Hamble Heights

About the service

Hamble Heights is a nursing home providing personal and nursing care to up to 60 people. The service provides support to older people some of whom may be living with dementia. At the time of our inspection there were 46 people using the service. Hamble Heights provides care for people over 4 floors, each floor providing specialist care to people living with different needs, for example, one floor delivers specialist dementia care and another residential care.

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

People using the service were not always kept safe. We could not be assured risks associated with people’s needs were always assessed appropriately or managed. A lack of robust record keeping meant we could not be assured people were getting enough daily fluids and being repositioned in line with their care plan.

We could not be assured risks associated with people’s needs were always assessed appropriately or managed. Care plans sometimes lacked information to keep people safe.

Environmental risks were not always managed effectively; Staff did not have regular fire evacuations to keep people safe. Peoples risk assessments were sometimes missing key information to keep them safe and to support staff.

Medicines administration records (MAR) confirmed people had received their medicines as prescribed. However, we found some concerns with medicines that wasn’t always safe. The service has since put in some measures to improve medicines. Health professionals felt people were not always kept safe as improvements were required to meet people’s clinical needs, especially around pressure area care.

Governance systems were not always effective in promoting a person-centred culture. A new manager was in place and was working to ensure new systems were in place and effective and was getting to know people at the service. There were systems in place to monitor the quality and safety of the service provided, however these were not always effective in identifying areas for improvement or where safety had been compromised.

Relevant recruitment checks were not always completed. For one staff member there were gaps in their employment history which meant the service could not check the staff members employment history to make sure they were of good character and had the necessary skills. Staff received support and one to one sessions or supervision to discuss areas of development. They completed training but some further clinical training was required. Systems were in place to protect people from abuse. Sufficient staff were deployed to meet people's needs.

People were supported with their nutritional needs. People received varied meals including a choice of fresh food and drinks. Staff knew people well and treated people with kindness and compassion

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.

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 requires improvement (published 29 January 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections. We will describe what we will do about the repeat requires improvement in the follow up section below.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of some regulations.

Why we inspected

The inspection was prompted in part due to concerns received about poor pressure care, lack of fluids and staffing. A decision was made for us to inspect and examine those risks.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Hamble Heights is a nursing home providing personal and nursing care to 51 people aged 65 and over at the time of the inspection. The service can support up to 60 people. Hamble Heights provides care for people over four floors, each floor providing specialist care to people living with different needs, for example, one floor delivers specialist dementia care and another residential care.

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

Relatives told us their loved ones were safe. However, environmental risks were not managed effectively; staff did not have regular fire evacuations to keep people safe. Peoples individual emergency evacuation plans were not always updated. We could not be assured risks associated with people’s needs were always assessed appropriately or managed.

We found poor record keeping meant medicines were not always managed safely.

Staff did not receive regular support and one to one sessions or supervision to discuss areas of development and to enable them to carry out their roles effectively. Both staff and relatives felt there were not always sufficient staff on duty.

Health care professionals felt although they had seen some improvements in the general standards of care and effort from staff to improve processes over the past six months, they still had improvements to make to keep people safe and achieve good outcomes.

Overall, improvements had been made to governance systems, but these needed to be further embedded. Governance systems were not effective in promoting a person-centred culture and failed to ensure people received high quality care.

We were assured that most infection prevention and control practices were in line with current guidance. However, some improvements were required.

The service had started a programme to transfer peoples care plans from a paper-based system to an electronic system. Staff felt this would improve the service and provide them with more current information.

Systems were in place to protect people from abuse. Staff we spoke to were aware of how to identify, prevent and report abuse. Staff were safely recruited, and we only received positive feedback about Hamble Heights.

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 requires improvement (published 17 June 2021) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had not been sufficient or sustained and the provider was still in breach of regulation.

Why we inspected

This inspection was in part prompted by information received about areas of concern such as medicines, infection control and, staffing. In addition, at our last inspection of this service, a breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance in the home.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of Safe, Effective and Well-led.

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 ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. At this inspection enough improvement had not been made and the provider was still in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last one consecutive inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment, staffing and good governance.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, the local Clinical Commissioning Group (CCG) and the local authority (LA) to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.

Hamble Heights is a residential care home which was providing personal and nursing care to 50 people aged 65 and over at the time of the inspection. The service can support up to 60 people. Hamble Heights provides care for people over four floors, each floor providing specialist care to people living with different needs, for example, one floor delivers specialist dementia care and another residential care.

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

Systems were in place to protect people from abuse and staff told us they would report concerns to management. Relatives had mixed opinions about the safety of their family members at Hamble Heights, some believed them to be entirely safe and others were concerned about safety issues. The premises were safely maintained however staff were concerned with risk levels at times, particularly at night. Several relatives had not yet been into the premises due to the pandemic so were unable to feedback about it.

The provider’s records for medicines administration, did not give assurance that medicines were administered as the prescriber intended. Medicine incidents reported were not appropriately investigated and actioned to prevent repeats of these incidents. Learning from audits and incidents were not embedded into practice. This was a breach of regulations.

Staff were safely recruited, and we only received positive feedback about Hamble Heights staff members.

Both staff and relatives felt there were not always sufficient staff on duty as family members had long waits for assistance from staff.

We were assured that infection prevention and control practices were in line with current guidance.

There were care plans covering a range of areas however these were not regularly reviewed. Care plans lacked a person-centred focus.

There was a training plan and records showed that most staff were up to date with essential training.

There had not been sufficient support in the form of supervision or one-to-one sessions with staff.

People’s nutritional needs were assessed, and their requirements were shared with the catering team. Not all needs had been communicated accurately which could cause significant risk of harm to people.

The service was supported by a local GP surgery, mainly through video calls during the pandemic.

The premises were purpose built and accessible to people. We received several comments about a lack of stable wi-fi provision in the service which had a detrimental effect on video calls.

People were usually 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. Some relatives had felt excluded from decision making even when they held a relevant power of attorney.

The provider did not have an embedded and effective audit process in place to ensure provision was monitored and improved. This was a breach of regulations.

The culture at Hamble Heights was not positive when we inspected. The management team were not visible on the floor of the service and we received many concerns from relatives about a lack of regular communication.

We were not assured that the provider understood the duty of candour and relatives were concerned they were not contacted when incidents involving their family member occurred.

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 (published 11 November 2020).

Why we inspected

We had received several concerns in relation to medicines, care of people living with specific conditions and there had been several changes to the management team. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hamble Heights on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a breach in relation to the how the provider monitored the service and records at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hamble Heights is a residential and nursing home providing personal and nursing care to 52 people aged 65 and over at the time of the inspection. Hamble Heights is a purpose-built care home with nursing located in Park Gate, near Southampton. The home can accommodate up to 60 people who require either residential or nursing care. Some of the people using the service lived with dementia. The home is arranged over four floors, however, at the time of the inspection the home made the decision to keep one floor vacant to support their management of, and response to, the COVID-19 pandemic.

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

Systems were in place to regularly audit and review the health, safety and quality of the service. However operational difficulties relating to COVID-19 meant that some audits and reviews had not always been completed consistently. The registered manager had plans to address this.

Feedback from relatives was mixed. Relatives were mostly happy with the care and support people receive. Some relatives told us they thought communication from the service could improve and did not always find the management team approachable. Some relatives felt that were not as involved in people’s care as they wanted to be and had to initiate contact. Staff told us they were focussed on ensuring people received care which was person centred and treated people as individuals. The provider had utilised technology to support contact between people and their relatives but acknowledged their IT connection was insufficient and had invested in an updated system.

Staff knew how to protect people from abuse and report concerns. The provider had a whistleblowing process which staff were aware of. The registered manager had worked closely with the local authority to ensure people were safe and were responsive.

Risk assessments were in place to ensure people were protected from known risks associated with health conditions. Staff were aware of these and described how risks were reviewed and acted upon. Risks associated with the building were managed.

Staffing levels were meeting the care needs of people living in the service. The emotional well-being of people during the COVID-19 pandemic had been prioritised by the provider. Recruitment records showed staff were recruited safely and in line with current legislation.

People received their medicines as prescribed. A clear policy was in place and staff receive training and their practice was observed. The provider had implemented an improved medicines administration, storage and auditing system to ensure medicines were safely managed. This was in the process of being embedded within the home.

Systems were in place to ensure risks associated with infection control were managed. Staff were following national guidance in relation to COVID-19. Cleaning schedules were in place and the service appeared clean and was free of malodour. The service operated an effective one-way system around the home.

A system was in place to ensure accidents and incidents were recorded. Staff described confidently how accidents were reported and responded to. Most staff told us how the culture had become more positive with a consistent management team and that they felt there was an open and honest culture with a strong leadership.

Why we inspected

This was an inspection based on the previous rating and was prompted in part due to concerns received about unsafe medicines management. The concerns were shared with the local authority who carried out a safeguarding investigation. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hamble Heights on our website at www.cqc.org.uk.

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.

We last inspected the service in September 2015 and rated the service as good overall. This inspection found that the service remained good overall.

Hamble Heights is a purpose built care home with nursing located in Park Gate, near Southampton. The home can accommodate up to sixty people who require either residential or nursing care. Some of the people using the service lived with dementia. At the time of the inspection there were 59 people using the service. The home is arranged over four floors with each of the main floors or units being led by a unit manager who was a registered nurse.

The service had a registered manager. 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 and associated Regulations about how the service is run.

There were a range of systems and processes in place to identify and manage risks to people’s wellbeing but also environmental risks. However, some improvements were needed. Post falls protocols were not being consistently followed. Food and fluid charts used to monitor risks to people’s nutrition hydration had not always been fully completed.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. However, some incidents which raised potential safeguarding concerns had not been escalated to the local authority safeguarding teams. The registered manger told us they would seek further advice from the local authority to support their understanding of expectations around reporting and escalating concerns.

Additional checks are being put in place to ensure that all of the required pre-employment checks are consistently completed before new staff start work at the service.

There were suitable numbers of staff deployed to meet people’s needs. The provider will continue to review staffing levels with people who use the service and is shortly implementing a new tool to facilitate consistent evidence-based decisions about staffing levels.

The home was clean and staff were observed to be using appropriate personal protective equipment (PPE).

Overall systems were in place to ensure the safe and responsive use of medicines.

Staff were provided with opportunities to develop their skills and knowledge and performed their role effectively.

Staff sought people’s consent before providing care and people were encouraged and supported to make decisions about their care and support.

Staff worked in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were applied appropriately.

People were supported to have enough to eat and drink. Plans were in place to improve the dining experience.

The premises were suitably adapted and pleasantly decorated. There were landscaped and fully accessible gardens which included a variety of areas for people to enjoy including sensory plants and seating areas.

Where necessary a range of healthcare professionals including GP’s, community mental health nurses, dentists and speech and language therapists, had been involved in planning peoples support to ensure their health care needs were met.

People were cared for by kind and compassionate staff. Staff were very motivated and spoke with enthusiasm about providing a family environment where people and their relatives felt safe, valued and cared for. Staff knew people well and had developed a meaningful relationship with each person.

Staff supported people to maintain the relationships and friendships with people who were important to them. Relatives felt involved and told us they could visit at any time and share in their loved ones care. Relatives felt a particular strength of the service was the care they too were shown by the registered manager and staff team.

People told us they were treated with dignity and respect. Staff focussed on meeting people’s individual wishes about how they would like their care and environment to be managed in their final days. They were supportive of families and loved ones both during end of life care and following a person’s death.

Care plans continued to provide a detailed record of people’s individual needs, preferences and choices. This enabled staff to have a good knowledge and understanding of the people they were supporting and helped to ensure people received care and support which was responsive to their needs.

Staff provided creative opportunities for people to be engaged in a range of activities that were meaningful to them and met their needs in a person centred way.

People and relatives told us they were confident they could raise concerns or complaints and that these would be dealt with.

The service was well led. Staff were positive about the leadership of the service and felt well supported in their roles. Staff morale was good and staff worked well as a team to meet people’s needs.

The registered manager and provider were proactive in driving the service forward to improve outcomes for people and there were robust systems in place to monitor and improve quality and safety within the service. The provider sought feedback from people, their relatives and from staff and used this to continually improve the service.

The registered manager demonstrated knowledge, passion and enthusiasm. Their commitment to the service, the people in their care and to the staff team was clear to see. They fostered a homely, friendly and person centred culture within the home and spoke enthusiastically about their vision and future planned developments for the service.

We were accompanied on our inspection of Hamble Heights by a pharmacist inspector. This was because we had received information of concern about the management of medication at the home.

At the time of our inspection there were 60 people accommodated at Hamble Heights (the home) and 41 were receiving nursing care.

We used a number of different methods to help us understand the experiences of people who lived at the home. This was because many people were unable to talk with us because of physical frailty and/or mental health problems such Alzheimer's disease.

The home has bedroom accommodation and communal rooms on four floors. We "pathway tracked" seven people who lived at Hamble Heights and ensured that we included at least one person accommodated on each of the four floors. This meant we looked at records the home kept about them, including care plans that contained information about how their needs were met. We were able to speak with two of the people we pathway tracked and the relative of another.

We spoke with a further nine people who lived at the home, five relatives and seven members of staff during our inspection. We also contacted a local authority adult social care manager who had recent contact with and knowledge of the home.

Where it was appropriate such as at mealtimes we observed the care and support people received. We also observed the day to day activities in the home's communal lounges.

We looked at other documents that helped us understand how people were supported, such as staff training records, surveys, complaints, risk assessments and equipment servicing and maintenance records.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service caring?

The service is caring. Relatives we spoke with described the home's staff as caring. One said, 'I am really impressed they really seem to care about my Mum ' she came back here from hospital and was seriously ill, so much so the doctors thought she was dying, but she really bounced back'.

Another relative we spoke with told us their relative who lived at the home was 'Very fussy' and said, 'They always accommodate her'.

We saw staff were friendly, attentive, calm, patient, considerate and sensitive. They checked with people that they were comfortable, asked people what help they wanted, what choices they wanted to make and anticipated the needs of people who were unable to communicate verbally.

Is the service responsive?

The service is responsive. People's needs and risks to their welfare were normally re-assessed/reviewed at least monthly. This ensured that support plans were amended and updated when people's needs changed.

Records we looked at showed visits from or to healthcare professionals. Appointments had been arranged by the home's staff to ensure people's feet, dental or eye care needs were met. The records also showed the home's staff contacted specialist healthcare staff for advice and support or when people's needs changed. The specialists included speech and language therapists, stoma and tissue viability nurses, physiotherapists and mental health specialists. We saw a support plan for one person had been developed by a speech and language therapist for the home's staff to ensure the specific needs of a person we pathway tracked was met.

People who lived at Hamble Heights, their representatives and staff were asked for their views about the service provided at the home and some suggestions they made were acted on.

A local authority adult care services manager told us that following recent concerns about the home the owner's response had demonstrated they wanted to be a quality provider. They said the owner had invested in staffing and made other changes to improve the service they provided.

Is the service safe?

The service is not as safe as it could be. People were not always protected from the risks of unsafe or inappropriate care and treatment because information about them in records was not always complete and accurate.

People were not always protected from risks associated with medicines because arrangements in place to manage medicines were not always appropriate.

The home's owner had arrangements in place that ensured the premises, equipment and utilities were regularly checked and tested by appropriately qualified personnel to ensure they were safe and effective.

Is the service effective?

The service is not as effective as it could be. The support and help people required with their personal care and health needs was not always planned and delivered in a way that met their individual needs and ensured their safety and welfare.

Is the service well led?

The service is not as well led as it could be. The absence of a manager for a period of time following the departure of the home's previous registered manager in June 2014 disrupted the leadership of the home. It resulted in some of the home's working procedures and practices not being consistently followed. Arrangements to regularly check and monitor the quality of their service and identify and manage risks to the health, safety and welfare of people, were not sufficiently robust or up to date to ensure people were properly protected.

We started our inspection at 6:06 a.m. on 16 June 2014. This was in order to meet and talk specifically with the home's night staff. We spoke with six of the eight staff who had been scheduled for duty on the night of the 15 June 2014. We were unable to speak with one of the night staff as we were told they had left at 4:15 a.m. due to illness.

We spoke with a further nine staff after 08:00 a.m. when the day staff were on duty. The consisted of three registered nurses and 12 health care assistants as well as he home's manager and deputy manager. This was in order to obtain their views about the sufficiency of staffing levels at different times of the day and to check whether they had received appropriate training. We also spoke with them to hear their views about the abilities of temporary staff provided to the home by employment agencies.

During our inspection we spoke with four people who lived at the home. Due to their physical and/or mental frailty we were unable to speak with many people during our inspection.

We also spoke with two visiting relatives in order to hear their views about the abilities of the home's staff team and the adequacy of staffing levels.

We contacted a GP from a local surgery who regularly visited the home. They told us what they thought about the quality of care provided at Hamble Heights and the home's staffing.

We gathered evidence against the outcomes we inspected to help answer two key questions about the concerns that had been raised with us.

' Is the service safe?

' Is the service effective?

Below is a summary of what we found.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

During our inspection visit we spoke with a total of 15 nursing and care staff about the adequacy of staffing levels. All but one expressed satisfaction with the numbers of nursing and healthcare assistants on duty at all times. Many of the staff had previous experience of similar work in other care services and could compare their experiences.

The home had a nurse/alarm call system in place that enabled the response times to be checked. We saw that the average response time was less than 60 seconds which showed there were always enough staff on duty to respond quickly to requests for help.

One relative we spoke with said, 'The staff are very good here. There are enough now and it has greatly improved. Sometimes when she first came here there were not enough'.

Is the service effective?

Relatives we spoke with described the home's staff as 'very good' and 'excellent'.

A visiting GP from a local surgery told us they thought the home's staff appeared 'competent'.

The provider had measures in place to promote staff training and development and for staff to obtain further relevant qualifications. The provider promoted an environment where clinical excellence was encouraged.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We observed the care and support given to four people in a communal area of the home. We found people were involved in their care and support. Their privacy and dignity were respected. We saw that staff were caring and aware of people's needs and preferences.

We spoke with six members of staff and the manager, and reviewed records related to people's care. We found people's care needs were assessed and their care plans reflected their needs. Care and support were delivered according to plans which were reviewed regularly. We found the necessary checks were made before employees started work, there were effective recruitment and induction processes, and people were protected from the risk of abuse. The provider was monitoring the quality of service provided by informal means and was preparing to establish more formal quality monitoring.