Hendra Court

Hendra Court is a residential care home providing personal and nursing care to up to 48 people. The service provides support to people living with mental health conditions and dementia. At the time of our inspection there were 45 people using the service.

People’s experience of using this service and what we found

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.

Staff worked within the principles of the MCA and care plans guided staff to help build independence wherever possible.

People received their medicines in a safe and caring way.

The service was in a COVID-19 outbreak at the time of this inspection and staffing levels had been put under pressure at this time. However, the registered manager and clinical lead had managed to cover most shifts using agency staff.

There were enough staff to meet people's needs and ensure their safety.

The service had some vacant posts at this time. Recruitment of new staff was in progress. Processes in place helped ensure safe recruitment.

Risks were identified, assessed and monitored.

The provider had effective safeguarding systems in place and staff knew what actions to take to help ensure people were protected from harm or abuse.

We looked at infection prevention and control and found we were mostly assured that the provider was protecting people, staff and visitors from the risk of infection. The storage of aprons was identified as inappropriate and was addressed during the inspection.

The registered manager and the clinical lead had effective oversight of the service and were very knowledgeable about the needs of people they supported. They were passionate and motivated to provide the best level of care possible.

Staff and most relatives told us they thought the service was well run and that both management and staff were approachable. One relative told us they felt that communication could be improved.

Feedback on the food was mixed. One relative told us that meals were not always hot when delivered. Another relative told us, “The food always looks good and (Persons’ name) has a good appetite so likes a good plateful. They have put on weight since they moved there.”

Relatives told us, “(Persons’ name) used to be florist. The activity coordinator often sends me cards and photographs when (Persons’ name) has taken part is flower arranging. It is lovely” and “There is always some activity or board game going on, it was one of the things that helped us decide on Hendra Court. People are not just left to sleep in chairs all day.”

The registered manager understood their responsibilities under the duty of candour. Relatives were kept informed of any changes in people’s needs or incidents that occurred.

People had been asked for their views and experiences of the service provided. Response had been mainly positive. Where concerns were raised, the provider and registered manager took steps to help resolve the matter.

The registered manager and clinical lead worked together to keep up to dates with developments in practice. All the staff team worked closely with local health and social care professionals.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating

Rating at last inspection was Good, published 23 July 2018. At this inspection the rating stayed the same.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Recommendations

We have made recommendations in relation to the monitoring of potential fire and infection risks. We will check if the provider has acted on any recommendations at our next inspection.

Follow up

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

The service is on two floors in the main house and on one floor in the adjoining annex (called the bungalow). Shared living areas include three lounges, a conservatory, two dining rooms, garden and patio seating areas. In the main house there is a passenger lift and stairs to access the first floor.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

As part of this comprehensive inspection we checked to see if the provider had made the improvements recommended at the inspection of 26 June 2017. In June 2017 we found records to evidence when staff monitored certain aspects of people’s care were not consistently completed. Also at that time extensive work to upgrade and improve all areas of the premises was in progress. Some parts of the premises were either out of use or in the process of being adapted to make them suitable to meet the needs of the people who lived there. People, who were cared for in bed, had bedrooms in an area of the main house that, due to the work that was in progress had low occupancy, and was isolated from the rest of the service.

At this inspection we found all the major work to redesign and upgrade the premises had been completed. The bungalow area of the service, not in use during the last inspection, had been completely reconfigured and redecorated and was being used by people. A corridor had been constructed around one of the shared lounges in the main house. This meant people, staff and visitors no longer had to walk through this lounge to access other parts of the service. Eight out of the ten rooms on the first floor of the main house had been upgraded and all eight were occupied. The shared lounge and dining room in this part of the service were now being used and people living in this area were no longer isolated. We observed people seemed happy and calm in the reconfigured and upgraded environment. We also saw people spending time in newly created enclosed garden areas, walking in and out whenever they wanted to.

During the inspection we spent time in the shared living areas across the service to observe staff interaction with people and how people responded to the care and support received. We observed that people were relaxed and comfortable with staff, and had no hesitation in asking for help from staff. People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "The staff make me safe because they are always around to help", "All the staff are very helpful" and "The staff are always keeping an eye on me." Staff knew how to recognise and report the signs of abuse.

Care records were personalised to the individual and detailed how people wished to be supported. They contained accurate and up to date information to enable staff to provide the agreed care and support for people. Risks were clearly identified and included guidance for staff on the actions they should take to minimise any risk of harm. Risks in relation people’s skin care and nutrition were being effectively monitored.

Management and staff had developed good working relationships with healthcare professionals to help ensure people had timely access to services to meet their health care needs. These services included tissue viability nurses, community nurses, GPs and speech and language therapists (SALT).

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff demonstrated the principles of the MCA in the way they cared for people. Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements. Applications for DoLS authorisations had been made to the local authority appropriately. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff were supported in their roles by a system of induction, training, one-to-one supervision and appraisals in place. Staff all told us they were very well supported and felt valued by management. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people's changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge.

There were safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained. Medicine Administration Records (MARS) were completed appropriately and there were no gaps in the records.

People were able to take part in a range of group and individual activities. An activity coordinator was in post who arranged regular events for people. These included jigsaws, board games, craft work, visits by external entertainers and trips out. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong and supportive leadership. Comments from staff included, “The manager is fantastic”, “Feel very supported and can approach the manager anytime” and “Management want to know what we think and we are involved.”

People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. Where complaints had been received these had been well managed and effectively resolved. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.

Hendra Court is a care home which is registered to provide nursing care for up to a maximum of 48 older people, some of whom had a diagnosis of dementia. Accommodation is divided into two units with 36 bedrooms in the main house and 12 bedrooms in the adjoining annex (called the bungalow). On the day of the inspection there were 30 people living at the service. At the time of the inspection communal areas in the bungalow (lounge, dining room and kitchen) were not in use due to refurbishment.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

The service had been operating under new ownership for nearly six months, since December 2016. In that time many vital repairs to the structure of the building had been completed. This included a new roof and the servicing of the boilers, to ensure safe and effective heating and hot water systems could be maintained in the service. Any repair work that presented an immediate safety risk to people had been rectified such as uncovered pipework, unsafe electric heaters and unlocked boiler rooms.

An extensive plan to upgrade and improve all areas of the premises had started. Major redesign and redecorating work to the bungalow, to provide a more suitable environment for people with dementia, was nearing completion at the time of the inspection. It was anticipated that people would be able to use the new facilities within two weeks of the inspection date. While these works were taking place people who lived in the bungalow spent their day in the main house. This had resulted in more people using a communal lounge which was not the most suitable either in its design or location. The registered manager had decided not to take any new admissions until the bungalow was re-opened to help manage the situation. While any disruption to people’s lives had been well managed, until these works were completed the premises were not entirely suitable to meets people’s needs.

Three people, who were cared for in bed and unable to call for assistance, were in bedrooms on the first floor of the main house. While staff carried out regular safety and care checks, these three people had little interaction or stimulation. The registered manager told us work was in progress, in consultation with people, to understand how best to use different areas of the premises and these rooms would be part of that review.

Where people needed to have specific aspects of their care monitored staff completed records to show when people were re-positioned, their skin was checked or their food and fluid intake was measured. While there was no evidence to suggest that checks were not being completed appropriately, records to evidence the care people received were not always consistently completed. We also found there were no written records of the daily handovers that took place. This meant there were no records for staff to read, about people’s needs, if they were not present at a handover. We judged that staff were knowledgeable about people’s needs and the gaps in some records had not impacted on the care provided for people. We have made a recommendation about care records.

People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "The staff are so good, it's them that make it safe”, “I've got a nice room and the staff make me feel safe”, “I know my partner is safe, because I visit nearly every day.”

Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. Staff were kind and attentive to people’s needs and interacted with people in a caring and respectful manner. Comments from people included, “I'm very happy with the care I receive” and “The staff do almost everything for us, they're wonderful.”

Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and as people’s changing needs recorded. Wherever possible, people and their relatives were involved in the reviews. Any risks in relation to people’s care and support were identified and appropriately managed.

People had access to healthcare services such as occupational therapists, GPs, community nurses and chiropodists. Care records confirmed people had access to health care professionals to meet their specific needs. A visiting healthcare professional told us, “The care provided is excellent and care plans provide me with all the information I need.”

There was a wide range of meals on offer and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told they enjoyed their meals. Comments included, “I vary where I eat my meals and there's a good choice of food”, “There's a good choice of menu”, “It's a good varied menu” and “There's always a good choice.”

The service acted within the legal framework of the Mental Capacity Act (MCA) and Deprivation if Liberty Safeguards (DoLS). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse. Staff supported people to keep in touch with family and friends.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

Staff were enthusiastic about their work and positive about the support they received from the registered manager and provider. Comments from staff included, “I am really happy working here”, “I love the job”, “Staffing levels are much better”, “We now get everything we need equipment wise”, “We have proper equipment such as gloves and aprons”, “We have the chance now to sit and chat with people” and “Everything is different and better.”

People, visitors and healthcare professionals were all positive about how the service was managed. Comments included, “The biggest and most impressive change in the service is the number of staff on duty and the attitude of staff. They are highly motivated and as a result the care people received is much better” and “Everybody who works here are marvellous.”

People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. People told us they knew how to raise a concern and they would be comfortable doing so. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.