of what we found.

On the two days of our inspection there were 47 people using the service. The summary is based on conversations with 13 people using the service, 13 staff supporting them, eight people's family and two health care professionals. We looked at records, toured the building and observed what happened at the home throughout our visit.

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

Is the service safe?

The service was safe because the registered manager, nursing and care staff knew people's needs and had the skills to deliver the care which was required. A GP said "The provision of care is good. It has improved". The skills of staff were especially noted for people with dementia and required support and observation to ensure they and other individuals were safe. However, there was a need for continued vigilance in this area of care, based on a recent incident which resulted in a referral to the local authority safeguarding team.

The service was safe because the premises and equipment was serviced and maintained in a fit state. Where faults occurred these were dealt with in a timely manner.

The service was safe because the registered manager was aware of where staff needed additional support and we found this support and supervision was provided.

The service was safe because record keeping had improved and the CQC was notified of events which affected the service and people's welfare.

Is the service caring?

The service was caring because the vast majority of comments about the nursing and care workers were positive. People told us 'It is very welcoming and friendly' and 'Two of the carers are first class.....they listen and handle me gently' However, there were some comments about staff not appearing to care. For example, 'Some carers are in a hurry and sometimes I am pushed around a bit'. The care we observed was kind, friendly and at a pace which did not rush the person. Staff told us 'Carers work hard to provide good care'. This is what we observed during our visits.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Applications under this legislation had been submitted and successful. We saw those deprivations were under regular review and staff were clear how to comply with the arrangements so as to protect the person and provide the care required in their best interest. The registered manager had also involved appropriate agencies where decisions were required in people's best interest but restrictions of liberty did not apply.

Is the service effective?

The service was effective because people's need were assessed, care was planned and risk was managed. We confirmed from records and talking to staff that people's dietary needs were met and health and safety promoted, for example through review of medication, the use of equipment and instructions to care workers. A GP told us the nurses were competent in ensuring people's health care needs were met.

Is the service responsive?

The service was responsive because concerns and issues raised had been investigated and, where it was in the interest of the person using the service, changes as requested had been made. For example, the staff skill mix had been altered so there were additional care workers early morning so people were able to rise at their preferred time. Where appropriate external health and social care professionals had provided information and advice this had been followed. For example, where there was an increased risk of a person choking a speech and language therapist had been requested and their advice was followed.

Is the service well led?

The service was well led because the registered manager and provider had continually improved the service for people. For example, changes to the layout of the home and grounds, staffing and recruitment, maintenance and servicing of equipment, provision of new equipment and addressing issues relating to staff practice.

People at Hatherleigh Nursing Home had complex needs and those needs were met for the majority of people the majority of time. Shortfalls were always taken seriously and improvement made where possible.

We had received some information which might indicate that people's needs were not being met. We looked closely at the care of six people, spoke to others who we joined for lunch, spoke to staff and some visitors.

We found that staff had a good understanding of consent to care and treatment and how to protect people's legal rights if they did not have the capacity to make decisions about their own welfare. Decisions had been made in people's best interest with information from the people who knew them best, such as family and GP.

We saw staff being attentive and kind. They offered people physical and emotional support. Asked if the care workers were friendly two people told us "Oh yes". We saw people engaged in meaningful activities, such as flowers for the tables and a men's lunch club with beer for those who wanted it. People smiled and were engaged in those activities.

We found that people were supported to receive an adequate diet and fluids. Staff knew who would refuse help to eat and gave help to those that wanted it. People's weight and dietary intake were monitored and concerns had been followed up.

Continence products were available to people with an assessed need for the products, which were ordered and delivered monthly. We saw that there was additional stock in case of unexpected need.

We found that people were receiving the care that they needed, in line with their wishes, assessment and GP advice and support.

The home's record management did not protect people. This had already been identified by the registered manager as an area for improvement.

We first received information that there was a heating failure at the home and then other concerns were raised about staffing levels and equipment. We visited twice, observed the care, spoke to three people who used the service, seven people's families, 10 individual staff and other people involved with the home.

Positive comments about the registered manager included 'She tries hard' and 'She is really good for the home'. There were only positive comments from people about the staff, who were considered to be "lovely".

We found that people's individual emotional and social needs were better met due to changes in the environment, increased staff training in dementia care and more access to the gardens. Staff were attentive and kind.

The maintenance arrangements did not ensure the safety and suitability of the premises. There had been system failures which put people using the service at risk of discomfort or harm.

There were risks posed from inadequate equipment. For example, care workers had not always known when a person needed assistance. The registered manager said the situation had been "deteriorating for months and months."

There were some staff increases but not always sufficient numbers of staff to ensure a safe service. People told us 'Sometimes it takes ages for someone to come' and 'We spend a lot of time trying to find staff'.

The Commission did not receive information when requested and we were not always notified of incidents, as the provider was required to do.

We spent two days at Hatherleigh Nursing Home to look at the standard of service people received. People told us, "The staff are absolute darlings. They are marvellous". A GP said they were happy with the standard of care provided. However, a health care professional was unable to express confidence in the service.

We saw that people receiving physical care looked comfortable and were well cared for. People's dietary needs were well met. One person said, 'The standard of food is excellent on the whole.' Staff were kind, caring and attentive. Plans to improve people's emotional and social needs were under discussion and being implemented but had not yet translated to a service that always met those needs.

The home operated a robust recruitment of new staff so that recruits were suitable for the role and safe to work with vulnerable adults.

The acting manager was clearly known to people, their families and staff. One person's family after meeting with the acting manager, told us how their parent's health was improved and how happy they were with the home.

People's opinion was surveyed with actions taken. The service was monitored. Complaints and comments received were acted upon. Staff performance was monitored and they were supported in their role.

We carried out an unannounced inspection on 16 July 2012 as part of our planned inspection programme. On the day of our visit there were 48 people living at Hatherleigh Care Home. We spent time talking to people, their relatives and staff. Some of the people who used the service at the home had a cognitive impairment, such as a dementia, and therefore were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.

People we spoke with who lived at the home said that their care and welfare needs were being well met. Comments included, 'my health has definitely improved'; 'staff are competent and know how to provide care'; 'staff are really kind and there is a friendly atmosphere' and 'I feel safe here.' In addition, we spoke to people's relatives. Comments included, 'it's really wonderful here'; 'staff are great and the care given is brilliant' and 'I feel fully involved in my relatives care.'

People we saw and spoke with confirmed that they felt safe and supported by staff at Hatherleigh Care Home and had no concerns about the staffs' ability to respond to safeguarding concerns. They felt that their human rights were upheld and respected by staff. Relatives we spoke with also commented that they felt people's safety was paramount and were alerted to any concerns identified in a timely manner.

We toured the home and found it to be clean and well maintained. No concerns were identified at this time. We saw that the homes lay out supported the needs of the people living there, with spacious lounge and dining rooms and handrails along corridors for people to use.

People we spoke with informed us that staff met their needs in a timely manner. People said that generally call bells were quickly responded to and if there were a short delay they understood the reasons why. People said that this was not a regular occurrence.

The registered manager demonstrated how they conducted clinical audits on a monthly basis. These included, wound care, care plans, medication, nutrition and risk management. These were conducted to ensure the timely follow up of arising issues and to make sure that other health and social care professionals were involved.

People told us staff were cheerful, kind and caring. People felt they were treated respectfully and that staff were patient. People spoken with told us they felt safe living in the home because they were cared for so well. One person told us 'I don't have to worry about anything, I feel safe and secure'.

People who were able told us that the staff team explained their care and treatment to them. Some said that they had attended meetings where they were asked their opinion of the home and the care they received. They felt their opinion mattered and was listened to.

Relatives spoken with told us 'the care is absolutely fantastic, it is five star, the staff team are brilliant'. They told us they were very impressed with the staff team saying 'they are professional, respond quickly and appropriately and deliver excellent care'.

Relatives confirmed they were invited to and involved in their relative's care reviews and were told of any changes to their care. They told us they attended relative's meetings and gave an example of how they felt listened to when their relative was not eating. They said the chef had met with them to find out their relative's favourite foods and prepared different meals for them that encouraged eating. They said their relative's eating had improved.

During the inspection we spent a period of time observing four people who were unable to verbally communicate their views. This helped us understand what it is like for them to live there. We found that the four people did not join in the activities of dominoes that were going on in the lounge at the time. The activity lasted over half an hour, we found that these four people spent the majority of this time looking around the room. Staff did not engage with them during this half hour. Although the four people did not appear unhappy or in discomfort they were quiet and two of them went to sleep for the last ten minutes. Following the period of observation we found that the people doing activities appeared bright, cheerful and fully engaged with staff.

We also observed that staff were patient and kind with people who were more demanding of their time. We observed that staff supported people in a caring and respectful manner.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Hatherleigh

All Inspections

21, 23 and 29 December 2015

During a routine inspection

31 March 2015

During an inspection looking at part of the service

9 &18 December 2014

During a routine inspection

4, 12 June 2014

During a routine inspection

28 February 2014

During an inspection in response to concerns

29 November and 3 December 2013

During an inspection in response to concerns

1, 2 August 2013

During a routine inspection

16 July 2012

During a routine inspection

30 August 2011

During a routine inspection

Reports under our old system of regulation