We carried out a review of the data available to us about Hembury Fort House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Hembury Fort House, you can give feedback on this service.
We carried out an unannounced comprehensive inspection on 6 and 7 September 2018. On the first day of the inspection there were 24 people living at Hembury Fort House as one room was being refurbished.
At our last inspection we rated the service Good. At this inspection we found the service remained Good overall, with one key question now being rated as ‘Outstanding’. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Some parts of this inspection report are written in a shorter format because our overall rating of the service has not changed since our last inspection.
There was a registered manager working at the home. 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 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 manager is also one of the directors of the company that owns the service.
Since our last inspection, the registered manager and the staff group have shown an excellent understanding of people’s diverse backgrounds and responding to their individual needs. For example, staff had enabled a person to build an enhanced sense of well-being and an improved quality of life. A social care professional said, “What is clearly evident on arrival at Hembury Fort or via telephone calls is the professional person-centred and caring attitude of both the manager and her staff team.”
The registered manager was a strong role model to staff; her commitment and energy meant the service did not ‘stand still.’ The registered manager created a culture where there was an openness to learn and improve, recognising practice and good quality care was not static but evolving. Complaints were logged, investigated and responded to in a sensitive manner. People told us staff were approachable and they felt confident concerns or complaints would be addressed.
The registered manager’s values and ethos promoted the rights of people living with dementia and were central to the way the service was run. The management team demonstrated acceptance and treated people living at the service as equals. They encouraged staff to consider the world through the eyes of people living with dementia, which care plans and handover notes demonstrated.
People built up friendships with other people at the home which were respected. Some people were more confident and vocal than others; staff ensured quieter people were included in the general conversation. They took time to ensure they heard quieter people’s opinions; staff were patient and kind involving people and offering choices.
People’s experiences were at the centre of the service and staff responded in a flexible and responsive manner. People were consulted and treated as equals. The registered manager was open in the way they spoke with people. They were committed to encouraging people in the local village and surrounding area to visit Hembury Fort House and shared information in a local village newsletter to ensure they were included as part of the community. They explained they wanted people not to fear moving into residential care or visiting people in residential settings.
People benefited from a catering team who recognised their role in supporting people to keep well and healthy. In addition, the catering team knew their role was also vital to help people feel comforted and at home.
Staff knew people well so this meant they recognised the changes in people’s long-term health care conditions. Care records, feedback and our observation of staff practice confirmed staff responded to health changes or a person’s slow decline in health in a responsive, professional and calm manner. Staff worked closely as a team.
People’s care and support was planned in partnership with them. Care plans were written in a person-centred way. They were fundamental to keeping staff updated and to promote people’s emotional and physical care needs, as well as their choices and preferences. Care plans were tailored to meet people’s individual needs and were regularly reviewed.
People benefited from a staff team who respected each other’s roles and skills and worked together to provide a consistent standard of care. The registered manager had created systems to improve communication to help ensure everyone knew the individual needs of people living at the home and could plan and respond quickly to their changing needs.
Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns and to report them in a timely manner. There was always sufficient staff available to meet people’s needs. People said they felt safe because there were enough staff on duty who knew how to support them, which was reflected by the staff rotas. Staff records showed the staff team was stable and experienced. Feedback from people and staff confirmed the provider recruited new staff who suited the caring values of the service and recognised the importance of team work to provide consistent and safe care.
Risks to people were recorded and reviewed with measures put in place to reduce assessed risks. Environmental checks were completed to help keep people safe, such as covering radiators with a hot surface temperature, restricting windows to help reduce the risk of falls, servicing equipment and fire drills. The service had good systems in place to support staff to administer medicines safely. People visiting and living at the home praised the high standard of cleanliness. A health professional described the home as “spotlessly clean.”
Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). 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.
Further information is in the detailed findings below.
We previously undertook an inspection in November 2013 and found the service was meeting the regulations of the Health and Social Care Act (2008).
The provider had been undertaking a major refurbishment of the house, remodelling bedrooms incorporating ensuites, redecorating corridors, replacing windows and installing a new call bell system. They had six bedrooms still to refurbish and had plans to redecorate the main lounge and dining room.
Several people at the home had a dementia type condition and we were unable to fully explore their experience of care and support through conversations. We spent time in communal areas observing the staff interactions with people and the care and support delivered to them. Not everyone was able to verbally share with us their experiences of life at the home. This was because of their dementia/complex needs. We therefore used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
The registered provider is also the registered manager of the service. 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 registered person undertook the day to day running of the service.
Everyone was positive about the registered manager and felt they were approachable and caring. They were very visible at the service and promoted a strong caring and supportive approach to people, their relatives and staff.
There were sufficient staff numbers of suitable staff to keep people safe and meet their needs. The staff, registered manager undertook additional shifts when necessary to ensure staffing levels were maintained.
The registered manager demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA. Staff had or were scheduled to receive training on the MCA 2005. They had a good understanding about giving people choice on a day to day basis.
People were supported by staff who had the required recruitment checks in place. Staff had received a full induction and were knowledgeable about the signs of abuse and how to report concerns. The majority of care staff had undertaken relevant qualifications in health and social care. Staff had the skills and knowledge to meet people’s needs and had annual updates to maintain their knowledge.
People were supported to eat and drink enough and maintained a balanced diet. People and visitors were positive about the food at the service.
People said staff treated them with dignity and respect at all times in a caring and compassionate way. People received their medicines in a safe way because they were administered appropriately by suitably qualified staff and there were effective auditing and competency checks were in place.
People had access to a rolling programme of activities at the service. People were encouraged and supported to develop and maintain relationships with other people at the service to avoid social isolation.
People’s needs and risks were assessed before and on admission to the home. Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff guidance about how to support them safely and these were reviewed on a monthly basis. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.
The home had a homely atmosphere with no unpleasant odours. The premises were well managed to keep people safe.
The provider had a thorough quality assurance and monitoring system in place. This included regular audits, quality monitoring visits and annual surveys for the registered person to assess the effectiveness of the service provided. The registered manager actively sought the views of people, their relatives, outside professionals and staff. There was a complaints procedure in place and the registered manager had a clear understanding of how to respond to concerns.
At the time of the inspection major building works and refurbishments were taking place, which had resulted in a reduction in the number of people living at the home. On the day of our visit there were 16 people living at the home; we met with or saw the majority of people. We spoke with four people to hear about their experiences. Overall they told they were happy with the service they received. People spoke highly of some of the staff, one person told us, 'They make a point of helping me' Another person said, 'The helpers are good. They do things to suit me'.
Several people at the home had a dementia type condition and we were unable to fully explore their experience of care and support through conversations. We spent time in communal areas observing the staff interactions with people and the care and support delivered to them. During our observation we found that interactions with people using the service and staff were positive. We saw that staff were patient and kind whilst offering choices and involving people.
As part of the inspection we spoke with two visiting relatives, four health professionals (including a physiotherapist; GP and two community nurses), an external trainer and following the inspection we had contact with environmental health officers. We also spoke with six of staff; including the registered manager, care staff and ancillary staff. Health professionals told us staff at the home were proactive in reporting any concerns or changes in people's health and they sought specialist advice when required. They confirmed that staff followed their recommendations to meet the needs of the people in their care.
We found that Hembury Fort House was meeting all of the outcomes we inspected.
The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience (people who have experience of using services and who can provide that perspective) and a practicing professional.
We spoke to all the people living at the home but most people were unable to directly express their views and experience of living at the home due to their mental health needs or dementia type condition. So we observed the care and support provided to others who were unable to communicate verbally with us. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.
People who lived in the home looked well cared for, relaxed and comfortable in their surroundings and with staff. There was a friendly atmosphere with staff finding time to chat with people living at the home throughout the day not just when they were performing necessary tasks.
We saw that staff knew people living at the home well and heard conversations that were focused on people's ability to understand. Some people liked to see what the owner was wearing so they did a 'twirl' every day and chatted about clothes. People living at the home were respected by staff. They were spoken to in a consistent respectful way and acknowledged as staff passed. One person liked to sit near staff and this area was made comfortable for them. We were introduced to each person only if they wished and staff knocked on doors before entering.
We saw that people had choice over how they spent their day. When staff encouraged people to socialise or use the communal rooms it was done only if people wished or if it was a specific part of their assessed care relating to their needs. We heard from one person who had clearly been involved in their care plan as they were able. Other people living at the home were involved in care planning as far as they could be depending on their understanding; otherwise relatives were involved so that staff could develop respectful, person centred care.
One person told us that they could do what they wanted such as have a lie in and we saw that this was happening. Staff made sure that people had what they needed before leaving a room including call bells.
We saw that people living at the home appeared to enjoy the meals provided. Staff promoted people's independent eating by discreetly offering assistance and providing suitable equipment. We saw that staff offered people choice throughout mealtimes and when they noticed that someone was not eating their meal. Food preference lists for each person living at the home were used by the cook and updated as staff found out additional information by asking people living at the home or observing people's actions.
People who lived in the home told us they felt safe but were not able to directly discuss safeguarding. Staff showed that they knew how to raise concerns and felt comfortable about doing so due to open communication within the staff team and management. People told us that they liked living at the home.