Archived: The Hornchurch Care Home

Hornchurch Care Home is registered to provide accommodation, nursing and personal care for up to 55 older people, some of whom maybe living with dementia. At the time of the inspection, 45 people were living at the home. The home has three units, each for people with particular needs, such as people that required nursing and dementia care. There were approximately 15 to 20 people living on each unit.

We previously inspected Hornchurch Care Home in March 2014, when they met the Regulations we inspected.

The home had a registered manager in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run. The registered manager was on leave on our first day of inspecting the home but we were able to speak with them when we visited the home again on 17 August.

Care staff understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare. Medicines were managed and handled safely for people. Arrangements were in place to keep people safe in the event of an emergency. The home followed their recruitment procedures to ensure staff were safe to provide care to people.

We were not assured that there was an adequate number of suitable and qualified care staff on duty to respond quickly to the needs of people living on some of the units, particular on days when the home was short of staff. Care staff told us that they did not have the support they needed to keep people safe. Some people complained that they had to wait for long periods before receiving personal care.

The environment within the home was safe and clear of any health and safety hazards. Infection control procedures were in place and equipment was used to safely move and transfer people. Staff undertook training and received supervision to support them to carry out their roles effectively. The registered manager and the staff team followed the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Staff training records showed they had attended training in MCA and DoLS. People were supported to maintain good health and had access to health care services when it was needed.

People received a nutritionally balanced diet to maintain their health and wellbeing. People’s fluid intake and output was monitored but not always measured or recorded accurately. People’s needs were assessed. Their care and support was planned and delivered in line with their individual care needs. The care plans set out how each person should be supported to ensure their needs were met. Care plans were person centred but they were not always updated or reviewed when people's needs changed.

We observed that staff had positive and caring interactions with people living in the home. Staff respected people’s privacy and supported them to express their views. Some people did not feel their dignity was respected because they were not provided with personal care when they required it. People participated in activities, with the support of staff but some people felt lonely and isolated and did not have many things to do to occupy themselves. People did not feel they had the ability to make complaints and asked relatives to do so on their behalf. The home responded to complaints appropriately.

The home had a clear management structure in place. The registered manager was appointed six months prior to our inspection and we saw that they had taken steps to improve the safety and standard of the home. We noted that most of the home had recently been redecorated. People and staff told us they found the registered manager approachable and supportive. The registered manager demonstrated an understanding of their role and responsibilities. There were systems to routinely monitor the safety and quality of the home provided.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the report.

At this inspection, we found that improvements had been made. Staff were appropriately supported to enable them to deliver care and treatment safely and to an appropriate standard. Staff we spoke with said they received support from senior staff to carry out their duties. We saw that staff received regular supervision from senior staff and appraisals were carried out. Comments included "we get good support from management " and "we get a lot of training. I get regular supervision, I recently had an appraisal with my unit manager."

People and their relatives told us they were well looked after and that their health care needs were met. People said " the staff are good they look after me." A relative told us "the staff are kind and caring they look after her marvellously." The care records we reviewed contained a range of assessments and care plans outlining how to support people using the service.The staff worked with other professionals, for example the tissue viability nurse and speech and language therapist to ensure that people's health needs were met.

People's needs were met by staff who were appropriately recruited, qualified and experienced to carry out their role. A member of staff told us "we have done a lot of training which helps us with our job." However, we found that staff files lacked clear records of supervision and appraisal received by staff.

Appropriate records were maintained by the home to ensure that people received safe care and treatment. The complaints process was accessible to people who used the service. We saw a record of complaints made and found that they were responded to and action was taken to improve service provision.

One person said, "Staff are kind to me, they look after me well." A relative said, "X is very kind to my dad." The care plans contained information about people's care needs and how these should be met by staff.

Staff understood how to protect people and the action to take if they suspected abuse. People said they felt safe in the home.

Staff were aware of people's individual needs and provided care to them in a professional and competent way.

A relative told us "they haven't got enough staff especially at teatime when they are busy feeding people, no one comes to help." At the time of inspection there were sufficient staff to meet people's needs. Staffing levels were adjusted to meet people's changing needs.

People's views about their care and treatment were sought and acted on.

Records in the home were not kept up to date and a compliance action has been made.