This inspection took place on 4 and 18 December 2017. Day one was unannounced. At our last inspection, the provider was found to be in breach of three regulations (12, 17 and 18) in relation to safe care and treatment, good governance and staffing. We imposed conditions on the provider’s registration in respect of employing a manager within a specific timeframe, improving staff supervisions, training and appraisals and developing the skills of the junior management team who were left in charge of the service when the senior management were not on site. Over the last six months the provider sent us a monthly action plan showing how they had progressed towards meeting the relevant legal requirements.
Following the last inspection the provider had enlisted various internal resources to support the service to improve systems and process. This had included regional quality support to assist the registered manager. The provider was still working when we inspected to embed improvements in some areas. The registered manager continued to work hard to recruit and support the current staff team whilst encouraging positive change and ensuring staff understood their responsibilities. The provider was committed to making further improvements and we were confident this would happen.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the provider demonstrated to us that improvements have been made and therefore the service is no longer rated as inadequate overall or in any of the key questions. The service is now out of Special Measures.
Hambleton Grange is a ‘care home’ without nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service provides support and care to a maximum of 50 older people and people living with dementia. On the dates of our inspection, there were 41 people using the service with varying degrees of need and dependency.
The service provided people with accommodation and communal spaces over three floors and each floor was staffed separately. On the ground floor were 12 bedrooms and on the first and second floors there were 19 bedrooms per floor. The ground floor was for people living with moderate onset dementia, the first floor was for people who were living with mild onset dementia and the second floor supported people with residential needs.
The provider is required to have a registered manager. A registered manager is a person who has registered with 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 manager had registered with CQC in October 2017.
The arrangements for ordering, storage, administration and recording of medicines were not carried out safely or effectively. Medicine management practices were being reviewed by the registered manager and action was needed to ensure medicines were given safely and as prescribed by people’s GPs.
People told us that care was sometimes rushed and not always person centred, but they also gave us positive feedback about the support they received. We observed that some care was task orientated. We have made a recommendation about this in the report.
People had access to a range of low key activities which, although people enjoyed, did not meet everyone's needs. People said they remained bored at times with nothing to do. We have made a recommendation in the report around this.
Improvements had been made to the quality of the care records, but further work was needed to include people's emotional needs within the care plans.
Improvements had been made to the accessibility of safeguarding information for staff and people who used the service, risk assessments and monitoring of risk. People told us they felt safe living at the home. We found staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes.
Improvements had been made to the staffing levels in the service. We found the management team were monitoring people’s needs and adjusting the staffing levels accordingly. A high level of agency staff continued to be used, but active recruitment for permanent staff was also in place.
Improvements had been made to infection prevention and control practices so that the environment was clean and tidy.
The uptake of staff training had improved; but there was a lack of regular supervision meetings and appraisals for the staff, which the registered manager was addressing.
Staff knowledge of people’s needs had improved and there was a better understanding of the importance of good communication.
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.
People were able to talk to health care professionals about their care and treatment. People told us they could see a GP when they needed to and they received care and treatment when necessary from external health care professionals such as the District Nursing Team or Diabetic Specialists.
People had access to adequate food and drinks and we found they were assessed for nutritional risk and were seen by the Speech and Language Therapy (SALT) team or a dietician when appropriate.
Improvements had been made to how staff respected people's privacy and dignity. People said staff were also friendly and caring.
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 manager had investigated and responded to the complaints that had been received in the past year.
The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the registered manager was making progress in improving the quality of the service.
At this inspection we have identified a breach of regulation 12 with regard to safe management of medicines.
You can see what action we told the provider to take at the back of the full version of this report.