Archived: Hurst Manor Nursing Home

We observed care over two days; spoke with the registered manager, the deputy manager, and the head of care and with three people using the service and four relatives. We spoke with six members of staff and looked at the service's records, systems and procedures. We looked at the records of eight people in depth and observed people and others throughout our visits. We used an observational tool to help us collect evidence about the experience of some of the people who used service, as they were unable to fully describe these themselves. Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

While we found some improvement in planning and delivery of care, we found some people's care and welfare needs were not always met. Assessment, planning and delivery of people's care in relation to nutrition and hydration were inadequate. Activities were not planned to meet people's welfare needs, particularly people living with dementia. Care was not always delivered in line with people's individual needs and choices.

A single inspector carried out this inspection. We considered our inspection findings to answer questions we always ask; 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 describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

At the last inspection of 23 May 2013 we found improvements were needed in person centred care planning and ensuring nutritional needs were met. We also found that there were not always enough staff to meet people's needs. At this inspection we found that staffing had improved. However care was not always arranged to meet people's needs.

People's needs were assessed before they came to live at the home which gave staff a good understanding of the person and their background; however important risk information was not always kept up to date. Communication between staff about risk was not always effective. Some care records were inconsistent or incomplete and this meant people were not protected from the risk of inappropriate or unsafe care or treatment.

People with capacity were consulted about their care. Staff varied their approach for different people. For those people who lacked mental capacity however, assessments were not carried out in accordance with the relevant code of practice. Suitable arrangements for obtaining valid consent for care and treatment were not sufficiently developed. This meant that some people's rights were not protected.

We found that the home was visibly clean and staff took a pride in keeping the home clean. Whilst improvements had been made since the last inspection in relation to the cleaning of equipment and devices used by people, some equipment used by people was insufficiently cleaned. This meant there was a risk of infection.

Is the service effective?

People's nutrition and hydration was monitored however not always effectively. There were gaps in guidance to staff about conditions such as dementia; diabetes and how these affected the care of individuals. This affected the quality of care for some people.

Is the service caring?

People and relatives spoke positively about the service and the friendly atmosphere. Relatives told us they felt welcomed whenever they visited. We observed staff treated people with kindness and patience.

Is the service responsive?

The service worked with people and other professionals, such as nurses and the GP, to obtain specialist assessment and advice, which helped to ensure people's needs were met. Falls and other incidents were recorded and monitored. Incidents were investigated in quickly and actions taken. Management records and notifications were up to date. Whilst the specific issues raised at the last inspection had been addressed, for example in relation to infection control and in relation mattresses, some other shortfalls in care and cleanliness were identified. The service did not always respond quickly enough where there were changes in people's condition. This meant that care was not always adjusted as required.

Is the service well led?

The service had a registered manager who kept an overview of staffing, care levels and coordination with other agencies. They worked closely with other managers in the service. They ensured that staff performance was managed positively whenever matters were brought to their attention. The manager carried out audits to detect what was working well and what was deficient; however, audits were still not always effective as gaps in care and welfare were picked up in this inspection. We found there was insufficient presence of managers or nurses in the areas where care was provided which affected the quality of care being delivered. This meant that supervision of care staff was not always effective. The registered manager acknowledged there had been some gaps in the stability of clinical staffing and we saw this was being addressed.

People appeared comfortable and relaxed with the staff who supported them, and activities were taking place. However, in some instances we saw that care plans were not being followed.

The home was clean and had clear maintenance systems in place, however we found that communal slings were being used and hoists and a standing aid were not clean.

The staff working were kind and respectful in all their interactions with people and relatives, but they were very busy and task focussed. There were times when people with dementia were not supervised because the staff were helping other people. One staff member told us "Generally I think it is adequate (the staffing level) but there are times when it is difficult."

The home had systems of quality assurance in place that were being used to monitor and improve practice, hoever these systems had not identified the majority of the concerns outlined in this report.

Care records demonstrated people were involved with their care plans and reviews, preferences and choices were recorded and plans included these. They were seen to be person centred and contained specific details regarding their needs and were signed by the person's relative in agreement. One person said 'the staff ask me about my care often'.

We saw there were two choices or more of meals at lunchtime and evening meal. People we spoke with told us they could have an alternative if they didn't like the meal choice that day. We saw evidence of staff asking people about the meal choices they wanted for that day and offering alternatives, in one instance staff suggested to one person 'you could have some scrambled eggs-you like then'.

We found that the provider monitored the service and gained views on the service from relatives and from people who used the service. We saw a 'You say-we do' comments board in the foyer of the home that actively encouraged staff and people in the home to make comments on how to improve things. The manager had seen this on a visit to another home and 'liked the idea'.