This was an unannounced inspection that took place on 12 and 13 November 2018. The service was previously inspected in April 2016, where it was rated 'Good' overall. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns.

We found that some improvements could be made with regard to the service being well-led and have made a recommendation in this area. However, no breaches in regulations were found.

We found that much emphasis was being given to senior manager oversight and forward planning. This in turn sometimes had the negative effect of missing the pressure that staff sometimes worked under and was heavily reliant on agency staff.

The senior managers of the home acknowledged this and confirmed they had plans in place to address it. We have made a recommendation about the need for the provider to develop a specific plan for reducing the dependency on agency staff.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Hampton Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 76 people across three separate units, each of which have separate facilities. There were 69 people living at Hampton Care Home at the time of inspection. People living in the service may have complex physical or health needs or are living with dementia and they need the support of trained nurses.

The home was in the process of recruiting a suitably qualified and experienced registered manager who had both a nursing and social care background. The previous registered manager had left the organisation. 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.

The staff team understood how to protect vulnerable adults from harm and abuse. Staff had received suitable training and spoke to us about how they would identify any issues and report them appropriately. Risk assessments and risk management plans supported people well.

Good arrangements were in place to ensure that new members of staff had been suitably vetted and that they were the right kind of people to work with vulnerable adults.

The acting manager and her senior team kept staffing rosters under review as people's needs changed. We judged that the service employed enough nurses and care staff by day and night. There were suitable numbers of ancillary staff employed in the home.

Staff were appropriately inducted, trained and developed to give the best support possible. We met team members who understood people's needs and who had suitable training and experience in their roles. Medicines were appropriately managed in the service with people having reviews of their medicines on a regular basis. Any issues were dealt with promptly and appropriately.

People in the home saw their GP and health specialists whenever necessary. Where necessary nurses in the home would liaise with external specialist nurses and consultants. The staff team had good working relationships with the local health and social care teams in the area.

People had their needs assessed and the staff team reviewed the delivery of care for effectiveness. They worked with health and social care professionals to ensure that assessment and review of support needed was suitable and up to date.

People told us they were satisfied with the food provided and we saw suitably prepa

We inspected Hampton Care on 4 and 5 April 2016 and the inspection was unannounced. Hampton Care is a care home with nursing providing accommodation and personal care for up to 76 older people including people with dementia. On the day of our visit there were 74 people living in the home. The premises are in the form of a large residential home with lifts to all floors, with nursing staff and facilities on all floors as well as ordinary domestic facilities.

There was a registered manager at the home. 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.

At the last inspection on 17 and 20 April 2015 we found that the staff supervision and training in place was insufficient. We also found that the quality assurance systems in place were not sufficient and did not take into account the views and experiences of people living in the home. We asked the provider to submit an action plan detailing the improvements to be made.

These actions have been completed and on this inspection we found that the relevant requirements were being met.

People’s feedback about the safety of the service described it as good and that they felt safe.

People were safe because the service had provided training to staff and had systems in place to protect them from bullying, harassment, avoidable harm and potential abuse.

Staff protected people’s dignity and rights through their interaction with people and by following the policies and procedures of the service Feedback from people and their relatives was that staff were caring in their attitude and responsive to people’s needs. A caring attitude was observed during the inspection and personalised care, dignity and respect formed part of staff training.

Staff training and supervision had improved since the previous inspection. There was a structure and system in place for regular staff supervision and each member of staff had a training record which was relevant to their role.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene. Medicines were well managed, with staff displaying a sound understanding of the medicines administration systems, recording and auditing systems.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were understood by the manager and acted on appropriately.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

Care, treatment and support plans were seen as fundamental to providing good person centred care. The service had moved to a new computerised system which meant that all staff would be able to access and update these plans at any time. Care planning was focussed upon the person’s whole life, including their goals, skills, abilities and how they prefer to manage their health.

The service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and companionship. The service enabled people to carry out person-centred activities within the service or in the community and encouraged them to maintain hobbies and interests.

This was supported by policies and procedures which emphasised the rights of people and developments in care planning which included people’s life histories written from their own perspective, which enabled staff to work in a person-centred way.

People described the responsiveness of the service as good. People received personalised care, treatme

The inspection team who carried out this inspection consisted of an inspector and an expert by experience. During the inspection, the team worked together to answer 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 using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure.

The staff we spoke with understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We saw that the home was clean and well maintained. People we spoke to told us that they were happy with the cleanliness of the home. Equipment was well maintained and regularly serviced and all health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

We inspected the staff rotas which showed that there were sufficient staff on duty to meet people’s needs throughout the day. However, some people told us that they often had to wait for a long time for staff to respond to calls. The provider may wish to review how staff levels are calculated and linked to current dependencies of people as uncertainty about how quickly a call for help will be answered could lead to a person feeling unsafe.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Recruitment procedures were rigorous and thorough.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Although the registered manager told us that no DoLS applications had been made, they were able to describe the circumstances when an application should be made and knew how to submit one

Is the service effective?

People all had an individual care plan which set out their care needs. Care records showed that people had been consulted with and information was presented from the perspective of the individual. However, some people we spoke with seemed unfamiliar with the concepts of "care plan" and "key worker" and could not recall their involvement in assessments and care decisions. This may therefore be an area for reflection by the provider.

People had access to a range of health care professionals including palliative care and GPs who visited the home. This meant that people were sure that their individual care needs and wishes were known and planned for.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. However, there was evidence that some staff demonstrated better awareness and skills than others, particularly in the areas of personal care assistance. We saw examples of excellent care during mealtimes. At other times, such as when people were using their call bells for help, some calls were not answered for some time.

Staff were aware of people’s preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is The Service Responsive?

The home had developed good links with other agencies, including palliative care services in order to ensure people received appropriate care. The home had activities co-ordinators who offered a range of activities. However, several comments from people indicated that activities may need to be reviewed. Whilst the home offered in-house activities such as singing and manicures, comments from some people were that they wanted more opportunities to go out of the home. There was an adapted minibus which was used by the adjacent day centre.

Some people were unfamiliar with some of the staff and concepts such as "care plans". However, they told us that they were pleased that the new manager took the time to visit them on an individual basis and talk to them.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed in the past but due to staff changes this had lapsed somewhat in the last month or so. The manager was able to describe a plan which included regular review of the quality of the service and increased supervision for staff.

People’s personal care records, and other records kept in the home, were accurate and complete. There was a general atmosphere in the home of teamwork and good communication between staff and manager.

Our inspection on the 29 April 2013 found that records and a number of care related documents were not always accurate or being fully maintained. Written entries in some records were not clearly dated and it was difficult to ascertain precisely when care provided had been administered. There were inconsistencies in how records were written and how care was recorded. We asked the provider to send us an action plan and they did.

During our unannounced visit on the 3 July 2013 we saw improvements had been made. We spoke to staff and reviewed daily records, current care plans and archived care plans.

Our inspection of 21st November 2012 found that some people were not receiving the full care and attention to meet their needs and that there was insufficient staff to meet the changing and diverse needs of people who use the service. The provider wrote to us and told us they would review staffing levels and make changes to how meals would be served within three months. We found some improvements to the level of care provided and staffing levels, although improvements were required in record management.

People we spoke with described receiving attention and good care from staff working at the home. One person told us, "they are all very kind". Relatives we spoke with described staff as "caring" and "helpful".

Four people living at the home said that staff were particularly busy in the afternoons, evenings and at weekends. The staff we spoke with gave similar accounts. The manager sent us details, which we checked, relating to qualified nurses who had been booked using a long term placement agency. This was to cover staff shortage until the current recruitment process was successfully completed.

We looked at the records and a number of care related documents and found that some records were not always accurate or being fully maintained. Written entries in some records were not clearly dated and it was difficult to ascertain precisely when care provided had been administered. There were inconsistencies in how records were written and how care was recorded.

People told us that the staff worked hard to provide the care they needed. People told us that they enjoyed the food provided and that there was a good choice of food available although some said they would prefer a choice of snacks towards the end of the day rather than a main meal. Relatives, visitors and some people living at the home complimented the staff on their manner and approach to caring for people while others expressed their concerns in relation to some aspects of care and an apparent lack of staffing and the time taken to respond to call bells. One person said "staff are marvellous, nothing is too much trouble". Another person said "the staff are very caring and approachable". Some people felt that the more vulnerable people living at the home did not always receive the care and support they needed, commenting that "people in their rooms who needed help were sometimes overlooked". One person said "messages I've left don't always seem to have been acted on, and I had to chase up several concerns". We observed staff caring for people at meal times in the main dining area and the communal areas and we saw care being provided sensitively. We also saw that people in their rooms were often left for long periods without attention or anyone checking on their needs.

In February 2012 we inspected the service and found that people’s medication was not always being safely managed, and that people’s dignity and respect was not always being addressed.

We made a further unannounced visit the home on the 20th June and spoke with seven people living at Hampton Care Ltd., five visitors and nine staff who work at the service.

People told us that they were offered opportunities to be involved in activities and trips, and could join in with events happening in the home. The individual we spoke with reported that staff were kind, considerate and supportive, and that they had confidence in the staff and their ability to care for people.

To help us understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool during the visit. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences. We conducted four separate SOFI observations over a period of one hour and forty-five minutes. We observed staff talking with people, asking how they were, and offering them choices while supporting them to participate in daily life at the home. Staff assisted people with their meals and engaged in conversation with some of the people we observed.

At this inspection we found that improvements had been made with reference to medication and that people were receiving care that respected their privacy and dignity.

We spoke with people living at the home, their visitors and staff. Some people told us that they were very happy living at Hampton Care. They told us that they had things to do, that they liked the environment and food and that the staff were kind and caring. Other people told us that they sometimes felt that their care needs were not always met. They said that although some staff were very kind, others appeared rushed and did not always give them the care and attention they wanted.

We conducted an inspection of the service in July 2011. At this inspection we found that people’s medication was not always being managed safely, that there were some risks to their health and safety in the environment and that they were not always being treated with respect. We returned to the service in November 2011 to see if improvements had been made to medication management. We saw that although some improvements had been made, some practices still put people at risk. At this inspection we saw that improvements had been made to the health and safety of the environment but that people were not always treated with respect and that their medication was not always safely managed.

We visited the home in July 2011 and found that people who live at the home may be at risk because medication practices were not always safe. People were sometimes administered medication without their knowledge and there was not enough evidence to explain why and how this is done.

A pharmacy inspector returned to the home in November 2011 to see if improvements had been made to the way in which medication was managed. We did not look at the rest of the service or check compliance with other standards during this visit.

At our visit in July 2011 people told us that they liked the home. They said that the staff were caring, the environment was good, there was plenty for them to do and they liked the food. They told us that they knew who to speak to if they had any concerns and that the manager was always available for them.

People who live at the home, their visitors and the other professionals we spoke to told us that they liked the home. They said that the staff were caring, the environment was good, there was plenty for them to do and they liked the food. They told us that they knew who to speak to if they had any concerns and that the manager was always available for them.

Some of the things people said were, ‘a lovely nursing home’, ‘the staff are very caring, supportive and helpful – nothing is too much trouble for them’, ‘the home is excellent’, ‘I would recommend this home’ and ‘as a visitor I am always made to feel welcome’.

In general we found that people were being well cared for. However, we found some practices which put people at risk. We spoke to the manager about these and she agreed to take action to make sure people were safe.

We inspected Hampton Care on 17 and 20 April 2015 and the inspection was unannounced. A previous inspection had taken place on 16 June 2014 where the home was found to have met the regulations we inspected.

Hampton Care is a care home with nursing providing accommodation and personal care for up to 76 older people. On the day of our visit there were 72 people living in the home. The premises are in the form of a large residential home with lifts to all floors, with nursing staff and facilities on all floors as well as ordinary domestic facilities.

At the time of inspection the home’s manager was newly appointed and had submitted an application to the Care Quality Commission for registration. 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.

People’s feedback about the safety of the service described it as good and that they felt safe.

People were safe because the service had systems in place to protect them from, bullying, harassment, avoidable harm and potential abuse.

The service had a proactive approach to respecting people’s human rights and diversity and this prevented discrimination that may lead to psychological harm. Staff protected people’s dignity and rights through their interaction with people and by following the policies and procedures of the service.

The service managed the control and prevention of infection well. Staff followed correct policies and procedures and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene.

There was a lack of consistency in the effectiveness of the care, treatment and support people received. This was reflected in what we found during the inspection and echoed in the feedback we received from some people and their relatives.

Management knew that staff needed training and support, and had put in plans to achieve this. However, this was not up to date for all staff and did not always cover the right areas to meet people’s needs. This was demonstrated by shortfalls in the amount of supervision and appraisal staff received and the depth of training in areas such as dementia and person centred care.

This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which requires providers to ensure that staff are trained and supervised appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005 were understood by the manager and acted on appropriately.

People at risk of poor nutrition and dehydration were sufficiently monitored and encouraged to eat and drink. The quality of the food was good, with people getting the support they needed and the choice that they liked.

People and relatives spoke positively about the caring attitude of the staff. People received care and support from staff who know and understand their history, likes, preferences, needs, hopes and goals. The relationships between staff and people receiving support demonstrated dignity and respect, and staff understood and responded to each person’s needs in a caring and compassionate way.

This was supported by policies and procedures which emphasised the rights of people and developments in care planning which included people’s life histories written from their own perspective, which enabled staff to work in a person-centred way.

People nearing the end of their life received compassionate and supportive care.

People described the responsiveness of the service as good. People received personalised care, treatment and support and were involved in identifying their needs, choices and preferences and how they are met. People’s care, treatment and support was set out in a written plan that described what staff need to do to make sure personalised care is provided.

Care, treatment and support plans were seen as fundamental to providing good person centred care. The service was in the process of updating care plans and moving to a new computerised system which meant that all staff would be able to access these plans at any time. Care planning was focussed upon the person’s whole life, including their goals, skills, abilities and how they prefer to manage their health.

The service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and companionship. The service enabled people to carry out person-centred activities within the service or in the community and encouraged them to maintain hobbies and interests.

People and their relatives described the front-line staff as very good. However, after a period without a registered manager and with the current manager being in post for only three months there were mixed views from people, their relatives and staff about the culture of the home and the quality of leadership and communication between the service and people.

The new manager has reacted well to immediate problems within the service, such as ensuring the recruitment of permanent staff and updating systems and procedures. However, the provider did not have sufficient systems or processes in place to assess, monitor and improve the quality and safety of the services provided in the home, including the quality of the experience of people living in the home. We also found that the provider did not have sufficient systems or processes in place to enable them to seek and act on feedback people and others on the services provided in the home in order to evaluate and improve the service.

This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which requires providers to ensure that they have robust quality assurance systems in place.

You can see what action we told the provider to take at the back of the full version of the report.