This inspection took place over two days on 23 and 24 May 2018. The first day was unannounced and the second day was announced. The last inspection of the service was carried out in April 2017 and during that inspection we found breaches of regulations in relation to the safe management of medication, consent to care and assessing and monitoring the quality and safety of the service. Following the last inspection, we asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions; is the service safe, effective, caring, responsive and well-led, to at least good.
During this inspection we found the required improvements had been made.
Hurst park Court 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. Hurst park Court accommodates up to 41 people who require personal care. At the time of the inspection there were 40 people using the service. The service provides accommodation over two floors.
The service did not have a registered manager; however, a manager was in post and they had applied to CQC to become the 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.
Improvements had been made so that people received their medication on time and in the right way. All medication was safely stored and accounted for. There was sufficient stock available so that people received their prescribed medicines at the right times. Rooms used for storing medication were appropriately ventilated, clean and well organised. Records were in place with instructions for staff on the use of medication including the application of topical creams and pain relief patches and the use of ‘As required’ (PRN) medication. Audits showed the management of medication had improved and that the improvements had been sustained.
Improvements had been made as to how the rights of people were assessed and recorded under the Mental Capacity Act 2005. People’s mental capacity had been assessed and plans put in place to guide staff on ensuring people’s rights were protected within the law. Records demonstrated that best interest decisions were made with the involvement of people and relevant others.
Improvements had been made to how some aspects of the quality and safety of the service were monitored. The registered provider's quality assurance framework was followed effectively. The required checks were carried out on areas of the service at the required intervals. Action plans were developed and followed through for areas of improvement identified.
People felt safe living at the service. Staff completed training and had access to advice and guidance about safeguarding people. Staff understood the different types of abuse and indicators of abuse and were confident about reporting any safeguarding concerns. Records showed that appropriate safeguarding referrals were promptly made and action was taken to protect people from further risk of abuse. Risks to people’s safety were assessed and mitigated, this included risks associated with aspects of people’s care and the environment.
The environment and equipment people used was clean and hygienic and there was a pleasant smell throughout the building. Cleaning schedules were in place and being followed. Staff followed good infection prevention and control practices. This included the use of appropriate bins for disposing of clinical waste and the use personal protective equipment (PPE) to help minimise the spread of infection.
Staff were recruited safely. The suitability of staff was assessed prior to them being offered a position. This included a check on their criminal background, previous work history, skills and qualifications. There were sufficient numbers of suitably skilled and experienced staff deployed across the service to meet the needs of people and keep them safe.
Staff received training and support for their role. On commencing work at the service staff completed induction training. This included learning about their role and people’s needs and the completion of training in line with The Care Certificate. All staff were provided with ongoing training in areas of health and safety and topics relevant to the needs of people. Staff received support through one to one supervisions, appraisals and staff meetings.
People’s nutritional and hydration needs were assessed and planned for using a nationally recognised tool. People were provided with a choice of food and drink which was prepared in line with their dietary needs. People were provided with aids they needed to help with their independence at meal times. Staff ensured people had access to regular snacks and drinks and where required people’s food and fluid intake was monitored to ensure they had a healthy intake.
People’s healthcare needs were understood and met. Staff supported people to access appropriate healthcare services as and when they needed to. Staff promptly identified and reported any concerns they noted about a person’s health or wellbeing and took appropriate action. For example, called upon the person’s GP or other health and social care professionals for advice and guidance.
The environment was equipped with aids and adaptations to help people move about safely and independently. There were focal points and signage to help orientate and stimulate people living with dementia. There were plans in place to further develop the environment, for example, the development of additional focal points for people who liked to keep busy along hallways.
People were treated with respect, kindness and compassion and their privacy and independence was promoted. Staff spent time with people and listened to them with interest. Staff were knowledgeable about people’s life histories, important relationships and things that mattered to them. Staff used this knowledge to engage people in discussions of interest and to comfort people when they were upset or unhappy. Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. Personal information about people was treated in confidence. This included keeping records secure and speaking in private with and about people.
Care plans were written in a way that focused on people’s individual needs and how they were to be met. They included direction and guidance for staff to follow to help ensure people received their care and support they needed and in the way, they wanted. Care plans were kept under review and updated with any changes as they occurred.
Activities and opportunities for interaction were available to people throughout the day and night. The care team organised and facilitated things for people to take part in, including baking, singing and dancing and light exercises. Profiles detailing people’s backgrounds, life history, things of importance and personal preferences were developed. These gave staff a good insight into people’s lives and lifestyle choices enabling them to engage people in conversations and activities of interest. People were given opportunities to maintain links with their local community through visits out to local shops, cafes and community groups and they received regular visits from local school children.
The manager had good values and strived for high standards of care for people, which they promoted amongst the staff team. The leadership of the service was described by people and others as positive and inclusive. There was an open culture whereby everyone felt able to share any concerns or ideas about the running and development of the service. Regular meetings took place for people, family members and staff, during which time they were encouraged to share their views and put forward ideas. There was good partnership working with others, including external professionals and other service providers and managers in the local area.