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Inspection carried out on 18 November 2019

During a routine inspection

About the service

The Hermitage is a residential care home providing accommodation and personal care in one adapted building to 19 older people at the time of the inspection. The service can support up to 24 people.

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

Staff followed the systems in place to monitor and manage people’s risks and keep people safe from avoidable harm. Staff used their training and knowledge to prevent the spread of infections. People had either a risk assessment in place to ensure it was safe for them to take their own medicines or staff who had been trained and competency checked, managed and administered people’s prescribed medicines safely.

Staff received training and appraisals from the management team that helped enable them to do their job well.

We have made a recommendation about the formal recording of the content of staff supervisions meetings.

The service was well managed by a registered manager and a management team. Motivated staff were encouraged and supported to give people a good-quality service. Checks were made to assess the quality of care being given including unannounced visits by the management team to the service. However, staff did not always record these checks, or any actions required.

We have made a recommendation about the formal recording of all governance checks and improvement actions to evidence the quality of the service provided.

Staff treated the people they supported kindly and with compassion. People had positive opinions of the staff who cared for them. Staff promoted and maintained people’s privacy and dignity. People enjoyed the activities that went on at the service. Links were established with the local community and people from the community were encouraged to attend events held at the service.

People were supported to eat and drink enough amounts and were involved in making decisions about their care. Staff gave and respected people’s choices. Their preferences on how staff delivered their care was recorded in care records for staff to follow.

No complaints had been received but people and their relatives told us they knew how to raise any concerns. People and their relatives were given opportunities to give their view of the service and from this feedback action was taken to make any improvements.

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

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 (report published 20 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 26 April 2017

During a routine inspection

The Hermitage is a care home providing accommodation for up to 24 older people. The service is in a residential area close to the centre of Whittlesey. It is not registered to provide nursing care. 21 people were living at the service on the day of our inspection.

This inspection was undertaken by one inspector. At the last inspection on 18 February 2015 the service was rated as ‘Good’. At this inspection we found the service remained ‘Good’.

A registered manager was in post at the time of the inspection. 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.

Systems were in place to manage risks to people using the service and to keep them safe. This included assisting people safely with their mobility and with their medicines.

There was sufficient numbers of staff on duty to safely assist and support people. The recruitment and selection procedure ensured that only suitable staff were recruited to work with people using the service.

The registered manager and staff understood the requirements of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to have choice and control over their lives as much as possible. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s needs were assessed, so that their care was planned and delivered in a consistent way. The management staff and care staff were knowledgeable about the people they supported and knew their care needs well. Staff offered people choices such as how they spent their day and the meals they wished to eat. These choices were respected and actioned by staff.

People experienced a good quality of life because staff received training that gave them the right skills and knowledge to meet their needs. People were supported and assisted with their daily routines, shopping and accessing places of their choice in the community.

People received appropriate support to maintain a healthy diet and be able to choose and help prepare meals they preferred. People had access to a range of health care professionals, when they needed them.

Staff were clear about the values of the service in relation to providing people with compassionate care in a dignified and respectful manner. Staff knew what was expected of them and we observed staff supporting people in a respectful and dignified manner during our inspection.

The provider had processes in place to assess, monitor and improve the service. People had been consulted about how they wished their care to be delivered and their choices had been respected. People, their relatives and staff were provided with the opportunity to give their feedback about the quality of the service provided.

Further information is in the detailed findings below.

Inspection carried out on To Be Confirmed

During a routine inspection

The Hermitage is registered to provide accommodation for persons who require personal care for up to 24 people. Nursing care is not provided. There were 24 people living in the home when we visited.

This unannounced inspection was carried out on 18 February 2015. The last inspection took place on 15 August 2013, during which we found the regulations we looked at were being met.

There was a registered manager in post. 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.

People told us they felt safe living at the home. Staff were knowledgeable about the procedures to ensure that people were protected from harm. Staff were also aware of whistleblowing procedures and would have no hesitation in reporting any concerns. People were safely administered with their prescribed medication.However, we did note that whilst the staff member was administering medication the room to store medication was left open and that people’s medication could have been accessible to anyone in the home.

There were sufficient numbers of suitably qualified staff employed at the home. The provider’s recruitment process ensured that only staff who had been deemed suitable to work with people at the home were employed after all pre-employment checks had been satisfactorily completed.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found that the registered manager and all staff were knowledgeable about when a request for a DoLS would be required. The registered manager told us that there were no applications currently submitted to the relevant local authority’s but they aware of who to contact should they need to submit an application.

Staff respected and maintained people’s privacy at all times. People were provided with care and support as required and people did not have to wait for long periods of time before having their care needs met. This meant that people’s dignity was respected and met in a timely manner.

People’s assessed care and support needs were planned and met by staff who had a good understanding of how and when to provide people’s care whilst respecting their independence. Care records were detailed, and up to date so that staff were provided with guidelines to care for people in the right way.

People were supported to access a range of health care professionals. Thes included appointments with a GP, hospital outpatient services, visits from district nurses and community psychiatric nurses. People were consistently supported with their health care needs in a timely manner. Risk assessments were in place to ensure that people were safely supported with potential health risks.

People were provided with a varied menu and had a range of healthy options to choose from. People with complex health care needs, including those people with diabetes, were supported with a diet that was appropriate. There was a sufficient quantity of food and drinks available at all times.

People’s care was provided by staff in a caring and compassionate way. People’s hobbies and interests had been identified and were supported by staff in a way which always involved people to prevent them from becoming socially isolated.

The home had a complaints procedure which all staff were aware of. People were supported to regularly raise concerns before their concerns could turn into a complaint. Prompt action was taken to address people’s concerns and prevent any potential for recurrence.

People were provided with several ways that they could comment on the quality of their care. This included regular contact with the provider, registered manager, completing annual quality assurance surveys and attending meetings. The provider sought the views of a wide spectrum of other organisations as a way of identifying improvement. Where people suggested improvements, these were implemented promptly and to the person’s satisfaction.

Inspection carried out on 15 August 2013

During an inspection to make sure that the improvements required had been made

We completed this follow up inspection to check that the provider had acted on improvements that we said needed to be made at our inspection of 10 May 2013. We found that improvements needed to be made to the way that the electrical wiring installation was being checked, to the recruitment and selection procedure and to the fire safety system. After this inspection the provider wrote to us and said that it had completed all of the necessary improvements.

At our inspection of 15 August 2013, people who used the service said that they were receiving all of the care they needed. They told us that the service provided a comfortable and safe setting in which to live. They also said that staff were kind, caring and trustworthy. One of them said, "The staff really are lovely and caring. They're always willing to help us all and I'm quite settled living here."

Also at this inspection we found that the electrical wiring installation had been certified as being safe to use, the recruitment and selection procedure was robust and there was a suitable level of fire safety protection.

Inspection carried out on 10 May 2013

During a routine inspection

All of the six people with whom we spoke gave us positive feedback about the service. One of them said, �The staff are always kind to me and they make me feel at home. I�m very pleased that I chose to live here because it�s so homely.�

We saw that people�s privacy, dignity and independence were respected.

People said that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

We found that the provider had measures in place to help safeguard people from abuse.

We found that the provider had not taken all of the steps necessary to provide care in an environment that was suitably designed and adequately maintained. This reduced the confidence people could have that their accommodation provided a safe setting in which to live.

Records showed that most parts of the recruitment and selection procedure were robust. However, a limited number of security checks on staff had not been completed. This reduced the provider's ability to fully reassure people that only suitable and trustworthy staff would be employed in the service.

We found that the provider did not have an effective system to fully assess and monitor all of the main parts of the service people received. This meant that people could not be fully assured that they would be fully protected from avoidable risks to their health and safety.