Hambleton Court Care Home

Hambleton Court Care Home is a residential care home providing accommodation and personal care to up to 18 people. The service provides support to older people, some of whom may be living with dementia. At the time of our inspection there were 14 people using the service.

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

Improvements had been made in the services governance systems; however, further work was needed in this area. Audits had failed to pick up the shortfalls found on the inspection. People had not come to any harm; however, we could not be fully assured about the quality systems in the service.

People received care from staff who knew them well. Care records needed expanding to ensure people’s needs and preferences were documented and known to all staff, particularly those who were new or providing agency support.

People received their medicines when needed and staff were suitably trained in this area. However, audits had failed to pick up when best practice guidance was not met. We have made a recommendation in this area.

People were appropriately supported at mealtimes; they told us they enjoyed the food and were given choice. More detailed information was needed to help ensure staffs knowledge of modified diets, we have made a recommendation about this.

The service has been struggling with the effects of the COVID-19 pandemic and recruitment had been an issue. Due to this, activities offered to people were limited, and people were not supported to follow their hobbies and interests. The provider was working to address this at the time of the inspection and a new activities coordinator was due to being employment.

Efforts had been made to improve the environment, making this more tailored for people living with dementia. Further improvement plans were in place which focused on outstanding maintenance, decorating bedrooms and increasing access to the garden.

People and their relatives gave positive feedback about the service, they felt safe and well cared for. One person told us, “Yes, I do feel safe. This is because it is nice here, the home is nice and clean, and I feel relaxed.” One relative told us, “I am more than happy with the way things have gone for [relative]. I have recommended the home to a neighbour.”

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 Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 20 October 2021) and there were breaches 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 we found the provider had made improvements, however, they remained in breach of regulations.

At our last inspection we recommended that the provider consider best practice guidance on medicines management and review their supervisions and appraisals process. At this inspection we found that improvements had been made and staff supervisions were currently underway. However, more work was needed to ensure the service’s medicines management met best practice guidance. We have made a recommendation about this.

The last rating for this service was requires improvement (published 20 October 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

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.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to the standard of records and quality assurance systems at this inspection.

We have made a recommendation in relation to the services management of medicines, their effectiveness in meeting people’s dietary needs and their complaints handling procedures.

Please see the action we have told the provider to take at the end of this report.

Follow up

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.

Hambleton Court Care Home is a residential care home providing personal care to people aged 65 and over, some of whom are living with dementia. At the time of the inspection there were 17 people in residence; the service can support up to 18 people.

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

The quality assurance and audit systems in the service were not used effectively. Shortfalls in quality and practice were not identified and people’s health and safety were put at risk.

People received person-centred care and support, but care plans and risk assessments were not always in place or reviewed when people’s needs changed.

Staff did not receive the support they needed to ensure they fulfilled their roles effectively. We have made a recommendation around staff supervision and appraisal.

People received their medicines as prescribed, but staff did not follow the medicine policy and procedure around record keeping and working practice. We have made a recommendation in the report.

People lived in a clean, comfortable and homely environment, but it was not designed to be dementia friendly. Work is ongoing to improve this aspect of the service.

Staff were not following Infection, Prevention and Control (IPC) practices effectively. However, shortly after the inspection the registered manager worked with the specialist IPC team and made the necessary changes to comply with the government guidance.

Staffing levels were consistent, and staff were confident they could meet people’s needs. We observed staff being patient, kind and respectful towards people.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 October 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

The last rating for this service was requires improvement (published 18 October 2019). The service remains rated requires improvement. This service has been rated requires improvement for two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 21 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

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

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

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. Please see the Safe, Effective, Responsive 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hambleton Court Care Home 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.

We have identified breaches in relation to risk management and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hambleton Court Care Home is a residential care home. It provides accommodation and personal care for up to 18 people over 65 years of age. At the time of the inspection there were 13 people living at the service.

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

The registered manager completed monitoring checks. However, these were not recorded and had not prevented repeated and new shortfalls in the quality of service provision.

It was not always clear from records whether staff received the support they needed to fulfil their roles effectively. Staff routines were task based and they had limited time to spend with people and provide emotional and social support. Care plans were not consistently person-centred and there was a lack of detail and guidance in risk assessments for staff to follow. Care plans and risk assessments had not always been reviewed on a regular basis or when people’s care needs changed.

People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible and in their best interests; the policies and systems in the service did support this practice.

Management systems including recording systems were at an early stage of development. Improvements were needing to provide information for people in an accessible format.

The environment had not been designed or updated to reflect best practice in dementia care.

People told us staff were kind, thoughtful and treated them well. Good personal and professional relationships existed between people, relatives and staff.

The local authority improvement team were supporting the registered manager to make improvements.

Rating at last inspection

The last rating for this service was good (published 24 February 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment and good governance. Details of action we have told the provider to take can be found at the end of this report.

We have made recommendations regarding the environment and activities suitable for people living with dementia; staffing and medicines handling.

We identified one breach of the Care Quality Commission (Registration) Regulations 2009. We will be addressing this issue with the provider outside the inspection process.

Follow up

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At our last inspection on 14 December 2015 we rated the service as ‘Requires Improvement’. There were two breaches of regulation and three recommendations within the report.

Hambleton Court Care Home provides accommodation and personal care for up to 18 older people. The service is provided over two floors and is a converted house located in the village of Hambleton near Selby. There is car parking available to the front of the service and disabled access into the building. People have access to a large garden area to the rear of the building and enjoy a selection of communal spaces within the service. These included two dining areas, a large lounge and a smaller sun room. Both floors of the service have communal bathrooms and toilet facilities. The bedrooms are all single occupancy and twelve bedrooms have a toilet and wash-hand basin en-suite facility.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. 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.

The registered manager monitored accidents within the service to ensure people were kept safe. However, they had not completed an analysis of these to identify any trends or problems within the service. There was a lack of information and evidence to show that feedback from staff, people and relatives was analysed, responded to and used to make improvements. We have made a recommendation about this in the report.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes. Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust.

Improvements had been made to how the service applied the principles of the Mental Capacity Act 2005. People gave consent to their care and their opinions and viewpoints were listened to and acted on.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Improvements had been made to the quality of the care plans. These had been rewritten and reflected person-centred care needs, which had been discussed and agreed with people and their families. We saw that the care being given reflected that which was recorded in the care plans.

People knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with. People had access to complaints forms if needed and the registered provider had investigated and responded to the one complaint that had been received in the past year.

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

Is the service safe?

The home had safe systems in place to ensure people received their medication as prescribed; this included regular auditing by the home and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was re assessed regularly.

Records required to protect people against the risk of unsafe or inappropriate care and treatment were up to date and reflected an accurate record of each person's needs.

Policies and procedures for the safe running of the service were fit for purpose and accessible to staff to support their role and responsibilities.

Is the service effective?

n/a

Is the service caring?

n/a

Is the service responsive?

n/a

Is the service well led?

n/a

During our inspection we asked the provider, staff and people who used the service

specific 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. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, and the staff who supported them and from looking at records.

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

Is the service safe?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. However, further training for staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards would ensure the provider had the knowledge and skills to act in accordance with legal requirements to safeguard people.

Some aspects of the systems in place for people to receive their medication were not always safe. Staff had received training prior to administering medication but a practical competence test had not been carried out or completed as part of a periodic review of competence.

There were sufficient staff available on duty to meet the needs of people.

Records required for the safe and effective running of the service were not kept up to date or accurate. This placed people at increased risk of receiving inappropriate and unsafe care.

Is the service effective?

People's health and care needs were assessed with them. People told us they were included indecisions about how their care and support was provided.

Staff received regular training relevant to their role. This helped ensure the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

Without exception people said they were very satisfied with the care and support they received. They said staff were attentive and 'nothing was too much trouble' and 'staff here go the extra mile for you; we are very well care for.' Another person said 'staff are wonderful and attend to my every need.' Care and support was provided in accordance with people's wishes.

We saw that staff acted in a kind and respectful way People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere. We saw staff crouching down to talk to people at eye level and speak at a pace that was comfortable for the person.

Is the service responsive?

People's needs were met in accordance with people's wishes.

The manager made sure they spoke with people and responded to requests and concerns. For example in facilitating specialist equipment to ensure someone could continue to go out in the car.

People we spoke with knew how to make a complaint if they were unhappy and felt confident they would be listened and responded to.

Is the service well-led?

The manager completed a daily walk around of the home to check on the environment and to speak to every person who used the service. They spoke with people about their satisfaction and took action to rectify any concerns.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. They told us the manager was supportive and promoted positive team working.