We carried out a review of the data available to us about Hurst Nursing Home 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 Hurst Nursing Home, you can give feedback on this service.
Hurst Nursing Home is a care home with nursing and is registered to provide accommodation and support for a maximum of 22 people in one adapted building. At the time of the inspection there were 17 people living at the service. People living at the service were older people, some living with long term health conditions and/or dementia.
People’s experience of using this service and what we found
Risks to people's safety had been assessed, and actions taken to mitigate them. People’s care plans detailed health needs reflected the personalised care which was being delivered.
People and their relatives were generally happy with the care they received and felt safe with the staff who supporting them. People were safeguarded from situations in which they may experience harm. Staff knew how to identify potential harm and report concerns. People received their medicines safely from registered nurses. Checks were carried out prior to staff starting work to ensure their suitability to work with people who used the service.
The culture of the service was positive, and people, relatives and staff were complementary of the management and provider. Improvements had been made to systems and process that monitored the quality of the service being delivered and accuracy of records. Care was personalised to meet people's individual needs and wishes. Staff knew people well and provided support in line with people's preferences. People's diverse needs were catered for and they were treated with dignity and respect. People and relatives described the staff as caring and thoughtful and said they were treated with care and kindness. Feedback about the service from people and those close to them were generally positive.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (06/07/2022) and there were breaches of regulation 10. 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 and the provider was no longer in breach of regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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 undertook a focused inspection to review the key questions of safe, caring and well-led only.
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 requires improvement to good based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hurst nursing home 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.
Hurst Nursing Home is a care home with nursing and is registered to provide accommodation and support for a maximum of 22 people in one adapted building. There was one bedroom being shared. At the time of the inspection there were 15 people living at the service. People living at the service were older people, some living with long term health conditions or memory loss.
People’s experience of using this service and what we found
People's privacy and dignity was not always maintained or seen as a priority. While this was not intentional, the results were, people not always feeling respected or cared for. The registered manager had identified some of the shortfalls we observed and had started to address them. As a result of the inspection, the registered manager implemented a more robust system to check on people’s wellbeing, which included their privacy and dignity.
Actions had been taken following the last inspection to ensure care and treatment was provided in a safe way. Risks relating to the health and safety of people had been robustly assessed and planned for. A relative said, “It’s a delightful place. We are so pleased with it. The staff obviously keep an eye on the person. They know who [person] is and what condition she’s in at any time.”
Medicines were managed safely, and people received their medicines as prescribed. Processes to ensure safe medicines management had improved; including as required medicine (PRN).
The provider and registered manager had improved their auditing systems; which were now effective in measuring and monitoring the care and support people received, to drive improvements. Staff were motivated and proud of the service.
People and their relatives said they felt safe due to being supported by staff who knew them well. A relative said, “The staff are amazing, absolutely amazing.” Another relative said, “The staff are kind and gentle with [person].” People were protected from the risk of abuse and staff were aware of their safeguarding responsibilities and how to report concerns.
There were enough staff with the appropriate skills and training to meet people's needs. A relative said, “There is enough staff, I’ve also seen consistent staff when I visit.” Staff were recruited safely and received supervision where opportunities to develop and feedback about their practice were discussed.
People were observed in a homely environment adapted for their needs and were supported to drink enough and maintain a balanced diet. A person said, “They do that very well, as a matter of fact (the quality of meals).” A relative said, “They know [person’s] likes and dislikes with food. They’ll always get [person] something else if [person] doesn’t like what they’re having.” Peoples' care plans contained clear information to enable staff to meet their needs; this included information about people's daily routines, how they liked to spend their time and what staff could do to support them.
People were supported to have maximum choice and control of 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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 23 June 2021) and there were two breaches of regulation. 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, and the provider was no longer in breach of these regulations.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
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 monitor the service and will take further action if needed.
We have identified a breach in relation to people not always being treated with dignity and respect at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Hurst Nursing Home is a care home with nursing and is registered to provide accommodation and support
for a maximum of 22 people in one adapted building. At the time of the inspection there were 17 people living at the service. People living at the service were older people, some living with long term health conditions or memory loss.
People’s experience of using this service and what we found
People did not always receive support in line with health professional guidance, this put them at risk of aspiration such as when food or liquid enters the lungs.
There was not an adequate process for assessing and monitoring the quality of the services provided and that records were accurate and complete. People's care plans and risk assessments lacked important detail to guide staff on how to keep people safe.
Aspects of leadership and governance of the service were not effective in identifying some service shortfalls, such as failing to assess, monitor and mitigate risks relating to the health and safety and welfare of people and medicine administration.
People were relaxed, comfortable and happy in the company of staff and told us they felt safe. People's independence and choice was considered important by staff and their privacy and dignity was promoted. Staff had a caring approach to their work, which was observed at inspection.
People and their relatives had the opportunity to share their views about the service and felt they were listened too. One relative told us, “When I raised an issue it was dealt with and it’s been fine since.”
Systems were in place to protect people from the risk of abuse and improper treatment and staff knew how to identify potential harm and report concerns.
People were supported to have maximum choice and control of 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.
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 Good (published 22 May 2019).
Why we inspected
The inspection was prompted in part due to concerns received about staffing levels, moving and positioning, lack of hydration and management of the service. A decision was made for us to inspect and examine those risks. This report only covers our findings in relation to Key Questions, Safe and Well-led. The ratings from the previous comprehensive inspection for the 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 Good 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 Hurst Nursing Home on our website at www.cqc.org.uk.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.
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 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 have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 17- Good Governance. The provider had failed to ensure there were adequate systems to assess, monitor and mitigate the risks relating to the health, safety and welfare of service users and improve the quality and safety of services provided.
Regulation 12- Safe Care and Treatment. The provider had failed to ensure care and treatment was provided in a safe way. There was a failure to assess and manage risks relating to people's health and do all that was reasonably practicable to mitigate any such risks.
Please see the action we have told the provider to take at the end of this report.
Follow up
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 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.
Hurst Nursing Home is a care home with nursing and is registered to provide accommodation and support for a maximum of 22 people. At the time of the inspection there were 19 people living at the service with one additional person admitted during the day. At certain times of the year the service also had two beds reserved by the local health authority to relieve winter pressures on hospital services.
People living at the service were mainly older people, some living with long term health conditions or memory loss, although the service was not a specialist dementia care home.
People’s experience of using this service:
People and their relatives spoke well of the service they received from Hurst Nursing Home. People’s needs, and wishes were met by staff who knew them well.
The service placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences wherever possible. People said the service listened to their wishes and suggestions to improve their care and support.
We identified some areas of the building that could potentially present risks to people, such as low windows with period glass, wardrobes not fixed to walls and a low bannister rail. Immediately after the inspection the registered manager sent us evidence these had been risk assessed and actions taken.
People received their medicines as prescribed. We identified some risks associated with long term health conditions were not being assessed, but this was addressed immediately following the inspection. Other risks around people’s care or health were assessed and managed, for example for falls or pressure ulcers. We have made a recommendation in relation to the service seeking a review and updating of forms used by medical professionals to record actions to be taken in the event of a sudden deterioration in people’s health.
Systems were in place to safeguard people from abuse, and the service responded to any concerns or complaints about people’s wellbeing. We saw good practice in relation to equality and diversity, and on the reviewing of the effectiveness of pain relief.
There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable. Enough staff were in place to meet people’s needs, and staff received the training and support they needed to carry out their role.
There was established leadership at the service. Effective quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided. Systems ensured learning took place from incidents and accidents, and information about best practice was used to inform improvements in care.
More information is in the full report
Rating at last inspection: This service was last inspected in September 2016, when it was rated as good in all areas and as an overall rating.
Why we inspected: This inspection was scheduled for follow up based on the last report rating.
Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.
Hurst Nursing Home is a nursing home registered for up to 22 older people. At the time of this inspection there were 16 people accommodated, 12 of whom lived with dementia.
A registered manager was in post when we visited. 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. The registered manager was present during our visit.
The registered manager had been appointed since our last visit. They were able to demonstrate the steps they had taken to make the necessary improvements that were identified at the last inspection. At the previous inspection in October 2015 we identified breaches of Regulation related to person-centred care and treatment, consent to care and treatment, safe care and treatment, good governance and staffing. The service was previously rated “Requires Improvement” overall. We required the service to make improvements to these areas and they sent us an action plan of how this would be achieved. At this inspection we found that previous Regulations that had been in breach were now being complied with and the overall rating for the service had improved.
The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.
Staff recognised the signs to look for if they suspected abuse had taken place; they knew how to report any incidents of abuse they may witness. Any potential risks to individual people had been identified and appropriately managed. People’s medicines had been administered and managed safely.
There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs. Staff were clear about their roles and felt well supported in their work.
Staff supported people to eat and drink if required. They ensured people at potential risk received adequate nutrition and hydration. People were provided with support to access health care services in order to meet their needs.
Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen. A relative, who spoke for their family member as well, said, “We would both recommend Hurst Nursing Home. (Family member) is quite happy here.”
The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements. One person told us, “I can guarantee this place is absolutely wonderful!”
Hurst Nursing Home provides nursing care and accommodation for up to 22 older people. At the time of this inspection, there were 18 people living at the home, all of whom required nursing care and nine were living with different stages of dementia.
A registered manager was in post when we visited. 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.
All of the people and relatives we spoke with during the inspection said they felt safe in the home. One person told us, “I absolutely feel safe; there is no funny stuff going on in here”.
We saw staff deliver care with compassion and understanding. They took time to listen to people to ensure they understood them. Staff were seen to be positively and meaningfully interacting with people. There appeared to be a good rapport between staff, people and their relatives.
Staff we spoke with knew how to keep people safe; they were able to identify signs of possible abuse and knew what to do if they witnessed them. However, not all staff had received up to date training in this area.
Staffing levels provided were sufficient to meet the needs of people accommodated.
People and their relatives said that the food at the home was good and choices had been provided. Where necessary, people were given help to eat their meal safely and with dignity.
Care records indicated risk assessments had been carried out, for example with regard to skin integrity, nutrition and hydration. However, records of nursing care and treatment provided were not up to date or complete. This meant that identified risks to people may not be effectively managed to reduce the likelihood of occurrence or recurrence.
Care plans were in place for all but one person who had recently been admitted. However, people, or their relatives, had not been consulted with regard to their needs and wishes to ensure the care provided was person centred. Information had not been kept up to date to ensure it reflected people’s current needs. Care plans were not effective in making sure people’s needs had been met.
A limited programme of activities had been provided. However, it was not clear how they provided for the needs of people who stayed in their rooms. This meant that they were at risk of isolation and withdrawal.
Not all staff had received supervision and appraisals at regular intervals to ensure they had the necessary skills and knowledge required to carry out their work. Staff training records indicated training had not been kept up to date and some staff had received no training at all in some essential areas, such as understanding dementia and diabetes.
The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.
People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). It is the responsibility of the Commission to monitor how the MCA and DoLS are applied in health and care services it has registered.
Despite having some training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the registered manager and staff demonstrated a limited understanding of their role and responsibilities in this. Where people did not have the capacity to make decisions about their care, the registered manager was unable to demonstrate how this was assessed and how decisions would be made. DoLS applications had been made on behalf of seven people even though there was no evidence to demonstrate they lacked capacity.
People and their relatives had been asked for their views of the quality of the service. However, the registered manager was unable to demonstrate how comments and suggestions received had been considered and, where appropriate, action implemented to improve the service.
A quality assurance system was in place to monitor how the service had been provided and to identify shortfalls. This did not include monitoring complaints, accidents, incidents or safeguarding referrals so that lessons could be learned and action taken to reduce the likelihood of recurrence. There was no evidence to demonstrate, where shortfalls had been identified, action had been taken to make improvements to the service.
We have identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.
On the day of our inspection there were 19 people living at the home. People told us that although staff were busy they were satisfied with their care. By observing care and looking at records we saw that people were given choices in their care, they were safe and their dignity and privacy were respected.
We spoke with four members of staff. One new member of staff explained that they had received enough training and support to do their job well.
We spoke with five people who use the service, of which three were able to communicate their experiences of the service to us. They told us that they "enjoyed the food" and that "nothing was too much trouble" for the chef.
We spoke with one relative who said that they had received support from staff to help maintain their spouse's mobility.
Records showed that people had been supported and encouraged to make decisions about their lives. We inspected care records that showed people or their representatives were asked for their consent.
Staff spoken with showed understanding of how to safeguard people from harm. Training records showed that staff received training. We found there were enough experienced and trained staff available to support people.
We saw records showing the provider assessed and monitored the quality of the service. We saw that people were asked their views about the home in surveys and actions from these. We saw audits and action plans that showed that the home was responding to people, their relatives and to staff.
People told us that they felt safe in the home and the quality of care was good. We were told that people got the help that they needed and we observed staff responding quickly to people's requests.
People spoken to on the day of the visit and their relatives were very happy with the care stating that staff are kind and respectful and always ready to listen.