Archived: Hampden Hall Care Centre

Accommodation is provided on three floors. People living with dementia reside on the ground floor. Nursing care is provided on the first floor with both nursing and residential care on the second floor.

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

Some people told us they felt safe living in the service, whilst others did not. We found the service was in breach of regulation 12 (Safe care and treatment) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to poor medicine management and a lack of accurate up to date recordings in relation to health needs and risk assessments.

People and their relatives told us “One of the problems is there's not enough staff.” They were concerned about the welfare of the staff and that people may not receive care in a timely way. The provider was aware and was attempting to address this issue by offering financial incentives to staff. Staff were knowledgeable about infection control and safeguarding people from abuse.

Records related to the risk of people suffering from malnutrition and/or developing pressure ulceration were not accurately completed. There were concerns about the competence of staff to provide catheter care, and to accurately record or set air mattresses correctly. Nursing staff were not able to demonstrate correct knowledge and expertise in dealing with diabetic hypoglycaemia (low blood sugar levels). People had access to a GP and other health professionals when necessary.

The ground floor environment was not conducive to caring for people with dementia because the environment was noisy and lots of people were gathered in the same area. 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.

There was a mixed response from people with regards to how they were treated by staff. Some people told us they weren’t always treated in a respectful way by staff. Others praised the staff for their kindness and support. People told us how their dignity was protected, others felt the attitude of some staff was “off.” Communication between staff and people was not always positive or skilled. We have made a recommendation about how to improve the care for people living with dementia.

There was a mixed response from people regarding the activities in the service. The activities were not always person centred or meaningful to people. We observed people being left for long periods without any stimulation and conversely enjoying a glitz and glamour day with staff and visitors.

The provider had tools in place to meet people’s communication needs. Complaints were dealt with in a timely way. We received positive feedback from the relatives of people who had died. People and staff were treated equally, and people’s cultural needs were catered for.

The service was going through a period of change and it was clear from our findings there had been a lack of oversight of records, and the support offered to people daily. Quality assurance audits had not identified the areas of concern we found. The provider was open and honest with us about the challenges the staff and people faced to improve the service. Plans were in place to improve the service to people. The provider had been proactive throughout the inspection to rectify what areas they could.

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 13 October 2017).

Why we inspected

The inspection was prompted in part due to the number of safeguarding notifications we had received. A decision was made for us to inspect and examine those risks.

Enforcement

We have identified breaches in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to a lack of accurate information relating to people’s health needs and records. Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to a lack of effective governance, including assurance and auditing systems or processes. Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to care and treatment that did not meet people’s needs. We identified these breaches during this inspection.

We have found evidence that the provider needs to make improvements. Please see the 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 Hampden Hall Care Centre 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.

At our last inspection on 5 May and 6 May 2015, the service was rated good .

At this inspection we found the service remained good.

Why the service is rated good:

People were protected from abuse and neglect. We found staff knew about risks to people and how to avoid potential harm. Risks related to people’s care were assessed, recorded and mitigated. The management of risks from the building were also considered. We found appropriate numbers of staff were deployed to meet people’s needs, although there were a number of vacant posts for care workers. We made a recommendation about staffing deployment. Medicines management was safe, but minor improvements were required. We made a recommendation about medicines management.

Staff training and support was good. Staff had the necessary knowledge, experience and skills to provide appropriate care for people. The service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and associated codes of practice. People’s nutrition and hydration was closely monitored. Appropriate access to community healthcare professionals was available. A refurbishment programme had commenced to further enhance people’s experience of living at the service.

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.

We consistently received complimentary feedback about the service. People and others told us staff were kind and caring. People and relatives were able to participate in care planning and reviews and some decisions were made by staff in people’s best interests. People’s privacy and dignity was respected.

Care plans were thorough, personalised and reviewed regularly. There was a satisfactory complaints system in place which included the ability for people and others to raise concerns. People and relatives told us they had no complaints, but knew the process for alerting staff to any issues.

Management and operation of the service was good. We found staff worked as an effective team to improve care, ensure people were safe and focus on the quality of the service. The service had good working partnerships with external agencies and were honest in their approach. We made a recommendation about statutory notifications for safeguarding allegations.

Further information is in the detailed findings below.

We saw people were respected and involved in their care. A range of activities were made available to people who used the service. Staff had read and signed the provider's confidentiality policy to ensure people's privacy and dignity was upheld. The provider had ensured people's capacity to make decisions was assessed in line with the Mental Capacity Act 2005 (MCA). Staff had also received MCA training since our last visit.

We saw care plans reflected people's needs and were reviewed and updated monthly. The provider had reviewed their staff training plans and all staff had completed training, or were expected to complete training by December 2013. We spoke with staff about the service. One member of staff told us 'It's much better now, we are working as a team.' One relative told us 'Staff are fantastic.' The provider had introduced life history books for people who used the service which included information about people's lives and personal histories. Staff were responsible for creating and maintaining these documents. This enabled staff to provide more personalised care to people within the service.

People were generally treated with respect by staff and their privacy and dignity was protected. We observed the care on all three floors of the home. We observed how the staff interacted with people. We saw positive interaction between people and the staff members on the first and second floor; however we saw examples of poor interactions between staff and people on the ground floor. The Mental Capacity Act 2005 had not been applied to the care that was being provided to people who lived on the ground floor; this placed them at risk of being deprived of their human rights and liberty.

We examined records relating to care of people and staff recruitment, supervision and training. We found that recruitment records were up to date and appropriate, however this was not reflective of the records in all other areas we inspected.

We noted that staff training and supervision was not up to date and in line with the provider's policy on training and supervision.

We found people received the appropriate care and support that met their needs. People were provided with adequate nutrition and hydration. The premises were kept clean and there were no untoward odours. Staff were appropriately trained, supervised and appraised. There was a system in place to ensure complaints were investigated and resolved satisfactorily.