Hunters Lodge Care Home

Hunters Lodge Care Home is a residential care home providing personal care to up to 44 people. The service provides support to older people, most of whom have dementia or a mental health need. At the time of our inspection there were 40 people using the service.

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

Risks associated with people’s health conditions and support needs had not always been assessed, monitored or mitigated effectively.

The management of medicines was not always safe. This included in relation to ‘as required’ medicines, topical creams and time sensitive medicines.

The provider lacked effective governance systems to identify concerns in the service and drive the necessary improvement. At times, there was a lack of detailed records regarding people's support needs and any potential risks posed to them.

People were mostly supported to have maximum choice and control of their lives and staff often supported them in the least restrictive way possible and in their best interests. However, not all practices that restrict people’s privacy and freedom were carried out within the MCA framework. We have made a recommendation about this.

Records did not always reflect the requirements of the duty of candour had been met to show an open and transparent service. We have made a recommendation about this.

The provider had safeguarding processes in place. Staff understood how to recognise abuse and how to report this. We were assured the service were following safe infection prevention and control procedures to keep people safe. Recruitment practices were safe.

Staff enjoyed their work and spoke warmly about the people they supported. People, relatives and staff told us they were given the opportunity to feed back on the service. They were confident the registered manager would listen and act on any concerns.

The management team were responsive to feedback given and were dedicated to ensure people received a safe, person-centred and compassionate service. They began taking action to make improvements in the service.

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 the service was good, published on 31 August 2019.

Why we inspected

The inspection was prompted in part due to concerns that some people were being hurt by others who were experiencing distress and agitation. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We have found evidence that the provider needs to make improvements. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Enforcement and Recommendations

We have identified 2 breaches in relation to safe care and treatment and good governance.

We served a warning notice for the breach in relation to safe care and treatment.

Follow up

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 will check the requirements of the warning notice have been met when we next inspect.

Hunters Lodge Care Home is a care home for older people, some of whom were living with a dementia related condition. They provide personal care for up to 30 people aged 65 and over. At the time of the inspection there were 27 people living in the home.

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

Prior to the inspection we had received some concerns about how staff supported people who regularly refused their medicines and recognition of when these may need to be given in an alternative way, such as covertly. We found action by the provider and registered manager had been taken to address these concerns. The temperature of medicines storage was not checked regularly. When the temperature was higher than recommended, we could not see what action had been taken. The provider told us that they would address this promptly and bring forward their plans to install air conditioning in this room. Care plans were in place where people were prescribed 'as required' medicines, but these would benefit from more guidance for staff.

People could be confident they were supported by staff who had access to appropriate guidance and understood how to keep them safe. Staff’s knowledge of the people they supported was good and they were able to tell us about the risks associated with their care and how to minimise these. There were enough staff who had been recruited safely, to meet people's needs and keep them safe.

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. Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role.

People's needs were met in an individual and personalised way by staff who were kind and caring. People felt listened to and knew how to raise concerns. They, and a healthcare professional told us they would recommend the service to others. Staff respected people's privacy and protected their dignity.

People knew how to raise concerns. They had confidence in the registered manager and told us they would recommend the service to others.

A quality assurance system was in place to assess, monitor and improve the service. Incidents and accidents were monitored by the registered manager. Where incidents occurred in the home the registered manager ensured appropriate action was taken for people to reduce the likelihood of injury or recurrence.

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 requires improvement (published 21 February 2017).

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 last inspection of this home was carried out on 29 July 2014. The service met the regulations we inspected against at that time.

There was a registered manager at 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.

Hunters Lodge can accommodate up to 30 people who require personal care. The home is not registered to provide nursing care. There were 27 people living there when we visited.

People who used the service and their relatives told us they felt well cared for in the home. People we spoke with felt staff had the right skills to care for people. One person commented, “Staff seem to know what they’re doing and they’re very good.” A relative told us, “Staff are committed, compassionate and competent.” Staff told us they had lots of training opportunities.

There were enough staff on duty to support the people who lived there. Every morning staff were arranged into teams so they knew exactly who to support and when. The registered manager carried out thorough checks to make sure only suitable staff were employed.

People’s right to make their own decisions was respected and their consent was sought before care was provided. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision.

People were complimentary about the quality of the food. Their comments included, “It’s always very nice”, “the cooks like to feed us up” and “it’s a very nice place to have meals”. Relatives also said people were supported to eat and drink enough. One relative commented, “They always make sure people are hydrated – there’s lots of drinks and ice-cream.”

People and relatives told us the home arranged appropriate health care input when required, and acted quickly if people were poorly. One relative told us, “They’ve completely turned my [family member’s] health around.”

People and relatives had many positive comments to make about the caring and compassionate nature of the staff. People described staff as “very kind” and "very friendly”. Staff were polite, respectful, friendly and sensitive when assisting people.

Relatives described staff as “very caring” and “very patient”. One relative said, “The staff are lovely people. They get down and look at people when they’re talking. They use gentle touch to help people feel reassured.”

During this inspection we found a small number of people’s care records were out of date which could lead to inconsistent care, so these were being updated.

Relatives felt staff knew each person well and everyone was treated as an individual. One relative commented, “They can get up when they want, have breakfast in bed if they want or have a late brunch. The staff do what people want them to do and they do it in a gentle manner and supportive way.”

People told us there was a good range of activities and entertainment to take part in if they wanted. One person said there was always “plenty to do”.

People and their relatives were asked for their views about the home at meetings and in surveys and these were used to improve the service. Each person had received written information about how to make a complaint when they moved to the home.

People, relatives and staff said the registered manager was “very approachable” and took time to listen to their views and suggestions. There was an open, family-style culture in the home and staff felt valued by the provider.

As part of the inspection we used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences were. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time and whether they had positive experiences.

During our visit we spoke with six people who lived at the home. We spoke with three relatives/visitors, the registered manager, two senior carers and three members of staff. We also spoke with a community nurse who was visiting the service.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

Is the service safe?

None of the people we spoke with had any concerns about the support they received.

We saw care and treatment was planned and delivered in a way that ensured people's safety and welfare. All of the care plans we looked at had risk assessments in place to help minimise any risk that had been identified.

The home had a clear policy on the protection of vulnerable adults and also had a copy of the local authority adult protection policy.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Is the service effective?

Each person had a plan of care and support. We saw that support plans explained what the person could do for themselves and what support they needed from staff. Staff told us the care and support plans gave them the information they needed to provide the level of support people required.

We observed staff supporting people and care staff we spoke with were aware of people's needs and how people wanted care to be delivered. We saw staff offered advice and support but they also enabled people to make their own choices and decisions.

Is the service caring?

We observed staff speaking with people appropriately and they used people's preferred form of address; We saw people and staff got on well together.

We observed that people were happy with the support they received. A relative of one person we spoke with was very happy with the care and support their relative received. They told us that the staff were caring and provided the help, care and support their relative needed.

Is the service responsive?

We saw people had regular reviews of the care and support they received. We saw review notes showed alterations had been made to people's plans of care as their needs had changed.

We saw that people were able to participate in a range of activities both in the home and in the local community. Staff told us that they encouraged and supported people to participate in activities to promote and maintain their well-being.

People who used the service, their relatives and staff were asked for their views about how the home met people's needs and any concerns or ways to improve the service were acted on.

Is the service well led?

The Lodge had a policy and procedure in place for quality assurance and the provider organisation also employed a head of care who visited the service on a regular basis.

The manager told us they carried out a range of weekly and monthly audits to ensure that Hunters Lodge was maintaining a good standard of care and support. The head of care checked that these audits were undertaken. A report was compiled after each visit and a copy of these reports were kept on the computer system at the home.

A relative we spoke with told us that they had regular contact with the home and said they could speak to the manager or staff at any time. They told us they were kept informed about any issues which affected their relatives.

Staff meetings took place six times per year and minutes of these meetings were kept. Staff we spoke with confirmed this and said the staff meetings enabled them to discuss issues openly with the manager and the rest of the staff team.

The manager told us that all staff received regular one to one supervision where staff performance issues were discussed and additional staff training was identified. Staff we spoke with confirmed this.

We spent time in their company in the lounge/dining area observing the support people received before and during their meal. We saw that the staff were friendly and respectful and they were quick to respond if anyone appeared unhappy or distressed.

We observed the majority of people receiving assistance and support in a timely and respectful manner. We saw that one person got up and left the room and their meal for 20 minutes before staff acted. The person was then assisted by three different staff, only one of whom asked if the person wanted something else to eat. They were then given something else but staff did not check to see how much they had eaten.

Comments from staff included "We are a good team, we work together well". "We have everything we need to be able to care for people living here at Hunters Lodge". Visitors and health professionals were positive in their comments about the care and support offered to people at the home.

The registered manager sent us a copy of the policy and other information such as how they monitor issues and complaints and action they have taken as a result.