Hallmark Angmering Grange Luxury Care Home

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs. This is the first assessment for this newly registered service. This key question has been rated Requires Improvement. This meant people’s needs were not always met.

This service scored 61 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had tools in place to enable people to be at the centre of their care and treatment choices. However, these were not always effective.

People had care plans in place which reflected their health and social care needs. These were reviewed with people and relatives where needed. However, people did not always receive personalised care in line with their needs. People told us there was not always continuity of staff which meant not all staff knew them well. A relative said, “The regular staff are aware of my loved ones likes and dislikes. That only breaks down when unfamiliar staff are on the floor.” Staff told us they did not always have enough time to read care plans. Some said they were moved around the service and did not have the opportunity to get to know people well. Staff said, “I am moved around quite a lot. We can't give people the care that they need or deserve” and “Sometimes, I'm not on the allocation sheet and I'm just being thrown onto another floor. We don't have time to get to read care plans and get to know people.” Although the provider already had an action plan in place, this had not identified all of the issues we found during this assessment. They have subsequently taken further actions to address this.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

The provider understood the diverse health and care needs of people and their local communities. However, care was not consistently joined up to support continuity. For example, people told us they did not always feel they received the level of care, support and access to facilities they expected from the service. People told us there were often delays in getting help because staff were busy. They said they did not always have the same “faces” supporting them. A relative said, “Improvement could be made on staffing levels. My loved one finds it difficult with unfamiliar staff. Especially if they are not familiar with their likes and dislikes.” Staff told us people did not always have continuity of care or get help when they needed it. Comments included, “Residents pay a lot and are neglected because of our concerns due to staffing” and “ One shift we had 6 agency carers on. I had 1 regular carer and 1 agency, so I was lucky. But the other communities were not so lucky.” The provider had started making changes to drive improvements. This included a review of staff rotas and deployment of staff. However, this will take time to embed.

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People were provided with the information they needed about their care and support. They had access to equipment and systems that allowed them to communicate more effectively, for example, using pictorial information or large print. People’s preferred communication methods and any impairments were documented in their care plans. Staff told us how they adapted their communication for people, for example, if they had any specific communication or sensory needs. The service met the requirements of the Accessible Information Standard and ensured people’s communication needs were known and understood.

The provider had systems for people to share feedback and ideas, or raise complaints about their care, treatment and support. However, these were not always effective.

Mechanisms for gathering feedback were in place, including resident and relative meetings, and surveys. However, not all people or relatives felt their views led to meaningful change. For example, the use of some onsite facilities such as the massage room and sweet treats room required improvement.Comments included, “We are supposed to have massages but that hasn’t materialised” and “I do not feel the facilities are always used. For example, the hair salon. When I visit my loved one’s hair is greasy. The residents are supposed to get a weekly visit to the hairdresser and manicure.” Leaders told us they were trying to recruit a masseuse. They took on board feedback about the sweet treats room and put a plan in place for it to be used more often by people.

People had raised concerns about communication around activities and frequency of trips out. Whilst some actions had been taken, there was still room for improvements. People told us, “Most local things are actioned but not always” and “The minibus here, there are hardly any trips. There is either not enough staff, or they say equipment needs to be checked. [Activities staff] said they would do the outings but there's only 2 of them. It's very restrictive. I asked them if relatives can support with the trips out. They said yes but they told me to organise it. How can I contact people's relatives? So, nothing has improved there.” We reviewed the providers records for activities and trips out. It evidenced not all people were always offered equal opportunities for outings or activities. This indicated that work was needed to ensure feedback leads to lasting improvements.

The provider had a complaints procedure. Where people had raised concerns and complaints had been documented, appropriate actions were taken. However, not all people were confident to raise concerns with leaders or felt anything would change if they did. One person said, “Staff tell me to speak to [Leader] and then [Leader] does not do anything.” This meant people did not always feel they were taken seriously when they shared concerns. While the provider had an action plan in place, it had not identified all of the issues found during the assessment. The provider has since taken additional actions to address the areas highlighted. However, this will take time to embed in practice.

Relatives told us they knew how to raise concerns and who to approach if needed. A relative said, “I am comfortable speaking to the staff and if I had any concerns I would speak to the manager.” Staff understood the complaints procedure and how to escalate concerns. A staff member said, “I will listen to their complaint, then tell [Leaders]. If it’s simple I will try to solve it. If it’s a complaint, I’ll tell [Leaders] and ask them to come have a word with the person.”

The provider made sure that people could access the care, support and treatment they needed when they needed it.

The environment was spacious and accessible, supporting people to move independently around the service. There were sufficient accessible communal areas available for people to find social interaction or a quiet space.

Referrals were made to the relevant health and social care professional to meet people’s needs. Processes were in place to ensure people did not experience any barriers in accessing health and social care services. Feedback from people, relatives, staff and partners confirmed this.

The provider did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Staff could identify people who were at risk of isolation and understood how to prevent this from happening. However, they told us not all people had equal opportunities for activities and engagement due to staffing issues. Comments included, “You want to sit with [people] and spend time with them, but you can't because there are so many tasks to do. Leaders say if there is a gap in the activities list, the activities staff can do 1-1 activities with [people] in their rooms. But there are only 2 activities people, they can't do that and the whole home” and “There is a lack of activities or engagement that people in their rooms get. I don't feel it's down to the staff because there are not enough of them.” We reviewed records submitted by the provider, including for people identified as being at higher risk of social isolation. While these showed that some activities had taken place, there were gaps which indicated not all people received consistent opportunities for engagement. This meant not all people had equal opportunities to minimise the risk of social isolation. Although the provider already had an action plan in place, this had not identified all of the issues we found during this assessment. They have subsequently taken further actions to address this. However, this will take time to embed.

The home provided group activities for people. This also involved local communities to provide activities such as “Songs and Smiles” where mums and kids came in and sung with people. We observed one activity where alpacas visited the home. They were taken to all floors in the home to give people an opportunity to interact with them. People appeared to really enjoy this activity. We observed group activities throughout the day. People were supported effectively to engage in them. We witnessed kind and meaningful interactions between staff and people.

Care plans contained information about how people’s social, cultural and spiritual needs should be met. A relative said, “My loved one is religious, and the staff are aware and make sure when there is a mass on screen. They are able to watch it, that means a lot to them.” A staff member said, “We have a local church service every Sunday via Zoom which we encourage residents of that belief to go too.” Training records showed staff received equality and diversity training. This helped them to recognise, promote and protect people's protected characteristics, and understand discriminatory behaviours and practices.

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

End of life plans were developed in people’s care plans. This included any advanced decisions and wishes regarding emergency medical care. People received care according to their wishes. Some families did not wish to discuss their preferences, and this was respected. However, the conversation remained open to ensure follow up discussions could take place. A staff member said, “If I notice that the patient is heading towards end of life, I’ll talk to our clinical lead and GP to prepare the ‘just in case’ medicines. We also have the palliative care team who can tell us how to comfort people such as lower lighting or music on. We follow the person's wishes, including priest or religion.”