Archived: Hampton Court

We found the following examples of good practice:

• The home had a testing programme in place ensuring people living at the home and staff were regularly tested for COVID-19. Appropriate action had been taken in response to any positive test result.

• The home was clean and hygienic throughout. Cleaning products and schedules had been reviewed and amended in response to COVID-19 ensuring regular and effective cleaning was carried out, particularly frequently touched surfaces.

• Staff donned, doffed and disposed of personal protective equipment (PPE) safely and in line with the relevant national guidance.

• Staff were able to access hand sanitiser and stocks of PPE at various locations around the home.

• Staff supported people to see and speak with their loved ones safely and in line with the national guidance. The design of the building supported positive window visits and the provider had invested in a self-contained external visiting pod, which was carefully managed with appropriate infection prevention and control measures.

• The layout of communal areas at the home were naturally spacious and people were able to maintain social distancing with the observation and support of staff.

Further information is in the detailed findings below.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

A registered manager was 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.

The service maintained effective systems to safeguard people from abuse.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA).

The service had a complaints’ procedure. We saw evidence that complaints had been responded to in a professional and timely manner by the registered manager. Relatives told us they felt able to raise concerns and they would be acted on.

People's needs were assessed and recorded by suitably qualified and experienced staff. Risk assessments, a plan of care and supporting care documents were completed to help ensure people’s needs were met; this included cultural diversity and protected characteristics. We found some minor inconsistencies in the detail of information recorded to support individualised care. The registered manager said they would act to improve these records.

We saw evidence that the service learned from incidents and issues identified during audits. It was clear from incident records that staff were vigilant in monitoring people’s behaviours to minimise risk and provide the right level of support.

It was evident that the staff team knew people well and had a good knowledge of their individual support needs. People using the service and relatives had a close working relationship with the staff.

People told us that staff treated them with kindness and respect; this view was also shared by relatives. Staff were clear about the need to support people's rights and needs regarding equality and diversity. Consent was sought from people at the appropriate time.

The service ensured that staff were trained in appropriate subjects. This training was subject to review to ensure that staff were equipped to provide safe, effective care and support.

We saw clear evidence of staff working effectively to deliver positive outcomes for people. People we reviewed were receiving care and support which included advice from external health and social care professionals to maintain their health and wellbeing.

People using the service, relatives and staff were involved in discussions about the service and were asked to share their views. This was achieved through daily contact by the managers and staff, via meetings and completion of satisfaction surveys. We saw positive responses and suggestions to improve practice were acted on by the registered manager.

Staff had been appropriately checked when they were recruited to ensure they were suitable to work with vulnerable adults.

Medicines were administered safely by staff who were trained and deemed competent. Medicines were subject to auditing to ensure the overall management remained safe.

Policies and procedures provided guidance to staff regarding expectations and performance.

Menus offered a varied choice of hot and cold home cooked meals and people's specific dietary requirements and preferences were considered. People living in the home were very complimentary regarding the meals.

There was a clear management structure and people, relatives and staff were positive regarding the registered manager’s leadership of the home.

Quality assurance systems and processes were in place to monitor standards. We spoke with the registered manager regarding consideration around more in-depth auditing in areas such as, privacy and dignity to support staff practices. Following the inspection, the registered manager advised us that a more focused dignity audit that would be introduced to monitor this more closely.

The registered manager understood their responsibilities in relation to registration. For example, notifications had been submitted in a timely manner and the ratings from the last inspection were displayed as required, including the provider website.

Further information is in the detailed findings below.

We asked the provider to take action to address these concerns. After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach.

We undertook a focused inspection on 20 January 2017 to check that they had they now met legal requirements. This report only covers our findings in relation to the specific area / breach of regulation. This report only covers one question we normally asked of services; ‘Is the service safe?’ the other four questions; whether the service is ‘effective’, ‘caring’, ‘responsive’ and ‘Well led’ were not looked at on this inspection.

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

Hampton Court EMI Care Home provides accommodation for up to 26 people who have dementia.

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.

We found the service had made improvements to the way medicines were administered and managed. We found the breach had now been met.

At the last inspection in October 2015 we found concerns because; medicines policies were not sufficiently developed; some areas of medicine administration needed further development such as the use and recording of medicines to given when necessary [PRN], or covertly [without the person’s knowledge but in their best interest]; review of medicines by the doctor; auditing of medication practice and an understanding of the application of the Mental Capacity Act 2015 when managing medications.

All of these areas had been addressed. We spoke with the registered manager how the recording of external applications [creams] could be further improved.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

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

Is the service safe?

People who lived at the home and their families told us there was sufficient staff on duty at all times to meet the needs of the people. A family member told us, 'They seem to have plenty of staff and staff are always around and about the lounge.'

Arrangements were in place to monitor accidents and incidents and this included a process for analysing incidents each month so that any emerging themes could be identified.

A range of audits and checks were established to monitor the safety of the service provided. These included weekly medication audits and a monthly check of the care records.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection nobody who lived at the home was on a Deprivation of Liberty Safeguards (DoLS) plan. The manager and senior care staff had attended DoLS training.

Is the service effective?

People we spent time with were satisfied with the care and said their needs were being met. A person told us, 'It's nice and clean here. My bedroom is comfortable and the food is perfect.'

Equally, family members we spoke with were pleased with the care and support their relatives received. A family member said to us, 'The staff are good. They take time out to talk to people. There is plenty going on and my [relative] is content and happy ' that is the main thing.'

Care plans were in place for each person. Care plans were reviewed each month to ensure they were current.

People told us they were satisfied with the food and menus. Arrangements were in place to monitor people's views of the meals served.

Is the service caring?

People who lived at the home told us staff were approachable, friendly and responsive. One of the people said, 'Everybody is very nice. We are not rushed or pushed to do to things we don't want to do.'

Family members we spoke with were all pleased with the care. A family member said to us, 'The minute we stepped in to the home we liked the feeling. The staff were nice and friendly and made us feel welcome. My [relative] knows who his keyworker is.'

Throughout the day of the inspection we observed care staff engaging with people in a positive, respectful and individualised way. Staff had a good knowledge of each person's needs.

Is the service responsive?

People's needs had been assessed before they moved to the home. Records confirmed people's preferences, interests and preferred routines had been recorded, and staff provided support in accordance with people's wishes.

People and/or their families said they were involved in decisions about their care. A family member told us, 'The staff communicate well and talk to me about my [relative's] care and support.'

Is the service well-led?

Processes to seek people's views about the quality of the service were in place. Feedback questionnaires were distributed to people and their families twice a year. In addition, monthly meetings with people living at the home took place. Families were also invited to attend these meetings.

Arrangements were in place for undertaking a staff survey to seek staff views about the working environment. Staff meetings were held six weekly. Training records informed us the majority of the staff team were up-to-date with their mandatory training. Staff told us the training was good and they were encouraged to participate in training. The staff we spoke with confirmed they received an annual appraisal and regular supervision.

In this report the names of two Registered Managers appear who were not in post and not managing the regulated activity at this location at the time of our inspection. Their names appear because they were still registered managers on our register when we inspected.

The people who were living at the home, and their relatives, told us they were satisfied with how staff supported people and how staff provided care. One person said, 'The staff are easy going and that suits me. I'm happy with the staff.' A relative told us, 'I honestly cannot fault the staff. I can tell the staff are very caring and I see they have a passion to do the job well.' Some people and relativies thought the home would benefit from additional staffing.

The care records were in the process of being restructured. Assessments and care plans had been revised for each person and were reviewed each month to take account of people's changing needs. Care plans were signed by either the person or their relative.

A programme of social activities was in place, including trips outside of the home. The manager informed us that this programme would be further developed to take account of people's preferences and interests.

Arrangements to monitor the safety and quality of the service provided had been enhanced. This included the introduction of environmental monitoring checklists, behavioural monitoring charts, food diaries and continence monitoring charts.

One person living at the home told us, 'The staff are always nice to me.' Another person said, 'The staff are very good. If you ask for something there is no problem getting what you want.' People told us they could make choices about what to eat and when to go to bed. Throughout the day we observed staff speaking to people in a respectful and kind way. We heard from relatives and people living at the home that there was not enough suitable recreational and social activities available for people.

Some of the risk assessments and care plans either lacked detail or had not been developed. Relatives told us they were not routinely involved in the reviews of their dependent relative's care plan.

We observed that the home was clean and effective arrangements were in place to monitor the cleanliness of the environment.

Overall, staff were up to date with required training and they had completed training specific to caring for people with dementia. Staff annual appraisals were up to date.

Relatives told us there was not enough staff on each shift to meet the needs of the people living there. There was no clear process in place for determining the sufficiency of staffing levels. Opportunities for relatives to share their views about the service and how the home is run were not sufficiently developed.

We looked specifically at the outcome related to supporting the staff in carrying out their care role. Arrangements were in place for staff training and development. In addition, arrangements were in place for staff to receive supervision and an annual appraisal.