Hatherleigh Care Village

Hatherleigh Care Village is located in the village of Hatherleigh near Okehampton in Devon. It is registered to provide nursing or personal care for up to 53 people. The service is provided over 3 floors and provides care, treatment and support for people living with dementia and those who have nursing needs. At the time of our inspection, there were 52 people living at the service.

Peoples’ experience of using this service and what we found

People told us they felt safe with staff and we made observations to support this. We identified that whilst people received their medicines as prescribed, some areas of improvement could be made.

Risks of abuse to people were minimised because the service had safeguarding systems and processes. Staff understood safeguarding reporting processes and were confident appropriate action would be taken.

There were effective systems to ensure the environment was safely maintained. Health and safety checks, together with effective checks of the environment were completed. There was sufficient staff on duty. The provider was taking action to address current sickness levels. Staff were recruited safely to the service.

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. There were systems in place that ensured people who were deprived of their liberty were done so with the appropriate legal authority. Where people who were assessed as lacking capacity and had decisions made in their best interest, accurate records were maintained.

Staff treated people with dignity and respect and were caring. People told us staff at the service were caring and we received positive feedback. One person we spoke with commented, “I think the staff are kind and accommodating.” Another comment we received was, “They are caring and are good fun.”

People and their relatives were positive about the quality of care people received. The feedback about the service leadership was positive. There was an extensive range of quality monitoring and governance systems embedded in the service. These were both clinical and non-clinical and were at both service and provider level. This meant the risks of poor care being received were reduced.

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 Good (published 20 August 2018).

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.

The overall rating for the service has remained Good based on the findings of this inspection.

Follow Up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The provider had set aside five rooms on the ground floor as a designated area of the home in response to the Winter Plan for people discharged from hospital with a positive Covid-19 status. The provider intended to only use the designated setting for people who already lived at Hatherleigh but had had to be admitted to hospital for treatment. This part of the home was easily accessed from a separate rear entrance and each room had patio doors to the outside which would be used to accept people on admission. The rooms were self contained with en-suite facilities.

At the time of the inspection there was one person living in one of the rooms. They had been moved here from another area of the home. This was due to the person needing to self-isolate after they had shown some symptoms of Covid-19.

We found the following examples of good practice

There was a detailed pre-admission procedure for staff and people to follow. The service were also devising a separate brochure for people who would be admitted to the designated setting so they were reassured and knew how they would be supported there. A designated team of appropriately trained staff had been identified to work solely in the isolation unit to prevent cross infection. A back up team had also been identified to ensure that trained staff were available if required. This helped ensure people’s safety was maintained and that they had the appropriate support to settle in.

The proposed area was visibly clean and hygienic. There was a one way route in and out with suitable hand washing stations. Each room had been made as welcoming as possible whilst minimising décor. This included a hot drink station, TV and radio as well as a separate Personal Protective Equipment (PPE) station, laundry and clinical waste bin. There would be a dedicated domestic staff member and a detailed cleaning schedule. The laundry was adjacent to the area with a clear ‘clean’/ ‘dirty’ flow through.

There were no communal areas. A large room had been allocated to enable staff to take breaks safely. When people were discharged, their room would be left empty for 72 hours and decontaminated before any new admission was made to that room.

The provider had a very clear visiting protocol for people, relatives and staff to follow. Visits were by appointment only and were carefully managed to ensure they met the latest Government guidance. All visitors were required to complete a health questionnaire and have their temperature checked on entry to the home. When this was completed satisfactorily, they were supplied with the required PPE. There was good ventilation. Named visitors would be able to visit via each person’s individual patio door rather than access the home itself. Other visitors would be able to enjoy private window visits outside the person’s room.

The provider had recognised the potential impact of isolation on people’s wellbeing. In addition to facilitating visits and providing 1:1 activities, the provider had purchased specific individual hand held computer devices and mobile phones to facilitate contact between people and their family and friends. These initiatives helped maintain people’s mental and physical wellbeing.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

At this focussed inspection we looked at two key questions safe and well-led. No risks,

concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection

When we last inspected this service in July 2017, we found the key area of safe as requires improvement. This was because he upstairs lounges and communal areas had a strong odour. This had been addressed by replacing all the carpet in these areas. We did not issue any requirements.

Hatherleigh care village is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hatherleigh accommodates up to 52 people in one adapted building. At the time of the inspection there was 51 people lioving at the service. It is set over three floors with bedrooms on all three floors and communal lounges, with dining areas on two. The service is in the process of making changes to the way people are accommodated. They are adapting the building into four distinct houses in order to allow they to follow a new model of care, which will mean people will be living in houses according to the stage of their dementia. The service mainly provides care and support for people living with dementia. It also provides nursing care.

Since the last inspection, the service has had a new registered manager. 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.

At this inspection we found people were appropriately dressed, looked for the most part well groomed. We identified one person who looked unkempt. We spoke with staff and checked their care records. This showed staff had attempted to assist them with personal care but they had refused all help and appeared resistive to any interventions other than being assisted to eat their meal.

People were being assisted to eat and drink sufficiently to keep they healthy. It was a hot day when we visited and staff were offering people hot and colds drinks throughout the day. The lunchtime meal experience would benefit from improvements. There were no condiments on the tables and no menu for people to be able to make choices. Everyone we saw being served appeared to have the same meal. No choices were being offered. The cook said there was always a main meal and a vegetarian option.

We observed the nurse administering medicines being constantly interrupted by staff to request keys. Following feedback to the provider immediate action was taken to address this. This meant the nurse would not be constantly disturbed but it also meant medicines were only accessible to staff who were administering them.

Some improvements were needed in respect of infection control due to the strong odour in downstairs area and a lack of regular washing of soft toys. People would also benefit from improvements to their mealtime experience. The provider agreed to address these areas.

Risk assessments were in place for each person. These identified the correct action to take to

reduce the risk as much as possible in the least restrictive way. People received their medicines

safely and on time.

There were sufficient staff who mostly had the right skills and understanding of people’s needs and wishes. The provider had recognised through their own quality assurance checks that there had been a significant staff team change. Some staff needed additional support to enable them to have the right skills and understand the ethos of their person-centred approach. They had a programme of support going into the home to mentor and model the care approach they were promoting. This was working well and staff felt supported and listened to.

There was a robust recruitment process and staff understood when and who to report any concerns about abuse. There had been good engagement with the local safeguarding team to ensure that where alerts had been raised, lessons had been learnt and practice improved, such as record keeping.

Risks were well managed and systems were in place to review and learn from any accident and incidents.

Quality assurance processes and audits helped to ensure that the quality of care and support as

well as the environment were closely monitored. This included seeking the views of people and

their relatives.

Hatherleigh Care village is registered to accommodate up to 53 people with nursing and care needs. They provide care and support to people with nursing needs and those living with dementia. The service is set up over three floors. People with nursing needs are on the ground or first floor and people living with dementia accommodated on the second floor.

The service has a registered manager. 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.’

Hatherleigh Care Village was about to undergo some refurbishments to enable the service to develop a model of care which will divide the service into four houses to cater for different stages of dementia. The provider has developed a care model based on the household model of care

pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. This will result in the

environment being divided into smaller houses to support small group living. Groups will be determined based on the stage of the dementia of the person living at the home. The provider is implementing this model with the support of specially recruited dementia practitioners. The staff group are currently undergoing training in respect of this new model and refurbishment work is due to begin within the next few months.

During this inspection we found upstairs communal areas had a strong malodour which was unpleasant. We heard from two relatives that this smell was persistent. We also heard from a healthcare professional that when they had visited there was a strong smell in the upstairs area of the service. We fed this back to the registered manager who initially believed this may be due to several people using areas to urinate which had permeated into the fabric of the carpet and furnishings. They later agreed the smell was strong and that despite their cleaning team shampooing and deep cleaning carpets they were unable to get rid of the smell.

We found one of the sluice rooms was not kept locked and one of the bathroom cupboards was left unlocked with some cleaning fluids in it. This presented as a possible risk to people. We were assured by the registered manager that this was an oversight rather than normal practice.She took immediate action to ensure checks wee being made throughout the day to ensure peopkle’s safety.

Prior to the inspection we had received some information of concern about low staffing levels particularly at the weekends. Rotas showed there had been three occasions when due to staff sickness care staffing levels had fallen below the providers preferred numbers to ensure people’s needs could met in a timely way. The provider has said that following this feedback, they have commissioned additional agency staff to cover weekends to ensure there are always sufficient staff on duty even if permanent staff go off sick.

People benefitted from staff who knew their needs and wishes to enable them to provide personalised care and support. This was well planned with detailed care plans and risk assessments. These directed staff how to support people safely and in a way they wished.

Medicines were well managed and people received their medicines on time.

Staff had good training and support to enable them to do their job safely and effectively.

Staff understood how to keep people protected and who to report any concerns to. Recruitment practice was robust and ensured only staff who were fit to work with vulnerable people were employed.

People’s rights were protected because the service understood and applied the Mental Capacity Act 2005. They assessed people’s capacity to make decisions. Where people lacked capacity, Applications to Deprivation of Liberty Safeguarding teams had been made. Where restrictions such as bed rails and pressure mats were being used to keep people safe, best interest decisions were recorded.

People, relatives and staff felt their views were listened to and that the management approach was open and inclusive. People could make their concerns and complaints known with confidence they would be fully investigated.

Systems were used to ensure the building, medicines and records were all well maintained. Quality assurance processes including ensuring the voice of people and staff were used in the development and review of the service.