Background to this inspection
Updated
1 July 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We undertook this comprehensive inspection of Hurst Manor on 25 and 26 May 2016. This inspection was to check improvement to meet legal requirements planned by the provider after our comprehensive inspection 18 and 19 August 2015 had been made.
Before the inspection we reviewed the information we held about the service. This included previous inspection reports, statutory notifications (issues providers are legally required to notify us about) other enquiries from and about the provider and other key information we hold about the service. During our inspection we spoke with one peripatetic manager and one regional manager, 14 people living at the home, four visitors and eight staff. We also spoke with health and social care professionals. We looked at the care records of six people living at the home. We also looked at records relevant to the running of the service. This included six staff recruitment files, training records, medication records and quality monitoring procedures.
Some of the people living in the garden wing were unable to fully express themselves verbally. We therefore spent time observing care practices. To help us gain more information about people’s experiences we used a Short Observation Framework for inspection (SOFI). A SOFI is an observational tool used to help us collect evidence about the experience of people who use services, especially where people may not be able to fully describe these experiences themselves because of cognitive or other problems. We looked at the care records of three of the people we had observed through the SOFI.
Updated
1 July 2016
We carried out an unannounced comprehensive inspection of this service on 18 and 19 August 2015. At which five breaches of legal requirements were found. These related to, risk assessments which were not completed and reviewed. People did not have adequate support to eat and drink to meet their nutrition and hydration needs. There were not sufficient staff numbers of suitably skilled, competent and experienced staff to make sure people’s needs were met. People were not receiving their medicines on time. Where a person lacked capacity to make informed decisions or give consent, staff did not act in accordance with the requirements of the Mental Capacity Act 2005. Although there was a registered manager in position systems and processes such as regular audits of the service to assess, monitor and improve the quality and safety of the service were not being met.
After the inspection the provider wrote to us to say what they would do to meet the legal requirements in relations to the breaches. We undertook an unannounced inspection on 25 and 26 May 2016 to check that they had followed their plan and to confirm that they now met legal requirements. We found they had met the previous breaches but some improvements were still required.
This report only covers our findings in relation to this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hurst Manor on our website at www.cqc.org.uk’
Hurst Manor is registered to provide accommodation with nursing or personal care for up to 36 people. At the time of the inspection there were 21 people living at the home. Seven people were living in the garden wing which provided care and support for people living with dementia.
Hurst Manor is situated in the village of Hurst in Somerset. The home was a period building with single storey extensions at the back of the main building. Many of the rooms opened up onto the garden or courtyards.
There was not a registered manager in post at the time of the inspection. 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.
The home was being managed in the absence of a registered manager by a peripatetic manager, who had the support of a regional manager. People and staff all knew of the manager and discussed seeing them on the floor often. One person, who did not leave their room, told us, “She [the manager] comes in most days just to say hello and ask how I am”. The manager had made significant changes to the running of the home since taking over. We were informed the manager would stay in place until a qualified registered manager was appointed.
Improvements had been made in relation to staffing levels. People were now being supported by sufficient numbers of staff to meet their needs in a relaxed and unhurried manner. A clinical lead had been appointed as a deputy manager. People told us they felt safe and knew the staff who were caring for them. Call bells were answered promptly and people told us the staff responded in an appropriate time if they rang their bells.
At the last inspection people were at risk of not receiving their medicines on time as nurses administered medicines to both people requiring nursing care and those who did not. Risks have been reduced because senior carers were now trained to support the nurses by administering medicines for people who do not require nursing support. One person told us, “My health condition is managed well. I always get my insulin before my meal so I know I am safe”. We observed medicines were administered in a timely manner and people did receive their medicines at the time prescribed by MAR sheets (Medication Administration Records).
At the last inspection instructions by health professionals were not being followed consistently. At this inspection we saw improvements in the way people’s health needs were being met. There was always a qualified nurse on duty to make sure people’s clinical needs were monitored and met. The clinical lead and manager both agreed they needed to appoint more nursing staff but had the consistency of regular agency staff to support them until they could fill their vacancies.
At the last inspection we found people’s nutritional needs were not always met. Improvements had been made. A SOFI observation showed people were supported to receive a diet in line with their needs and wishes. Some people needed support to eat and drink as part of their care plan and were given appropriate support.
At the last inspection we found improvements were needed to make sure that quality assurance systems in place enabled the provider to effectively monitor the standard of care offered, and plan ongoing improvements. At this inspection we found quality assurance systems had been improved. The manager completed a monthly audit which gave an audit trail of improvements being made and targets set.
Although staff we spoke with confirmed they had received induction before being able to work, induction training records did not demonstrate the detail or depth of the induction. We discussed our concerns with the manager who was aware there needed to be improvement. The manager explained they were planning that all future new staff would complete care certificate booklets if they did not have the necessary qualifications for their role. The care certificate is a set of standards that social care and health workers follow in their daily working life.
Staff had received additional training in relation to supporting people with dementia and supporting people to eat and drink. The manager explained there was a varied training programme that now ensured all staff were receiving regular training. This meant people benefited from staff who were more aware of people’s issues and had a good understanding of what was important to people and provided support with kindness respect and dignity.
Where people lacked capacity to make decisions and did not have someone else to speak for them, their legal rights were not being protected. We discussed our concerns with the manager and operational manager, who, provided evidence following the inspection to show they are taking the appropriate action to rectify these issues
Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their wishes. One person informed us “I know about my care plan, they come in everyday and write in the small one over there”.
People were able to engage in activities according to their interests. Activity coordinators spent time in different parts of the home encouraging people to participate. Kind caring interactions were observed from staff throughout the inspection. The home published a newsletter on a monthly basis with the activity programme inside so family and friends could support people to be involved.
Risk of abuse was minimised because the provider had robust recruitment procedures. Recruitment records showed the provider had obtained the appropriate information before new staff began work.
The manager sought people’s feedback and took action to address issues raised. On one of the days of the inspection a relatives meeting had been organised. Relatives we spoke with all informed us they were invited to meetings and knew the manager and felt they could approach them with any concerns.