Hamshaw Court

Hamshaw Court is a residential care home providing accommodation and personal care for up to 45 older people who may also be living with dementia. At the time of our inspection, there were 19 people using the service.

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

People gave positive feedback about the improvements that had been made since the last inspection. The new manager and provider had worked to address concerns and reduce risks.

More detailed care plans and risk assessments were used to guide staff on how to safely support people. The manager was responsive and made further improvements where needed following our feedback.

Improvements had been made to help make sure people received their prescribed medicines when needed. We spoke with the manager in relation to recording issues for one person and made a recommendation in relation to making sure medicines were stored at the right temperature.

People were supported to have maximum choice and control over 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. Applications had been submitted to ensure people were lawfully deprived of their liberty.

Systems and processes were in place to help minimise the risks associated with COVID-19. Some environmental issues needed to be addressed to ensure all areas of the service could be kept hygienically clean.

People felt safe living at the service. Staff were safely recruited, and enough staff were deployed to safely meet people’s needs. Agency staff were used where necessary to cover gaps in the rota. A system was in place to help make sure agency staff had the information and skills to safely support people. The manager was working to reduce the number of agency staff used.

Regular audits were used to help monitor the quality and safety of the service. Action plans were used to support continuous improvements. People praised the changes made, the improved communication and how management responded to feedback.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 9 November 2021) and there were multiple breaches of regulation. At this inspection, improvements had been made and the provider was no longer in breach of regulations.

This service had been in Special Measures since 9 November 2021. During this inspection, the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced focussed inspection of this service on 30 September and 5 October 2021. Breaches of legal requirements were found.

We undertook this focused inspection to follow up on action we told the provider to take following our last inspection and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led, which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hamshaw Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service

People were at risk of harm as risks to their health, safety and wellbeing were not effectively identified and managed. There were significant concerns about the quality and safety of the service, which had not been identified or addressed by the registered manager or provider.

Robust systems were not in place to ensure safe management of infection control and effectively reduce the risks of people catching and spreading COVID-19.

Accidents and incidents were not effectively reported, recorded and responded to. This placed people at increased risk of harm.

Arrangements were not in place to support the safe management of medicines. People did not receive their medicines as prescribed. People who relied on staff to administer pain relieving medication did not receive it when they needed it, and were left in pain, or to experience discomfort and distress.

People’s needs were not robustly assessed on admission and as a result the service was unable to meet their needs. People's care and support needs were not managed safely or regularly reviewed. Care plans and risk assessments did not always reflect people’s needs, risks or provide up-to-date information to guide staff on how to safely support them. This placed people at significant risk of harm.

People were unlawfully deprived of their liberty. The registered manager's lack of knowledge in this area meant appropriate applications to the local authority had not been made. The provider had failed to identify this issue via a robust governance system.

Staff were not always effectively deployed. People and their relatives gave negative feedback about the responsiveness of staff. Agency staff did not receive information about the care and support needs of the people they would be supporting.

The provider failed to demonstrate how they complied with requirements relating to duty of candour.

People were not consistently supported to have maximum choice and control of their lives and staff did not support them in the least restrictive ways possible and in their best interests; the policies and systems in the service did not support this practice.

The service was not well-led. There were significant concerns about the quality and safety of the service. The provider had failed to take sufficient and timely action to address safety issues and to make improvements, which would help keep people safe and improve their quality of life. There was a lack of effective oversight and governance.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 July 2021) and there were two breaches of regulation.

At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service is therefore rated inadequate. This service has been rated requires improvement or inadequate overall for the last five consecutive inspections.

Why we inspected

We undertook this targeted inspection to check on specific concerns we received about people receiving poor care, unsafe management of medicines, poor management of and failures to respond appropriately to risks. A decision was made for us to inspect and examine those risks.

We inspected and found there were concerns with people's care and treatment and poor governance and leadership of the service, so we widened the scope of the inspection to become a focused inspection, which included the key questions of Safe and Well-Led.

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.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding service users from abuse and improper treatment, staffing, duty of candour and the provider’s governance arrangements.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

People and their relatives gave positive feedback about the effective and person-centred care staff provided. The provider and registered manager had worked to make improvements in response to concerns identified at the last inspection and positive progress was seen. However, inconsistencies remained in the quality and safety of the service, which showed further improvements were needed.

Medicines were not always managed and administered safely. Robust systems were not in place to ensure a person received effective and timely support to meet their complex needs. Audits and the provider’s governance arrangements had been ineffective in identifying and addressing these concerns. These inconsistencies put people at increased risk of harm and showed, despite the improvements, that the service was still not consistently well-led.

People felt safe with the staff who supported them. Recruitment checks were completed to help make sure suitable staff were employed. Staff were trained to identify and report any safeguarding concerns.

People gave positive feedback about staffing levels and systems were in place to monitor and help make sure enough staff were deployed to safely meet people’s needs.

Improvements had been made to the cleanliness of the home environment. COVID-19 risks were assessed and managed.

Regular checks helped make sure the environment and equipment used were safe. An improvement plan was in place to support continued redecoration and improvements in the environment.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was inadequate (published 23 December 2020). There were breaches of regulation relating to the safety of the service as well as the provider’s record keeping and governance arrangements.

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 improvements had been made, but further improvements were needed. The provider was still in breach of regulations.

This service has been in Special Measures since 21 January 2020. During this inspection, the provider demonstrated enough improvements have been made and the service is no longer rated inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 and 8 October 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-Led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hamshaw Court is a residential care home providing personal care to 27 people aged 65 and over, some of whom may be living with dementia, at the time of the inspection. The service can support up to 45 people.

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

Although the person we received a concern about was not at risk of harm, the information used to guide Hamshaw Court staff and agency staff needed review so care and support was consistent.

More oversight was required in relation to ensuring a consistent agency staff team and recording the 1-1 support they delivered. There was also a need to improve communication and support systems between Hamshaw Court staff and agency staff.

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 inadequate (published 24 December 2020).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the care delivered to a person, which it was alleged placed them at risk of neglect. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We found no evidence during this inspection that the person was at immediate risk of harm from this concern. Please see the safe and well-led sections of this report.

CQC have introduced targeted inspections to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 Hamshaw Court 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months of the publication date of the last inspection report to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hamshaw Court is a residential care home providing personal care for up to 45 older people, including people living with dementia. At the time of our inspection 29 people were receiving personal care in one adapted building.

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

People who lived at the service did not receive a safe and well led service. Standards of cleanliness were poor, and staff did not follow infection control guidance. Aspects of the service including standards of redecoration, refurbishment and maintenance and were not always effectively monitored by the provider and improvements were needed.

This was the fifth consecutive inspection where the provider had failed to meet all regulatory requirements and improve their rating to Good. They had not identified the issues we found during inspection and we identified two continued breaches of regulation.

People’s care plans were not always person-centred. We have made a recommendation about person-centred care.

Staff had not consistently gained consent before carrying out tasks such as placing clothes protectors on people. However, people were supported to have maximum choice and control of their lives where possible and staff supported them in the least restrictive way; the policies and systems in the service supported this practice. We have made a recommendation about consent.

Staff received appropriate training for their roles. Supervision and appraisals systems were in place but some staff told us they had not received regular supervision. The provider had a safe system of staff recruitment. The use of high numbers of agency staff had reduced and they now received inductions to the service.

Since our last inspection the provider had introduced a number of checks to monitor the safety and quality of the service and some improvements were evident. A new area manager was in post and they spoke with us about their plans to improve people’s experience at Hamshaw Court.

There were positive comments about the care staff approach but there were also comments from relatives that this could be improved to be more caring and consistent. We observed positive interactions between staff and people throughout the inspection and people praised the kind and caring nature of staff.

Improvements had been made to the way staff managed individual risks to people and the completion of records. Guidance was now available to staff about how to minimise harm, but for some people further detail was required.

Medicines were managed safely. People’s nutritional needs were met, and menus provided them with choices for the main meals.

For more details, please see the full report which is on the Care Quality Commission’s website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 5 August 2020). The provider completed an action plans after the last inspection to show what they would do and by when they would improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 and 8 October 2020. Breaches of legal requirements were found. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection control, the environment and governance. Immediately after the inspection we wrote to the provider and requested they provided us with an action plan telling us of the improvements they were making. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hamshaw Court is a residential care home providing personal care for up to 45 older people, including people living with dementia. At the time of our inspection 34 people were receiving personal care in one adapted building.

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

People who lived at Hamshaw Court did not receive a safe and well led service. People's medicines were not well managed. Staff did not ensure correct procedures were followed and people did not receive always their medicines as prescribed. People were placed at risk of harm, including from the risk of fire. The provider had not provided staff with opportunities to practice progressive horizontal evacuation using evacuation equipment nor had all staff completed fire drills.

The provider had failed to carry out inductions with agency staff to ensure they had the required information they needed to support people using the service in a safe and effective manner. Records were also not available regarding the training of agency staff to confirm what skills and knowledge they had completed before starting work at the service.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. The provider had not ensured that their systems and processes were effective in enabling staff to provide safe and good quality care for people.

Records relating to people’s care did not always contain information and guidance to enable staff to provide the safe care and support people required. Risk management was not in place for some people who were at a high risk of skin breakdown and who presented a risk to others from their behaviour. Staff told us they did not have time to read care plans or risk assessments and when they were short staffed, this had an impact on records being completed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service had a manager in post, but they had not yet made an application to register with the Care Quality Commission. 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 management team, which had been appointed following our last inspection had demonstrated some improvements and this was reflected by people and staff in their comments. Positive feedback was received and observations were made in relation to staff interactions with people using the service, increased staffing levels, the completion of supplementary records and the ambience of the service.

Staff told us they felt the service was improving, but further improvements would need to be made before they would consider placing their relatives at the service.

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 inadequate (published 17 March 2020) and there were multiple breaches of regulation and the service was placed in special measures. Prior to this, the service had been rated requires improvement for the previous four consecutive inspections.

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 not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also carried out this focussed inspection, in part, in relation to concerns we received about the management of medicines, neglect, poor care and treatment, poor pressure area care, poor record keeping and the overall management of the service. As a result, we reviewed the key questions of safe and well-led only. This report only covers our findings in relation to those requirements.

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safety, management of medicines and other risks, staffing, records and improving the quality of the service at this inspection. After the inspection we wrote to the provider and requested that they provided us with urgent information regarding poor standards of care and record keeping, high use of agency staff and inductions of agency staff, issues relating to infection control and management of medicines and fire safety concerns to ensure people were safe. The provider responded and took action to address some of the areas of concern that we had identified.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service and we will continue to work with partner agencies. We will also request a specific action plan to understand what the provider will do immediately to ensure the service is safe. We will work alongside the provider and the local authority to closely monitor the service. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Hamshaw Court is a residential care home providing personal care for up to 45 older people, including people living with dementia. At the time of our inspection 41 people were receiving personal care in one adapted building.

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

The systems and processes the provider used to monitor the quality and safety of the service were ineffective and placed people at significant risk of harm. This included fire safety procedures, management of risk and management of medicines.

The provider did not have suitable systems in place for staff to recognise and report abuse and injuries. The provider did not investigate incidents fully.

The environment was not always odour free. Systems in place in the laundry did not promote good infection control practice.

The environment was not dementia friendly with a lack of appropriate signage to support people to orientate throughout the building.

People did not receive person centred care relevant to their needs. People’s care files were not kept up to date and relevant to their current care needs. People’s records were not fully completed and there were gaps in people’s daily monitoring charts.

The principles of the Mental Capacity Act were not always followed. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. The policies and systems in the service did not support this practice.

The lunchtime experience was not always positive. People had to wait for long periods of time before being served and did not always have their preferred choice of food.

Staff, people using the service and relatives shared their concerns about the recent high turnover of staff which the provider was acting to address. We have made a recommendation about reviewing staffing levels.

People’s care plans were inconsistent in recording information about their wishes for their care and treatment at the end of their life. We have made a recommendation about this.

Professionals shared their concerns about poor communication and not following up on recommendations delaying the help required for people.

People using the service told us they knew how to make a complaint but some lacked assurance the registered manager would ensure the required changes were sustained.

Activities were provided which some people enjoyed. People who preferred to spend time in their rooms had less opportunities to engage in meaningful activities.

Staff morale was low and they were not provided with supervision in line with the providers policy.

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 requires improvement (published 27 March 2019) and there were multiple breaches of regulation. This service has been rated requires improvement for the last four consecutive inspections.

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 not been made and the provider was still in breach of regulations.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

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

Enforcement

The service met the characteristics of Inadequate in four key questions of safe, effective, caring and well-led, and Requires Improvement in responsive. We have identified breaches in relation to delivering person-centred care, need for consent, dignity and respect, nutrition and hydration, records and notification of incidents and safeguarding at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Since the last inspection we recognised that the provider had failed to make statutory notifications for three notifiable incidents within the service. Failure to make statutory notifications is a breach of Regulation 18: Notification of other incidents of the Care Quality commission (Registration) Regulations 2009. We are dealing with this outside of the inspection process.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service: People continued to experience unsafe administration of their medicines.

People did not always have their rights protected regarding when they lacked capacity to make decisions. People were not supported to have maximum choice and control of their lives and staff did not support this practice.

People and relatives continued to experience unsuitable management of their complaints.

The provider’s governance systems were ineffective and lessons were not always learnt when things went wrong. At times details were missing from support plans and staff did not carry out what was written down. Staff responsibilities were not clear and so support to people was sometimes missed. These and other shortfalls were not always picked up on audits.

The provider did not consistently carry out supervision and appraisal for staff, which meant people’s care was not always well directed. We made a recommendation about this.

People were not always monitored regarding a healthy intake of food and fluid or given their meals as advised by dieticians and speech and language therapists. We made a recommendation about this.

Systems used to safeguard people from abuse showed there was some improvement with a reduction in accidents, but further improvement was needed, as allegations of abuse were still higher than would be expected from a service of this size.

Risks that people faced were safely managed. Staffing numbers were safe and recruitment procedures were robust. Safe infection control measures were practiced in the service.

The registered manager and staff worked well with other agencies. The premises were suitable for older people and those living with dementia. People were well supported with their healthcare.

People expressed their views and also had effective opportunities to make these known on how the service was run. The provider respected their privacy, dignity and independence. People were supported at the end of their lives.

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

Rating at last inspection: Requires Improvement. This service has been rated requires improvement at the last two inspections. (The last report was published 09 March 2018.)

Why we inspected: This was a planned inspection based on the previous rating.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment, need for consent, receiving and acting on complaints and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We shall be asking the provider to meet with us to discuss the continued rating and to look at their action plan for improvement. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Hamshaw Court is a residential care home for up to 45 older people who may be living with dementia and is located down a residential street in Kingston-Upon-Hull. Accommodation is provided in individual flat-lets, each of which has its own bedroom/sitting area, a small kitchenette and an en-suite shower room. Some of the kitchenettes have been altered so that they are no longer functional to prepare or heat up meals, but still offer storage. There are communal rooms to sit in and an enclosed garden. At the time of our inspection there were 39 people using the service.

The provider was required to have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 time of the inspection there was a manager that had been registered for the last two years and eight months. However, the registered manager had taken another post and held a second registered manager's certificate without cancelling their registration at Hamshaw Court. They held two separate manager registrations for two different locations belonging to two different providers. They had returned to Hamshaw Court when their new position had not worked out.

At the last comprehensive inspection in September 2016 the service was in breach of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Requires Improvement’. These breaches in regulations were with regard to safe care and treatment, person-centred care and good governance.

The provider put people at risk of harm because staff practice and recording were not in line with how medicines were prescribed and had to be accounted for. Audits used by the registered manager had not identified issues with the safety of the environment, care plans or medicines. The provider had not ensured care plans were up-to-date with regard to managing anxieties, catheter care, pressure care, weighing people and personal hygiene. Therefore people could not be sure they accurately instructed staff on how to meet their needs. We issued two requirement notices and a warning notice to the provider.

At that inspection we asked the provider to take action and make improvements to the recording and practice when administering medicines, the effectiveness of identifying shortfalls with the environment, medicines and care plans when auditing them and with care plan reviews so that people received accurate care and support. The provider sent us an action plan saying when these improvements would be made to comply with the warning notice.

We visited again on 08 February 2017 to assess whether or not the warning notice we issued had been met and found that it had. We found sufficient improvement had been made to ensure the provider met the regulation, as audits had been set up and were being used to identify shortfalls with the environment, care plans and medicines. Action was being taken swiftly to remedy the shortfalls identified.

At this inspection in November 2017 we checked whether the requirement notices were addressed and if the provider was now meeting regulations. We found that they were not. Therefore the service was still rated as 'Requires Improvement'. This is the second consecutive time that the service has been rated as 'Requires Improvement'. There were still issues with the safe management of medicines in regard to recording. People’s medicines were not always safely managed, because recording and practice were still poor. This was a continued breach of Regulation 12: Safe care and treatment.

Systems were in place to detect, monitor and report potential or actual safeguarding concerns and staff were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing safeguarding concerns. However, people were not always safeguarded from neglect due to poor care and failure to follow risk assessments. We have made a recommendation about safeguarding people from harm due to neglect.

Staffing numbers were not always sufficient or appropriately deployed to meet people’s needs, as people said that staff were not always around to call on for help. We have made a recommendation about ensuring there are sufficient staff who are effectively deployed based on people's dependencies.

People and their relatives had complaints investigated by the registered manager, but were not always satisfied by the outcomes or the way in which they were treated. We have made a recommendation about seeking advice and guidance from a reputable source on the management and resolution of complaints.

There was a quality assurance system in place, which helped lead to improvements in service delivery, but it was not robust enough to always be effective. We have made a recommendation about ensuring the robustness of the quality assurance audits.

Recruitment practices were safely followed to ensure staff were ‘suitable’ to care for and support vulnerable people.

The premises were safely maintained and the environment was ‘friendly towards’ those living with dementia. Equipment was safely used in the service.

People were protected from the risks of infection and disease because suitable infection control management systems and practices were in place.

Staff encouraged people to make choices and decisions wherever possible in order to exercise control over their lives.

People were cared for and supported by qualified and competent staff. Staff received supervisions and annual appraisals of their personal performance, but this was an area where some improvement was required with the frequency of supervisions. Staff respected people's diverse needs.

People’s nutrition and hydration needs were met to support their health. The provider appropriately monitored people’s health care through observations and care plans and called upon the support of healthcare professionals when required.

People’s mental capacity was appropriately assessed and their rights were protected. 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 received care from considerate staff who knew about their current care needs and preferences. People were involved in aspects of their care and their right to express their views was respected. People’s privacy, dignity and independence were respected. Consent for care and treatment took place and was respected.

We saw that people were supported according to their person-centred care plans, which reflected their needs and which were regularly reviewed.

There were opportunities to engage in some pastimes and activities if people wished. People maintained family connections and support networks and their communication needs were assessed and met.

Staff appropriately managed people’s needs with regard to end of life preferences, wishes and care.

The culture of the service was described by staff as being friendly and supportive. However, this was not the view of relatives and external professionals who had made complaints that they felt were poorly received and addressed.

The registered manager understood their responsibilities with regard to governance. However, they presented a management style, which was inconsistent because we received mixed feedback from people, their relatives and healthcare professionals about how approachable and supportive they were.

This inspection took place on 8 February and was unannounced. The service was last inspected 28 and 29 September 2016 and was found to be none complaint with the regulations inspected at that time. Following that inspection we issued a warning notice to the registered provider to improve governance. This inspection was undertaken to check whether they had complied with the actions we told them to take in the warning notice.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a 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 we found issues with the way people’s medicines were handled, the environment and people’s care plans. We issued requirement notices for these breaches of regulations and these will be checked again at the next inspection.

During the previous inspection we found auditing systems in place had not identified those issues we found during the inspection. We also found some audits had identified issues with care planning but despite this no further checks had been undertaken to ensure these issues had been rectified, for this breach we issued a warning notice which told the registered provider to take action within a given time frame.

During this inspecting we found the registered provider had taken action to comply with the warning notice. Audits had been undertaken of all the medicines systems and actions had been taken to address any shortfalls, a full audit had also been undertaken by the supplying pharmacists. The medicines system will be looked at in more detail at the next inspection. We found a full environmental audit had been undertaken and there was an ongoing refurbishment programme. An inspection of the building showed us the work had been carried out to a high standard and all rooms looked well maintained and all work had been completed. We found a full audit had been undertaken of all care plans and further checks had been made to ensure any issues found were addressed. We cross referenced a sample of care plans and found updates had been undertaken promptly when any shortfalls had been identified. We will undertake a full inspection of care files again at the next inspection.

This inspection took place on 28, 29 September 2016 and was unannounced. The service was last inspected in December 2015 and was found to be non-complaint with regulation 10, 12 and 17 of the Health and Social Care act 2008 (Regulated activities) Regulations 2014. We undertook this inspection to check whether the registered provider had complied with what we had asked them to do following the last inspection.

At the time of the inspection 29 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we identified concerns about the handling of medicines. This could put people at risk of not receiving medicines as prescribed by their GP. The service had recently undergone an extensive refurbishment and this improved the overall appearance of people’s rooms. However, some of the refurbishments had not been finished off properly before people had moved into the rooms and there were lots of jobs that still needed doing. This was discussed with the operations manager and the registered manager and actions were put in place to rectify this. Many of the issues had been resolved before the end of the inspection. We found staff did not always follow good practice with regard to infection control; we have made a recommendation about this.

People’s care plans did not contain enough detail to ensure they received care and attention which met their needs. Care plans lacked clear instructions for staff to follow with regard to supporting people who may find certain situations threatening or frustrating. Documentation regarding people’s care needs had not been updated, for example catheter care, repositioning charts and the use of pressure relieving equipment. People’s weights had not been recorded consistently so assessments could not be made as to any changes in their nutritional and dietary needs. No other recognised good practice methods were used to ascertain people’s weights.

Although audits had been undertaken no time scheduled action plans were in place to address any issues found. Despite audits finding shortfalls in the care planning no follow up action had been taken to make sure any issues found had been rectified, similarly none of the audits undertaken had identified the short falls we found during the inspection.

Staff were able to tell us about the registered provider’s procedures in place to keep people safe from harm and how to report any safeguarding issues they may become aware of. They had received training in this area. Staff had been recruited safely and were provided in enough numbers to meet people’s needs.

People received a wholesome and nutritious diet which was of their choosing. People were offered drinks and snacks throughout the day and snacks were freely available in the main entrance. Staff had received training in how to meet people’s needs and this was updated regularly, they also received support to gain further qualifications and experience. Systems were in place which ensured current legislation was followed which protected people when they needed support to make informed choices and decisions. People who used the service were supported to access health care professionals when needed.

People were cared for by staff who were kind and caring. They had a good rapport with each other and staff understood the importance of respecting people’s dignity and privacy. Staff were patient when assisting people and explained what they were doing and how people should assist where possible. Staff also understood the importance of maintaining people’s independence and supported people to maintain skills.

An activities co-ordinator was employed to ensure people had access to activities both inside and outside of the service. A complaints procedure was available for people to access if they had any concerns about the service. This was displayed around the service and all complaints were recorded and investigated to the complainants’ satisfaction, wherever possible.

People had been consulted about the running of the service and meeting had been held with the people who used the service and their relatives about the refurbishment project. Meetings had also been held with the staff. Equipment used was serviced regularly and safety equipment was maintained.

This inspection took place on 2 and 3 December 2015 and was unannounced. The service was last inspected June 2014 and was found to be compliant with the regulations inspected at that time.

There were 37 people living at the service on the day of our inspection.

At the time of the inspection there was no registered manager in post. The deputy manager had taken on the responsibly until such time as a new manager was recruited, they will be referred to as the acting manager throughout the rest of this report. The area manager told us there had been an appointment made and the new manager was due to take up their post on the 18 December 2015. A registered manager is a person who has registered with the Care Quality Commission [CQC] to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered provider was found to be in breach of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were found with regard to, infection control, dignity and respect and governance. You can see what action we have told the registered provider to take at the end of this report. There were also issues found with the way people’s medicines were administered and handled and staffing levels, we have made recommendations about these.

Staff were not provided in enough numbers to ensure people’s needs were effectively met. Staff had not undertaken essential caring tasks and had not kept essential information about the person’s wellbeing up to date. There had been a number of unwitnessed falls and accidents at the service, which the staff had failed to summon attention for in a timely way. This could have a detrimental impact on people as their welfare might not be maintained and their care needs not met. Systems were not in place to ensure people were not exposed to the risk of cross infection and lived in a well maintained and clean environment. Bedrooms were dirty and carpets needed replacing. En-suite bathrooms and toilets were dirty and the flooring needed replacing. Toiletries were left out in bathrooms and lids had not been replaced on tooth paste and other creams, these were accessible to people who were living with dementia and exposed to the risk of cross infection. Kitchens in the flats were in need of refurbishment and food was not stored in accordance with good practise guidelines. Soiled laundry was not handled in line with good practise guidelines and the equipment was not used appropriately.

Staff used disrespectful, patronising and negative language in the daily reports to describe people’s behaviours. For example, words like ‘attention seeking’ and ‘demanding’ had been used to describe people explaining to staff their preferred choices. We also heard staff talking to people in a demeaning and argumentative manner. This was discussed with the area manager at the time of the inspection to address with the member of staff involved.

Systems had not been maintained which ensured people lived in well run service. Safety audits had not been carried out and consultation had not been undertaken with the people who used the service or others who an interest in people’s wellbeing. Staff meetings had not taken place.

Staff understood they had a responsibility to keep people safe and knew how to report any abuse they may witness. Staff had been recruited safely. People were provided with food which was of their choosing and this was monitored by the care staff. Referrals were made when needed to other health care professionals, however this was on occasions not done in a timely manner. People’s human rights were protected by staff who had received training in the Mental Capacity Act 2005 [MCA]. People were cared for by staff who had been trained to meet their needs. Staff were supported to gain further qualifications and experience and received regular supervision. People were supported by staff to access their GP and other health care professionals when required.

Staff had access to documentation which described the person and how they preferred to be cared for. This had been formulated with the input of the person or their representative when appropriate. The registered provider had a complaint procedure which people could access.

' 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, speaking with people using the service and the staff supporting them, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

During the short observation for inspection (SOFI) we saw people who used the service were treated with dignity and respect by the staff.

Staff had received training in the Mental Capacity Act 2005 and relevant staff had received training on Deprivation of Liberty Safeguards. The acting manager understood when an application would need to be made and how to submit one.

Risk assessments were completed so staff had guidance in how to support people in ways that minimised the risks.

Medicines were managed safely and people received their medicines on time and as prescribed.

There was sufficient staff on duty during the day and night. The number of staff on duty took account of people's care needs. Staff had received appropriate training in order for them to support people safely and meet their needs.

The service was safe, clean and regular checks of equipment and hygiene were carried out.

The service had policies and procedures to provide staff with guidance about their role and tasks.

Is the service effective?

People were able to make choices about aspects of their lives and could take part in activities inside and outside the service.

People's health and social care needs were assessed with them and there was input from relatives. Specialist needs in relation to religion, diet, dementia care needs, falls, mobility and equipment were identified and planned for. During the SOFI we observed staff provided people with dementia a visual choice at lunchtime. This made it easier for them to choose what they wanted to eat.

The layout of the environment and individual flat-lets helped people to maintain their independence.

Visitors told us they could see people in private and were made to feel welcome at all times.

Is the service caring?

People were supported by kind and attentive staff. During the SOFI we saw that staff showed encouragement and patience when supporting people. People who used the service told us they enjoyed having a laugh and a joke with staff.

People's preferences, likes and dislikes had been recorded and care and support was provided in accordance with people's wishes and choices. Staff demonstrated they knew people's needs and preferences.

Is the service responsive?

People had access to a range of health and social care professionals such as GPs, district nurses, dieticians, social workers, dentists, opticians and chiropodists. There was evidence the staff team sought appropriate advice, support and guidance during emergency situations.

People were able to complain and we saw these were investigated and addressed. People were able to make suggestions about the service during meetings and these were acted upon.

Is the service well-led?

The acting manager had been overseeing the service for the last few months due to changes in the management structure. Support had been provided by an area manager once or twice a week and a visit from an established manager from another service in the company, once a week. The acting manager told us they felt they had received the support they required during this period.

The service had a quality assurance system that included checks and obtaining people's views. Records showed us that shortfalls identified during these checks were addressed promptly.

Staff told us they were well supported by the acting manager, senior care workers and the area manager.

What people who used the service, and those that matter to them, said about the care and support they received.

People told us they were treated with dignity and respect. Comments included, 'I do like it here but I don't like joining in the activities', 'The staff knock on doors. I always lock my door but they have a key for emergencies', 'I enjoy time in my flat; I watch TV and play the accordion' and 'It's nice here but not quite like home of course. I don't think they could make any improvements; they work very hard and are always on the go. They come and have a chat with me.'

People said their health care needs were met. Comments included, 'Yes, I do feel the staff look after me; they will get the doctor out when I need him', 'I've seen the optician, the dentist and I had a flu jab' and 'Yes, I get all my tablets; I have eight in the morning, three to four at tea-time and one at night.'

A relative told us they were very happy with the service. They said, 'I looked at lots of other homes and did my research; this was the best one. They keep me informed; mum fell and they rang me.'

People who used the service were complimentary about the staff and said staff spoke to them in a nice way. They said staff answered call bells in a timely way. Comments included, 'The staff are very good' and 'Yes, they all respect dignity. I like to have a laugh and a joke with them.' A relative said, 'The staff are lovely; the way they speak to mum is really nice.'

Information was available for staff to follow which ensured people received care which met their needs. There was also information about how to keep people safe. People told us they were happy with the care they received. One person said, 'The staff are great, you just can't fault them' and 'I'm quite well looked after and all the girls are very caring.'

We saw that people were provided with a varied and nutritional diet. People told us the food was very good. One person said, 'The food is always of a high quality and there's always plenty of it' and 'I like the puddings.'

We saw that the provider had a recruitment process in place which ensured, as far practicable, people who used the service were protected and not exposed to staff who should not be working with vulnerable adults.

People who used the service knew they could complain and who they should complain to. Comments included, 'I would talk to the manager', 'Yes I know I can complain but I don't have any' and 'I would see the boss.'