The Hamlets

The Hamlets is a residential care and nursing home in Liverpool, providing personal and nursing care to people who may or may not be living with dementia and people with mental health needs. The service can support up to 30 people and there were 27 people living at the home at the time of our inspection.

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

Governance and quality assurance systems had improved since our last inspection and there were more robust auditing systems in place.

People were no longer exposed to risk of harm because their risk assessments and records were reflective of their current needs and contained sufficient detail to help guide staff with how to support them safely. Medications were given in line with best practice guidance. Accident and Incident logs had improved since the last inspection; and were regularly being checked for patterns and trends.

Some bedrooms still required decoration, however there was no broken furniture in rooms. There had been an agreed refurbishment programme for communal areas which was due to take place soon. Infection control prevention was improved, and the home looked and smelled cleaner. There were enough suitably qualified staff to support people.

People's privacy was respected. People told us they liked the staff and they felt safe at the home. Relatives told us they felt the home had improved since our last inspection.

Staff liked the registered manager felt they had made good progress in the home.

The registered manager understood their duty to share information in an open and honest manner. Safeguarding systems and policies were in place and staff could describe the action they would take if they felt people were at risk of abuse.

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 Inadequate (published 17 January 2023).

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 had made improvements and were no longer in breach of regulations.

This service has been in Special Measures since 11 November 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 Safe, Effective, Responsive and Well-led which contain those requirements.

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 changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.

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

Follow up

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

The Hamlets provides accommodation and nursing and/or personal care to up to 30 people with needs associated with their mental health. At the time of our inspection there were 29 people living in the home.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Care records did not always contain the most relevant information or guidance that staff needed to follow, and people were exposed to unnecessary risk. Areas of risk were not robustly monitored, and incidents and accidents were not analysed or reviewed which meant the provider missed opportunities to prevent incidents occurring in the future

People were not always supported to receive their medications safely. People's risk assessments did not always reflect the support they required to keep them safe and people were not always supported in a person-centred way.

There was enough staff deployed to support people’s needs, and staff were recruited and selected safely.

The environment was clean, tidy and stocked with PPE. However, staff were not always using PPE effectively. We identified some concerns with the general maintenance of the home on day 1 of our inspection which could put people at risk.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies systems in the service did not support this practice. People had choice around what food they ate.

People told us they liked living at the home and they liked the staff who supported them. However, we observed that not all interactions between staff and people were caring or dignified.

Quality assurance systems were not effective, areas of risk were not safely managed, and regulatory requirements were not complied with. Inadequate quality assurance and governance measures meant that the provision of care people received was compromised.

Following the first day of our inspection the provider ensured the risks we escalated were mitigated and there processes were put in place to avoid them being repeated.

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 09 July 2019)

Why we inspected

This inspection was prompted in part due to concerns received about staffing and the culture within the home. A decision was made for us to inspect and examine those risks focusing on the key questions Safe and Well-led.

We inspected and found there were concerns with other aspects of care, so we widened the scope of the inspection which included the key questions of Effective, Caring and Responsive.

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.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end 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 will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medications, risk assessments, training, Capacity and consent, person centred care and governance.

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 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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this time frame, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service

People we spoke with told us they felt safe in the home and families were very complementary and reassured by the management of the service.

Arrangements were in place for checking the environment to ensure it was safe in relation to infection control and the threat of Covid-19. We found the policies and procedures in place followed current national guidance.

The home was clean and tidy, there was a plan to redecorate and refurbish the service as some areas were in need of updates.

The home was staffed appropriately. The provider acknowledged the high use of agency staff necessary for the current one to one care packages but recruitment plans were progressing to employ further staff.

People were settled within the service and any risks in relation to their mental health needs had been carefully assessed. We observed really positive examples of care and respect from staff towards the people they supported.

The interim manager was described as supportive and approachable. They demonstrated a good understanding of their roles and responsibilities to safely manage and improve the service. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

Rating at last inspection:

The last rating for this service was Good (published 9th July 2019.)

Why we inspected:

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. A decision was made for us to inspect and examine those risks.

The Care Quality Commission have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We found the following examples of good practice.

• The service had responded well to the changing threat of coronavirus. Good liaison with statutory bodies had equipped the manager and staff with the latest knowledge so that people were receiving appropriate protection and support.

• In particular we noted the visiting ‘pod’ so that people’s relatives could visit in comfort and keep in touch with loved ones.

• Management support was good, and the range of infection control audits carried out helped ensure safe standards were maintained.

• The provider had liaised well with external agencies for support. A recent infection control audit carried out by Public health England [PHE] had been positive and highlighted good practice around infection control.

• There were individualised risk assessments for both staff and people living at the service which covered any specific risk associated with COVID19

People’s experience of using this service:

There was a strong person-centred culture. Staff knew the needs and preferences of people living in the home extremely well. Staff had developed very positive relationships with people and were seen to display kindness as well as compassionate support.

People received personalised care and support which was in line with their care plan. People's privacy and dignity was respected, and independence promoted. Staff were committed to improving the quality of life and opportunities available for people. It worked with health and social care professionals to deliver improved outcomes and experiences for people.

The home was clean and tidy, there was a plan to redecorate throughout and the lounge had recently been decorated. The home was well maintained.

Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm.

Medicines were managed safely, and people received their prescribed medicines at the right time. Health needs were understood and met.

There were sufficient numbers safely recruited and suitably qualified and skilled staff in place to meet people's individual needs. Staff received a range of training and support appropriate to their role

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.

People knew how to make a complaint and they were confident about complaining should they need to.

The registered manager was described as supportive and approachable. They demonstrated a good understanding of their roles and responsibilities as a registered person. They worked in partnership with other agencies to ensure people received care and support that was consistent with their assessed needs.

Rating at last inspection: Good (Date published 25 November 2016)

Why we inspected: This was a planned inspection based upon the ratings at the last inspection.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Hamlets in Mersey Parks provides nursing care and accommodation to older people living with a functional mental illness. It is registered to support up to 30 people and at the time of the inspection there were 30 people living at the service.

There was a manager at the service who had been registered with the Care Quality Commission (CQC) since July 2016. A registered manager is a person who has registered with the 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.

People were protected from the risk of abuse. Staff had received training in safeguarding vulnerable people and were aware of how to report their concerns, both inside and outside the organisation. The registered provider had a safeguarding policy in place which was up-to-date and available to staff.

Risk assessments were in place to protect people from harm. Care records contained clear and detailed information for staff about how to support people with managing risks. A record of accidents and incidents was maintained, and appropriate action was taken to mitigate the risk of issues arising again in the future.

Staff had received the training necessary for them to carry out their role effectively. For example moving and handling, fire safety and first aid. Staff had also completed training in the Mental Capacity Act 2005 (MCA) and were aware of their roles and responsibilities in relation to the Act. This helped ensure that people’s rights and liberties were protected.

People received their medicines as prescribed by staff who had received appropriate training. Medicines were stored securely and measures were in place to ensure that these were kept in accordance with manufacturer guidelines.

People were supported to meet their dietary needs. Details of all nutritional requirements were documented in individual care records, for example some people required thickened fluids, or soft foods due to swallowing issues. There were some issues with the contractor who provided meals, however the registered manager and registered provider had both been proactive in dealing with this.

Staff were kind and caring towards people. Good relationships had developed between people and staff and there was a lot of laughter throughout the service. People made positive comments about staff, using words such as “lovely” to describe them. Staff promoted people’s dignity and respect, and people commented that they felt safe and well supported.

People were protected from the risk of social isolation. There was an activities co-ordinator in post that organised quizzes and games with people. Other activities included nail care and resident meetings. People were able to spend time in the garden area which was tidy and well kept, communal areas or in their rooms.

There was a complaints process in place which was on display within the service. People had been provided with a service user guide that contained details of how to make a complaint to the registered provider. It also included the contact details for the local authority and the CQC in case people wanted to take their concerns to an external agency. Complaints were dealt with thoroughly and in a timely manner, in accordance with the registered provider’s own policy. This demonstrated that people’s concerns were taken seriously.

The service was well-led. Staff told us that they found the registered manager to be approachable, and that they would not hesitate to raise any concerns with him. The registered manager was knowledgeable about the people using the service and had appropriately shared any concerns with the local authority and the CQC as required.

An annual survey was completed by the registered provider to ascertain people’s satisfaction. This showed that overall people and their relatives were happy with the service being provided. Residents meetings were also held during which people had the opportunity to discuss what areas of the service were working well, or anything they would like doing differently.

There were audit systems in place to monitor the quality of the service being provided. These looked at areas such as care records and medication. Where issues were identified action was taken to address these. Subsequent audits revisited issues identified in previous audits to ensure that these had been rectified.

The nursing home was fully staffed at the time of our inspection and met the recommended staffing levels suggested by the local authority. We observed the staff rota which showed a senior staff nurse was always on duty during all shifts. There was an effective complaints system available at The Hamlets in Mersey Parks which meant any comments and complaints people made were responded to appropriately and within an acceptable time-frame.