Handford House 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 service provides residential and nursing care in a purpose built building for up to 52 older people, some of whom are living with dementia. There were 51 people living in the service when we inspected on 19 and 20 April 2018. This was an unannounced comprehensive inspection.

We last inspected this service in April 2017 and rated the service as ‘requires improvement’ in all key questions. We found the home was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During that inspection, we found that, there were insufficient numbers of staff on duty; staff were not always deployed effectively in order that they could meet people's needs effectively. Staff were not always well supported, and they did not receive any formal supervision or appraisal.

We also found that, although all medicines were administered by staff who were trained to do so, some aspects of the medicines management needed improvement. People's care records did not demonstrate their involvement in decision making. Mental capacity assessments were not completed and best interest meetings had not always taken place for people who lacked capacity to make decisions for themselves.

Care plans were not all up to date; the information within them was not always current. We could not be confident that people always received the care and support they needed. People received support from staff that were mainly kind and caring. However, people were not always treated with dignity and respect because staff were task focussed and care took place in a manner that was not centred on people as individuals and was at times hurried.

There was a quality assurance audit in place however the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process. This meant that the systems in place to assess and monitor the quality of care provided were not effective.

Following that last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of care a support people received to at least good.

During this inspection on 19 and 20 April 2018, we found that improvements had been made to meet the requirements to help ensure that people received a good service and were no longer in breach of regulations.

Handford House Care Home has had a newly registered manager since our last inspection in April 2017. 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 registered manager took up their post in June 2017 shortly after the previous manager had left. The new manager completed their registration process with us in September 2017. The people who used the service, their relatives and staff told us that they thought the new registered manager had made many positive changes to the quality of the service people received.

The people we spoke with and relatives also said they believed people were safe and well cared for. There were systems in place that provided guidance for staff on how to safeguard the people who used the service from the potential risk of abuse. Staff understood their roles and responsibilities in keeping people safe. There were processes in place to ensure the safety of the people who used the service. These included risk assessments, which identified how risks to people were minimised.

There were sufficient numbers o

Handford House provides accommodation and nursing and personal care for up to 52 older people. There were 51 people living in the home on the first day of our inspection.

This inspection took place on 26 April and 2 May 2017 and was unannounced on both days.

A registered manager was in post at the time of our 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 2008 and associated Regulations about how the service is run.

There was a change of provider at the home during April 2016 when the current provider Healthcare Homes Ltd took over the running of the home.

There were insufficient numbers of staff on duty. Staff were not always deployed effectively in order that they could meet people’s needs effectively. Staff were not always well supported. They did not receive any formal supervision or appraisal.

All medicines were administered by staff who were trained to do so but some aspects of medicines management needed improvement.

Care records did not demonstrate people's involvement in decision making. Mental capacity assessments were not completed and best interest meetings had not always taken place for people who lacked capacity.

Care plans were not all up to date; the information within them was not always current. We could not be confident that people always received the care and support they needed.

People received support from staff that were mainly kind and caring. However, people were not always treated with dignity and respect because staff were task focussed and care took place in a manner that was not centred on people as individuals and was at times hurried.

There was a quality assurance audit in place however the system was not always effective because issues identified at the inspection had not been recognised during the monitoring and auditing process.

Staff had an understanding of abuse and safeguarding procedures. They were aware of how to report abuse as well as an awareness of how to report safeguarding concerns outside of the service. Staff undertook safeguarding training providing them with knowledge to protect people from the risk of harm.

Risk assessments in relation to people, such as mobility, skin integrity and choking were in place and identified control measures to minimise risk.

Referrals were made to external healthcare professionals and we saw involvement from district nurses, chiropody, dentists and GPs.

We found the home was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 26 February 2015 and the inspection was unannounced. Handford House Care Home provides personal care for up to 52 older people, some living with dementia.

There was a registered manager in post. 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.

There were enough staff to support people safely and staff knew what to do if they suspected someone may be being abused or harmed. Recruitment practices were robust and contributed to protecting people from staff who were unsuitable to work in care. Medicines were managed and stored properly and safely so that people received them as the prescriber intended.

Staff had received the training they needed to understand how to meet people’s needs. They understood the importance of gaining consent from people before delivering their care or treatment. Staff were clear about their roles. Where people were not able to give informed consent staff and the manager ensured their rights were protected.

People have enough to eat and drink to meet their needs and staff assisted or prompted people with meals and fluids if they needed support.

Staff treated people with warmth and compassion. They were respectful of people’s privacy and dignity and offered comfort and reassurance when people were distressed or unsettled. Staff also made sure that people who were becoming unwell were referred promptly to healthcare professionals for treatment and advice about their health and welfare.

Staff showed commitment to understanding and responding to each person’s needs and preferences so that they could engage meaningfully with people. Outings and outside entertainment was offered to people and staff offered activities on a daily basis.

Staff understood the importance of responding to and resolving concerns quickly if they were able to do so. Staff also ensured that more serious complaints were passed on to the management team for investigation. People and their representatives told us that any complaints they made would be addressed by the manager.

The service had consistent leadership. The staff told us that the manager was supportive and easy to talk to. The manager was responsible for monitoring the quality and safety of the service and asked people for their views so that improvements identified were made where possible. The organisation also carried out quality assurance visits, set action plans and checked the actions had been undertaken.

We spoke with eight people who used the service. We also spoke with three staff members. We looked at five people's care records. We looked at other records including health and safety checks, staff and resident meeting minutes and the result of the satisfaction survey that had been carried out by the service. During our inspection and the analysis of our inspection findings we considered the questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

We found that the service was safe. When we arrived our identification was checked and we were asked to sign the visitor's book. Later, when we needed to re-enter the building, a different staff member challenged us for our identification. This showed that the staff took the security of the building and the safety of the people who lived there seriously.

We saw that staff wore their identity badges so that visitors and non-authorised people could be identified.

When we spoke with people they told us they felt safe living in the service and that they would speak with the staff if they had concerns.

Staff were trained to identify and act on any suspicion of abuse and our records showed that the service had acted quickly to safeguard people if they considered people were at risk.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), which was updated every year. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

We saw records which showed that the health and safety checks were carried out in the service regularly and action was taken if equipment was found to be faulty or unsafe. This included regular visual checks and servicing of equipment such as hoists, the fire alarm panel and wheelchairs. Regular fire safety and legionella tests and checks were carried out, which showed that people were protected from unsafe or poorly maintained equipment.

We saw that there were sufficient staff on duty to protect people’s health, safety and wellbeing. The staff rota and dependency level assessments showed that the service assessed people's needs to ensure that there were sufficient numbers of staff to meet their needs. People told us that the staff were available when they needed them. One person said, "I don’t have to wait long for help." Another person told us that, “We are always properly looked after.”

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said, "It’s brilliant here, especially when the sun comes out and we can get into the garden."

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information about how people's needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said that staff were, "Alright." Another person told us, "I couldn’t find anything to complain about."

Is the service responsive?

People who used the service were provided with the opportunity to participate in activities which interested them. People's choices were taken into account and listened to. The activity team worked flexibly, coming in at different times of the day to enable people to participate in activities of their choice.

We saw evidence that the service was flexible and made changes as required to ensure people were kept safe. For example staffing levels were based on the assessed needs of the people. If necessary, because of unforeseen circumstances, staffing levels would be increased to ensure people’s needs were met.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including the doctor, district nurse and dietician.

The people who used the service, their relatives and other professionals involved with Handford House who had completed the satisfaction questionnaires said that they felt that the service responded well to concerns raised with them. Where shortfalls or concerns were raised they were dealt with quickly.

Is the service well led?

Annual surveys were sent to the people who used the service and their relatives. The questions included; how do you rate the standard of care delivery in the home and how do you rate the standard of how telephones enquiries are handled? Forty-five questionnaires were returned and 87% of the questions were answered positively. Of those sent to the professional bodies, 12 were returned and 96% of them were positive.

The service had an effective quality assurance system in place and the records we examined showed that identified shortfalls were addressed promptly. This would ensure that the quality of the service was maintained.

The staff we spoke with told us that the manager was supportive, easy to approach and listened to what they had to say. The manager also told us that they felt supported by the organisation and by their direct line manager, who visited the service regularly to offer support and to check compliance.