Hawkhurst House

Hawkhurst House is registered as a care home with nursing and a supported living service, it provides personal and nursing care for up to 85 people. Both aspects of the service are provided in the same building. A person using the care home service may have their bedroom next door to a person using the supported living service and everyone may use the same communal facilities. At the time of our inspection 55 people were living at the home.

Where people use the supported living element of the service, they have a tenancy agreement with the home’s provider for their accommodation. As such, we may only include them in the inspection if they also receive the regulated activity of personal care. Staff confirmed everyone living at the service received personal care, we have therefore included everyone living at the service in our inspection. People using the service were older people, some of whom were living with dementia and nursing care needs.

In addition, Hawkhurst House is identified by the Local Authority as a 'designated service provider', as described in the Government's Winter Plan for adult social care. This means the service can deliver care and accommodation for people leaving hospital, who have tested positive for COVID-19 and who will be transferring to another care home at the end of their required isolation period.

The designated area is on a separate floor, with a separate entrance and exit. Staff working in this area do not work in other parts of the home. Specific policies, procedures, equipment and training are in place to maintain infection control and support the care needs of people during their isolation period. This enables the provider to deliver this service without increasing the risk of infection to staff, visitors or people using other parts of the home.

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

People using the home were positive about their experiences and told us they felt safe living there. However, we found some interactions between staff and the people they supported were poor and visibly did not meet people’s expectations or social needs.

There had been a significant turnover of staff in recent months and while there were sufficient numbers of staff to meet people’s needs, some staff were not familiar with the people they supported. We saw newer staff being prompted by more experienced staff about how to best support people. Conversely, experienced staff supported people positively. They engaged easily and confidently, often to the visible and verbal contentment of the people they were supporting.

Medicines were usually safely managed, there were effective checks that enabled any mistakes to be quickly identified and addressed.

Although training was continually reviewed and mostly up to date, a lack of competency assessments, other than in giving medicines, meant the provider could not validate staff practice when interacting with the people they supported. This created difficulty in ensuring there were sufficiently experienced staff to support people. The provider had created a new post for an experienced member of staff to coach, mentor and competency assess new staff to address this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Where some people were unable to make some decisions for themselves, decisions made in their best interests were clearly recorded.

Staff understood their responsibilities in relation to safeguarding people. However, on one occasion processes within the service failed to ensure a notification about a safeguarding was sent to CQC as needed. Internal quality assurance processes identified and rectified this oversight.

Assessments had been made about risks to people and actions had been taken to minimise these. Accidents and incidents were recorded and monitored; actions were taken to minimise risks of reoccurrence.

Staff worked closely with other professionals to meet people’s needs. People and families were invited to give their views on their care and they were listened to.

Oversight of the service was robust, there were effective audits in place which sought to address the concerns found during this inspection. However, some initiatives had not been in place long enough to understand if they were wholly effective. We will review the effectiveness of these initiatives at our next inspection.

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 18 November 2019).

Why we inspected

We received concerns in relation to safeguarding, staffing mix and experience, medicines and oversight of the service. A decision was made to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well Led. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating 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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Hawkhurst House 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.

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

The proposed designated care setting was on a separate floor from the rest of the home. Hawkurst House is registered for proving accommodation and personal or nursing care for up to 85 people. At the time of inspection there was no one living in the designated care setting but there were people living in other areas of the home.

We found the following examples of good practice.

¿ The designated care setting was on the middle floor of the home. There was a separate entrance to the setting accessible from the elevated car park. This car park would be designated for staff and health professionals accessing the designated care setting.

¿ Bedrooms on the designated care setting were self-contained.

¿ The manager had thought about the equipment that would be needed for the designated care setting and had ordered linens and towels in different colours to the rest of the home in order for them to be easily identifiable.

¿ The designated care setting had its own outside balcony area for people to spend time on if they wished. The communal areas were large enough to enable people to social distance.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Hawkhurst House is registered as a supported living service and a care home with nursing. The two elements of the service are provided in the same building. There is no physical separation between the parts of service. A person using the care home service may have their bedroom next door to a person using the supported living service and both people may use the same communal lounge.

A supported living service provides care and support to people living in supported living settings so that they can live as independently as possible. Under this arrangement people's care and housing are provided under separate contractual agreements. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement.

Hawkhurst House is registered to provide accommodation, nursing and personal care for 85 people. It can accommodate younger adults, older people and people who live with dementia. It can also provide care for people who have physical adaptive needs.

There was a total of 44 people using the service at the time of our inspection. Two of these people used the care home service. They were funded by a health authority as they needed complex nursing care. Forty two people used the supported living service, rented their accommodation and had tenancies with Hawkhurst House Limited. These people could choose which provider delivered their care.

At this inspection all people using the supported living service in addition to those using the care home service received their nursing and personal care from staff employed by Hawkhurst House Limited.

People's experience of using the service and what we found

People and their relatives were positive about the service. A person using the supported living service said, “I like the staff here and they’re friendly.” In a thank-you card to the service a relative said, "A big thank you. My mum seems very happy with you, she is looked after extremely well by your caring staff which is most reassuring.”

People were safeguarded from the risk of abuse. People received safe care and treatment in line with national guidance from nurses and care staff who had the knowledge and skills they needed. There were enough nurses and care staff on duty and safe recruitment practices were in place. People were helped to take medicines in the right way and lessons had been learned when things had gone wrong. Hygiene was promoted to prevent and control infection and people had been helped to quickly receive medical attention when necessary.

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

The accommodation was designed, adapted and maintained to meet people’s needs and expectations.

People were treated with kindness and compassion, their privacy was respected and confidential information was kept private.

People were consulted about their care and had been given information in an accessible way. People were supported to pursue their hobbies and interests. Complaints had been properly investigated and quickly resolved. People were treated with compassion at the end of their lives so they had a dignified death.

Quality checks had been completed. People had been consulted about the development of the service and their suggestions had been implemented. Good team work was promoted. Regulatory requirements had been met and joint working was promoted.

For more details, please read 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 Requires Improvement (published 5 January 2019).

The registered 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 improvements had been made and the registered provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

The service has a registered manager, who was present throughout the inspection. 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.

Hawkhurst House was first registered with CQC to provide regulated activities on 17 December 2017 and this is its first inspection.

Accidents and incidents were reported and responded to in most cases.

Staff knew how to keep people safe from abuse and neglect. The registered manager referred most incidents to the local safeguarding authority.

The provider had not kept CQC informed of all events that happened in the service as required by legislation.

Risks to people had not always been mitigated to protect people for harm. Prospective members of staff were living at the service without the relevant checks being completed. We have made a recommendation about the assessment of risk.

Audits and checks had not been fully effective in identifying and remedying shortfalls. The service had a Practice Development Manager in place working alongside the registered manager.

Care plans, risk assessments and guidance were in place to give staff knowledge about how to support people in an individual way.

The management of medicines was effective, people received their medicines safely and in a timely manner. Policies and procedures were in place for staff to follow ensuring safe storage and recording of medicines.

The safety of the premises was assured by regular checks on utilities and equipment. Fire safety had been addressed through training, fire drills and alarm testing. Maintenance had been carried out promptly when repairs were needed.

People had a choice of nutritious meals, snacks and drinks, and could choose where they would like to eat. Staff encouraged people to eat their meals and gave assistance to those that required it.

There were enough staff on duty that had received relevant training and supervision to help them carry out their roles effectively. Staff were observed putting their training into practice in a safe way. A dependency tool had been introduced to enable the registered manager to make sure that staffing levels remained adequate. Recruitment files contained all the required information about staff.

A range of professionals were involved in people’s health care and individual plans of care were mostly in place if people had specific health needs like diabetes, catheters or pressure wounds. Some care plans required review to ensure they contained clear, detailed guidance for staff to follow.

Staff and registered manager worked within the principles of the Mental Capacity Act 2005 (MCA) which ensured people’s rights and wishes were protected.

Staff treated people with kindness, compassion and respect. Staff took time to speak with the people they were supporting. We saw many positive interactions and people enjoyed talking to the staff. The staff on duty knew the people they were supporting and the choices they had made about their care and their lives.

Care plans were person-centred; they reflected people’s individual preferences and gave staff an understanding of the person. A range of activities were on offer with specific sessions and groups designed for people living with dementia. Staff encouraged people to be involved and feel included in their environment. People's privacy and dignity was respected.

Complaints had been documented and recorded. People and relatives said they knew how to complain if necessary and that the registered manager was approachable.

We found a breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have asked the provider to take at the end of this report.