Hungerford Care Home

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

People and staff told us they felt there had been a lack of leadership at the service which had led to concerns not being addressed and people and staff not feeling listened to. Quality assurance systems had not been effective in ensuring people’s opinions were heard and improvements in the quality of the service made. Where feedback had been sought, this had not been acted upon.

Risks to people’s safety and well-being were not consistently monitored and there was a lack of guidance for staff in supporting people’s emotional needs. Some people told us they had to wait for their care due to staff always being busy. Staff told us they did not always have time to fully support people with their care or spend time with them socially. The home was not always cleaned to a good standard and there was a strong odour in some areas.

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 and systems in the service did not support this practice. The principles of the Mental Capacity Act 2005 were not always followed to ensure people’s legal rights were protected.

At the time of our inspection a new management team had been in post for 3 weeks. During this time, they had made progress in reviewing the current concerns and implementing actions to monitor and address these areas. People and staff felt the new management team were listening to concerns and trust was being built. The provider ensured CQC were notified of concerns in line with their statutory responsibilities.

People had access to healthcare professionals when required and received their medicines in line with their prescriptions. People provided mixed responses regarding the quality of the food provided but confirmed they were always offered a choice.

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

Rating at last inspection – The date of the last inspection at which we awarded a rating was 3 November 2017 and the service was rated good.

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding.

This was a focused inspection which looked at the key questions of Safe, Effective and Well-led. 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 good to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to people’s safe care and treatment, consent to care and good governance 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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice:

Monthly audits of the infection prevention and control were completed by the registered manager. There was an associated action plan, which clearly listed steps that needed to be completed. Most actions related to the refurbishment of the premises.

There were sufficient supplies of personal protective equipment.

Most areas of the building were very clean. Daily walk arounds by the management team checked the cleanliness of each area in the service, as well as other aspects of care. We pointed out areas in the building where deep cleaning required more attention.

Hand hygiene points were available in bathrooms and along corridors. We asked the service to check hand sanitiser dispensers were functioning correctly.

The service ensured that visitors had their COVID-19 vaccination status and lateral flow test checked before entry to the main building. This ensured people’s protection from the risk of infection.

The service worked closely with the local authority and clinical commissioning group to keep people safe. They also kept up to date with best practice initiatives and shared information with other locations within the provider’s group of care homes.

Records regarding staff vaccinations showed only those eligible to work at the service were employed.

Essential caregivers were promoted to be part of people’s lives. Appropriate risk assessments and testing were in place. We met two relatives who provided complimentary feedback about the care people received.

Hungerford Care Home offers a service for up to 59 older people with nursing needs, some of whom also live with varying degrees of dementia. Twenty four hour support is provided by a regular team of staff across the three separate units.

A registered manager was in place in the service. A registered manager is a person who has registered with the Care Quality Commission 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. Due to changes in the provider’s registration, this was the first inspection of the service under its current legal status.

People and relatives felt people were safe and well cared for by the service and that their dignity, privacy, rights and freedom were supported by the staff. They felt staff were competent and well trained and worked together effectively. If issues were raised, people and relatives said they were addressed and they could go to one of the managers if they needed to discuss anything. People and relatives had been consulted about their views about the service and had opportunities to discuss any concerns.

The service provided an excellent range of activities, outings and entertainment to address people’s social and emotional needs, especially for those living with dementia. The ‘wishing well’ scheme, which identified and fulfilled people’s personal wishes, was exemplary. Activities staff were dynamic and actively sought new and innovative equipment to help engage with people. Cultural and spiritual needs were provided for.

Staffing levels were regularly reviewed and adjusted in relation to people’s needs. Staff received appropriate induction, comprehensive training and ongoing supervision and support.

The environment was well-maintained and work was under way to maximise its suitability to support the needs of people living with dementia. Health and safety and service checks took place as required and action was taken to minimise identified risks to individuals.

People were supported by caring staff who responded to their needs in a timely way. When staff identified concerns these were communicated to senior staff to be addressed. Senior staff were seen to be involved in hands on work with people, which enhanced their awareness of individual's needs.

Care was provided based on detailed care plans which were regularly reviewed in consultation with people and relatives where appropriate.

The service was monitored through a range of detailed audit tools which led to action plans, where necessary, to support its continued development.

We made a recommendation that the registered manager reviews the rights of relatives acting as legal representatives of people who lack capacity under the Mental Capacity Act 2005. This was to ensure they are fully familiar with the rights of people’s representatives in every situation.