OSJCT Hungerford House

Hungerford House is a care home providing accommodation and personal care to 39 people at the time of the inspection. The service can support up to 48 people. People live in three areas of the building, one of which specialises in providing care to people living with dementia.

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

People were safeguarded from the risk of abuse and received safe care and treatment. There were enough staff to meet people’s needs. Risk assessments and care plans were thorough, up to date and provided staff with enough detail to support people safely. Medicines were managed safely, and staff worked with health and social care professionals to help people maintain their health and well-being. The environment was clean and good infection control procedures were followed.

The service had a registered manager in place who was supported by the provider. Quality assurance processes were in place to monitor the service and made improvements where needed. Staff and relatives told us that the registered manager was approachable, and staff were confident that action would be taken if they raised concerns.

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 (published 6 November 2018).

Why we inspected

We received concerns in relation to the management of falls and incidents between people in the home. 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.

The overall rating for the service has remained as good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Hungerford House is a care home. 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.

Hungerford House provides accommodation and personal care for up to 49 people. At the time of our visit, 47 people were using the service.

The home was last inspected in September 2017 and was rated as Requires Improvement, with a warning notice for medicines management. At this inspection we found that action had been taken to address the breaches in regulation and the medicines warning notice. We found the service to be rated as Good overall, with the domain of safe rated as Requires Improvement.

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 saw that there had been improvements in the way that medicines were managed. There was a reduction in the number of medicine errors and we saw medicines being administered safely.

We received mixed feedback about whether there were enough staff. There was a dependency calculation tool in place showing a minimum and maximum number of staff required. Rotas showed that the staffing levels were regularly at the lower end of the dependency calculation.

Although there were safe recruitment processes taking place, there was not always a managerial overview of this. A matrix was in the process of being created, documenting the information that had been seen and was held on file for each staff member.

Staff received training suitable to their role. However, there was no up to date overview of any gaps in training needs. We saw that this was a work in progress and time had been allocated to the administrator to complete this.

Staff understood their responsibility to identify and report any concerns relating to safeguarding. They knew who they could contact within the organisation and who they could whistleblow or raise concerns with externally.

Accidents and incidents were reported and analysed. We saw records showing that trends were identified and actions were taken where possible to reduce the likelihood of recurrence.

People told us they felt safe living at the service. They told us staff were kind and caring.

There was pressure relieving equipment in place to support people’s skin integrity. Records were maintained to show that people had been repositioned. We saw some gaps in recording and recommend that the records are monitored to improve consistency.

Where people lacked the mental capacity to make certain decisions, appropriate assessments and documentation was in place. Deprivation of Liberty Safeguard authorisations had been requested from the local authority.

If people were at risk of malnutrition and dehydration, their nutritional intake was monitored. We saw that records were maintained and people’s weights were monitored.

There was an open culture of wanting to receive and using feedback to improve the service. An annual survey was circulated and regular meetings took place to obtain people’s views.

People were mostly positive about the food options. We saw that catering audits took place and the kitchen staff engaged with people to seek their feedback.

Staff from all departments interacted with people, we saw housekeepers and kitchen staff taking time to stop and chat with people. The staff team worked well together to meet people’s needs in a timely manner.

Staff were respectful of people’s dignity. We saw staff discretely supporting people to use the bathroom and change their clothing had food spillages.

Complaints were investigated and responded to. We saw records showing that accountability had been taken where the service was found to be at fault.

Staff spoke positively about the support they received from the registered manager. The registered manager supported staff to take accountability for different aspects of the service and to develop in their roles.

The registered manager had a clear vision for the service. Where actions had been identified following audits, there were realistic timescales in place. Where there had been areas for improvement, changes were made and quality monitoring processes were put in place.

This inspection took place on 12 September 2017 and was unannounced. We returned on 13 September 2017 to complete the inspection.

At the last inspection in August 2016, we identified the service was in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe medicines management. Following the last inspection the provider wrote to us and said they would take action to ensure medicines were managed safely by October 2016. At this inspection we found medicines were still not managed safely. People did not always receive the medicines they had been prescribed. One person continued to receive medicines after they had been stopped by their doctor. This was a continued breach of the regulation.

The service did not have 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. The previous registered manager left their post at the service in April 2017. The area operations manager informed us a new manager had been recruited, and was in the process of working their notice period before starting work at Hungerford House. The provider had a condition of registration that a registered manager must be in post at Hungerford House and was therefore not meeting their conditions of registration at the time of the inspection. We will monitor this and will consider enforcement action if the service continues to operate without a registered manager.

People had care plans in place, however, they were not always kept up to date and some sections had not been completed. The deputy manager told us they were aware care plans needed to be reviewed and updated. The deputy manager said review of the care plans was part of the improvement plan they had in place for the service and they planned to complete the work by the end of the year.

Hungerford House has been inspected five times since it was registered under the Health and Social Care Act in 2010. Four of these inspections, including this one, have identified breaches of regulations. The provider has not demonstrated they are able to consistently meet the requirements of their registration. There were quality assurance systems in place. However, they were not effective and had not ensured improvements were made to the quality and safety of the service being provided.

People said they felt safe living at Hungerford House. We observed people interacting with staff in a confident and friendly way. People appeared relaxed in the company of staff and did not hesitate to attract their attention if they needed assistance. Staff intervened promptly if people needed assistance to stay safe, including support to move safely around the home and support with managing disputes between people. Systems were in place to protect people from abuse and harm and staff knew how to use them.

People told us they were treated well and staff were caring. Comments included, “They’re [the staff] very good to me”; “The staff are very good, they listen to me”; and “The girls are super”. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy and responded to requests for support.

Staff understood the needs of the people they were providing care for. People told us staff provided care with kindness and compassion.

Staff received a thorough induction when they started working at the home. They demonstrated a good understanding of their role and responsibilities. Staff had completed training relevant to their role.

There were group and individual meetings for people to provide feedback about their care and complaints were investigated and responded to.

During our inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the back of the full report for details of the actions we have taken.

The inspection took place on 10 and 11 August 2016 and was unannounced. The service was last inspected in November 2013. There were no breaches of the legal requirements at that time.

Hungerford House care home is registered to provide personal care for up to 48 people. On the day of the visit, there were 47 people at the home.

There was a registered manager for the service. 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.

Some areas of medicines management were not safe. This had led to some people not always receiving their medicines when they needed them.

The provider's governance system for auditing the service was not used in a way that made it fully effective. There had been a lack of sufficient action when medicines concerns had been identified as part of the audit process.

The team had been trained to report concerns correctly. People told us they felt safe and secure at the home. They said that staff were kind and respectful towards them.

When health and safety risks to people were identified, suitable actions were put in place and followed by staff. This was to minimise the risk of people being harmed when receiving care. The risks of abuse to people were minimised, as staff were competent in their understanding of abuse.

People had their needs met by enough suitably qualified staff .Staff provided people with care that met their needs. The numbers and skill mix of staff deployed at any time of the day or night were enough to ensure the needs of people were met in a timely way.

When people did not have capacity to consent, their care needs were assessed in line with The Mental Capacity Act 2005. Staff had completed Mental Capacity Act training. They knew about consent, people’s rights to take risks and how to act in someone’s best interests. When people could, they were encouraged to be included in deciding how they wanted to being cared for. There were effective systems in place that helped ensure staff obtained consent to care and treatment in line with legislation and guidance.

People said they enjoyed the food and told us they were offered choices at each mealtime. People were provided with a varied diet that suited their needs.

People who lived at the home and the staff had built up positive and caring relationships. This also extended to include relatives and friends.

The environment had a number of features that was beneficial for people who lived there. These included a cinema room, a secure garden with wind chimes, a hairdressing salon and murals that people had chosen for communal areas. We saw people using and enjoying all of these features of the premises during our visit.

Care plans were informative and guided staff so that they knew what actions to follow to meet people’s range of care and personal needs. Staff knew what was written in each person’s care records. They knew how to provide care that was flexible to each individual and met their needs. Care plans were produced with people and/or families involvement where appropriate. The care plans were reviewed and updated regularly. This was to ensure they were up to date and reflected the current needs of people.

People were supported by a team of well-trained staff. The staff had attended regular training and were developed and supported in their work. This helped them to improve and develop their skills and competencies. Staff received supervision which helped to ensure they were competent in their work. Staff spoke positively about working as a team and the good moral that existed among them.

Staff were able to go on regular dementia training and updating of their skills. This was to help them know how to provide personal care based on up to date practice.

People knew how to complaint and make their views known. The provider actively sought the views of people and their families. Suggestions were acted upon and changes were made to the services when needed.

Feedback about the home from people and others involved in their care was positive. Regular reviews were undertaken to see where improvements were needed and where the service could be further developed. There were systems in place to monitor the service to ensure people always received care that was personalised to their needs. The provider had put the service onto an independent website that was used to give feedback .Recent feedback had been very positive.

Staff spoke positively of the management structure of the organisation. They said the registered manager provided them with supportive leadership. The staff team told us they were particularly well supported by the registered manager, who spoke positively about their role. Staff said they saw them every day and they were always there and helped them whenever they needed support and guidance.

We looked at three care plans and corresponding care records. We found significant improvements had been made. Care plans and associated risk assessments were comprehensive and up to date, and provided evidence that people's needs had been assessed and care planned to meet those needs. Records evidenced that people received the care and support they needed.

We returned to the home to check whether improvements had been made in these areas. We spoke with five staff and with the registered manager and the area operations manager. We also spoke with four people who lived at Hungerford House and we observed their care.

We found that practice in relation to the recording of consent had improved. People who lacked capacity to consent had been appropriately supported. People told us they were well cared for and all of our observations supported this view. The home provided a pleasant and stimulating environment and was well maintained. Staff told us that staffing levels had improved and people appeared to receive prompt and appropriate care. This good practice was not always supported by record keeping. Although records had improved as a result of staff training, they did not always provide the level of detail to show that people's needs had been properly assessed and consistently met.

We saw little documentary evidence that people were consulted about their care, although we observed staff allowing people to make choices. We saw incorrect practice and documentation in relation to obtaining consent for those people who lacked capacity, which demonstrated limited understanding of responsibilities under the Mental Capacity Act.

People's needs were assessed but they had not been regularly and properly reviewed. The standard of record keeping was generally poor, and we could not be assured that people received the care that was prescribed in their care plans. This was particularly the case for the most dependent and vulnerable people.

The home was clean and tidy and we observed staff taking appropriate steps to minimise the risk and spread of infection. The home was fully staffed when we visited but people who lived at the home and staff told us that they were frequently short staffed.