We carried out this unannounced inspection on 26 June 2017. This was the first inspection for the service since registering under a new provider in late December 2016. Hendra Court is a care home which is registered to provide nursing care for up to a maximum of 48 older people, some of whom had a diagnosis of dementia. Accommodation is divided into two units with 36 bedrooms in the main house and 12 bedrooms in the adjoining annex (called the bungalow). On the day of the inspection there were 30 people living at the service. At the time of the inspection communal areas in the bungalow (lounge, dining room and kitchen) were not in use due to refurbishment.
There was a registered manager in post who was responsible for the day-to-day running of 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 and associated Regulations about how the service is run.
The service had been operating under new ownership for nearly six months, since December 2016. In that time many vital repairs to the structure of the building had been completed. This included a new roof and the servicing of the boilers, to ensure safe and effective heating and hot water systems could be maintained in the service. Any repair work that presented an immediate safety risk to people had been rectified such as uncovered pipework, unsafe electric heaters and unlocked boiler rooms.
An extensive plan to upgrade and improve all areas of the premises had started. Major redesign and redecorating work to the bungalow, to provide a more suitable environment for people with dementia, was nearing completion at the time of the inspection. It was anticipated that people would be able to use the new facilities within two weeks of the inspection date. While these works were taking place people who lived in the bungalow spent their day in the main house. This had resulted in more people using a communal lounge which was not the most suitable either in its design or location. The registered manager had decided not to take any new admissions until the bungalow was re-opened to help manage the situation. While any disruption to people’s lives had been well managed, until these works were completed the premises were not entirely suitable to meets people’s needs.
Three people, who were cared for in bed and unable to call for assistance, were in bedrooms on the first floor of the main house. While staff carried out regular safety and care checks, these three people had little interaction or stimulation. The registered manager told us work was in progress, in consultation with people, to understand how best to use different areas of the premises and these rooms would be part of that review.
Where people needed to have specific aspects of their care monitored staff completed records to show when people were re-positioned, their skin was checked or their food and fluid intake was measured. While there was no evidence to suggest that checks were not being completed appropriately, records to evidence the care people received were not always consistently completed. We also found there were no written records of the daily handovers that took place. This meant there were no records for staff to read, about people’s needs, if they were not present at a handover. We judged that staff were knowledgeable about people’s needs and the gaps in some records had not impacted on the care provided for people. We have made a recommendation about care records.
People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, "The staff are so good, it's them that make it safe”, “I've got a nice room and the staff make me feel safe”, “I know my partner is safe, because I visit nearly every day.”
Where people were unable to tell us about their experiences we observed they were relaxed and at ease with staff. Staff were kind and attentive to people’s needs and interacted with people in a caring and respectful manner. Comments from people included, “I'm very happy with the care I receive” and “The staff do almost everything for us, they're wonderful.”
Care plans were well organised and contained accurate and up to date information. Care planning was reviewed regularly and as people’s changing needs recorded. Wherever possible, people and their relatives were involved in the reviews. Any risks in relation to people’s care and support were identified and appropriately managed.
People had access to healthcare services such as occupational therapists, GPs, community nurses and chiropodists. Care records confirmed people had access to health care professionals to meet their specific needs. A visiting healthcare professional told us, “The care provided is excellent and care plans provide me with all the information I need.”
There was a wide range of meals on offer and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told they enjoyed their meals. Comments included, “I vary where I eat my meals and there's a good choice of food”, “There's a good choice of menu”, “It's a good varied menu” and “There's always a good choice.”
The service acted within the legal framework of the Mental Capacity Act (MCA) and Deprivation if Liberty Safeguards (DoLS). 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.
There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse. Staff supported people to keep in touch with family and friends.
Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.
Staff were enthusiastic about their work and positive about the support they received from the registered manager and provider. Comments from staff included, “I am really happy working here”, “I love the job”, “Staffing levels are much better”, “We now get everything we need equipment wise”, “We have proper equipment such as gloves and aprons”, “We have the chance now to sit and chat with people” and “Everything is different and better.”
People, visitors and healthcare professionals were all positive about how the service was managed. Comments included, “The biggest and most impressive change in the service is the number of staff on duty and the attitude of staff. They are highly motivated and as a result the care people received is much better” and “Everybody who works here are marvellous.”
People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. People told us they knew how to raise a concern and they would be comfortable doing so. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.