People’s experience of using this service:

People and their relatives were positive about the quality of care at the home. Typical comments included, “The staff are fabulous – it feels like they are because they really care.” People told us how much they enjoyed the efforts that staff made to organise fun social events and make the place feel homely.

People told us they felt safe in the home and received their medication at the right times. There were enough staff on duty to keep people safe and to allow staff to spend time with people without having to rush.

Staff received the training they required to meet people’s needs and told us that the training had helped them to improve their practice. People told us how much they enjoyed the food on offer and we saw they had access to food and drinks throughout the day. Staff were consistently monitoring people’s health and acted quickly to refer people to healthcare professionals when it was needed.

Staff treated people with kindness and respect and were patient in helping people when they became anxious or confused. People’s independence was promoted because staff allowed people to mobilise independently and carry out tasks that people could do for themselves.

People and relatives knew how to complain and felt confident that action would be taken if they had any concerns. There were plenty of activities and events to keep people busy and people’s individual needs had been assessed and were being met.

People and staff were happy with the way the service was being led and managed. The registered manager was well-known and people felt they were approachable. There was a culture of quality improvement in the home, with action being taken when issues were identified.

More information is in the detailed findings below.

Rating at last inspection:

Good (report published 07 September 2016)

About the service:

Hasbury Care Home is a care home that provides personal care for older people, some of whom are living with dementia. At the time of the inspection, 19 people lived at the service. The home was established over two floors, with a range of communal areas included dining spaces, a large garden and smaller lounge spaces.

The service had a manager registered with the Care Quality Commission. This means they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

No enforcement action was required.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 27 and 29 July and was unannounced. We last inspected this service in June 2015 and found that the service required improvement. There were no breaches in regulation at the last inspection.

The home provides care and accommodation for up to 24 older people, some of who were living with dementia or have additional mental health needs. Nursing care is not provided. The accommodation is provided in both single and shared bedrooms. On the day of our inspection there were 23 people living at the home.

The registered manager was not present on the first day of our visit as they were on annual leave. They were present on the second day of our visit. 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.

People who lived in this home and, where appropriate, people’s relatives, told us that they were happy with the care provided.

People told us they felt safe and they were supported by staff who had received training on how to protect people from abuse. We identified a concern about a person’s safety in relation to an allegation that may not previously have been appropriately responded to. We brought this to the attention of the person in charge. On our second visit to the home we checked to make sure this allegation had been reported to the local authority and were provided with evidence that this had been done.

We saw there were systems and processes in place to protect people from the risk of harm. Care plans contained guidelines and risk assessments to provide staff with information that would protect people from harm, but incidents of falls did not always lead to an immediate review of the person’s falls risk assessment.

There were sufficient numbers of staff available to meet people’s individual needs. We saw that appropriate pre-employment checks had been carried out for members of staff. These checks are important and ensure as far as possible that only people with the appropriate skills, experience and character are employed. Staff told us and records confirmed that they received regular training and supervisions with senior staff to maintain their skills and knowledge.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected. We looked at whether the service was applying the safeguards appropriately. The registered manager and staff we spoke with understood the principles of the MCA and associated safeguards. They understood the importance of making decisions for people using formal legal safeguards.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when this was required. We reviewed the systems for the management of medicines and found that people received their medicines safely.

People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Staff demonstrated an understanding of people’s individual needs and preferences. They knew how people communicated their needs and if people needed support in certain areas of their life such as assistance with their personal care. We saw staff talking and listening to people in a caring and respectful manner.

People knew how to raise complaints and the provider had arrangements in place so that people were listened to and action could be taken to make any necessary improvements.

People who lived at the home, their relatives and staff were encouraged to share their opinions about the quality of the service and there were effective systems in place if people wished to make a comp

This inspection took place on 3 June 2015 and was unannounced. At the last inspection on 2 July 2014 we found that the provider had breached the regulations in relation to medication practice. Following our inspection the provider sent us an action plan telling us what they were doing to put things right. At this inspection we found that improvements had been made and there were no breaches in regulation.

The home provides care and accommodation for up to 24 older people, some of who were living with dementia or have additional mental health needs. Nursing care is not provided. The accommodation is provided in both single and shared bedrooms. On the day of our inspection there were 22 people living at the home.

The registered manager was present during 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 and associated Regulations about how the service is run.

People who lived in this home and, where appropriate, people’s relatives, told us that they were happy with the care provided.

We saw there were systems and processes in place to protect people from the risk of harm. Care plans contained guidelines and risk assessments to provide staff with information that would protect people from harm. These were not always consistently followed by staff. People were supported by staff who had received training on how to protect people from abuse.

We saw that appropriate pre-employment checks had been carried out for new members of staff. These checks are important and ensure as far as possible that only people with the appropriate skills, experience and character are employed.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The associated safeguards to the Act require providers to submit applications to a ‘Supervisory Body’ for authority to deprive someone of their liberty. We looked at whether the service was applying the safeguards appropriately. The registered manager and staff we spoke with understood the principles of the MCA and associated safeguards. They understood the importance of making decisions for people using formal legal safeguards.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals when this was required. We reviewed the systems for the management of medicines and found that people received their medicines safely.

People’s needs had been assessed and care plans developed to inform staff how to support people appropriately. Staff demonstrated an understanding of people’s individual needs and preferences. They knew how people communicated their needs and if people needed support in certain areas of their life such as assistance with their personal care. We saw staff talking and listening to people in a caring and respectful manner.

People knew how to raise complaints and the provider had arrangements in place so that people were listened to and action could be taken to make any necessary improvements.

We found that whilst there were systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the home was consistently well led. We found that some improvements were needed.

This inspection was undertaken by one inspector. At the time of our inspection there were 24 people staying at the home.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

There were effective recruitment and selection processes in place. These processes included the completion of an application form, being interviewed and appropriate checks being undertaken.

People in the home appeared relaxed and comfortable with the care staff who were supporting them. People confirmed they felt safe living at the home and the relatives of two people who lived at the home told us they thought people were safe.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS)which applies to care homes. While no applications have been made under this legislation for any person living at the home we found that the manager understood their responsibilities in relation to the law.

The systems for ensuring people received their medication as prescribed needed to be improved. We found there had been some occasions where medication had run out before new supplies had been received. We spoke to the manager about this incident and subsequently received information outlining the circumstances of this matter together with assurances that the errors would not be repeated.

Is the service effective?

Staff received the support and training needed to ensure that they offered effective support to people that used the service.

There were some organised activities available for people and a schedule of activities was on display in the home.

People were observed to have been appropriately supported with dressing, personal hygiene and grooming. With the exception of one person, everyone told us they were satisfied with the frequency they were offered a bath or shower.

Our discussions with staff showed they had a good awareness of people's health conditions and records showed that people were supported to attend the health care checks that they needed to.

People had access to a range of health and social care professionals both within the community and those that visited the home. Following our visit, we spoke with a health professional who had regular contact with people at the home. They told us they had no major concerns about the care people received and that when they suggested areas for improvement that these were acted on.

Is the service caring?

People who were staying at the home made positive comments about the staff who supported them. One person told us, “Staff are all lovely and help me.” Another person told us, “I could not find anywhere better.” We spoke with the relatives of two people living at the home who told us they were satisfied with the care provided. One relative told us, “Staff are really lovely, I’ve no concerns, it’s an excellent home.”

From observations it was evident that staff took their time when supporting people and did not hurry them. We saw good interactions between people and staff. We saw that staff were friendly and laughing and joking with people as they offered support. We saw that people were supported by staff in a sensitive and respectful way.

Is the service responsive?

We found that people who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People had opportunities to express their views about the service provided. This included their involvement in group meetings and service satisfaction surveys. Surveys seen indicated that people were mostly happy with the service. People told us they were able to raise any concerns they had.

Our previous inspection in January 2014 we found that there were some areas that needed to be improved and we issued compliance actions. At this inspection we found that improvements had taken place to meet the compliance actions.

Is the service well-led?

We saw that the home had a staffing structure that enabled the service to be managed appropriately. This included a manager that was registered with us and was responsible for the running of the service.

A care staff told us “It’s very rare I have any concerns. The home runs smoothly, staff are all lovely to work with and the management structure works well.” A relative of a person living at the home told us the manager was approachable. They told us the manager had been open about the findings of our previous inspection and that the home needed to make improvements.

There were 22 people using the service at the time of our inspection. We spoke with nine of these people and four of the staff that were supporting them. We spoke with five visitors to the service, including relatives and health care professionals.

People told us that they were happy with how their care and support needs were being met. One person who had lived at the home for some time told us, “My brother found it (the home). He looked at it and was quite impressed with how clean it was and how friendly the staff were. As soon as I saw it, it did impress me. I like it. I like good standards.”

People told us that staff were usually available at the times they needed them and that they supported them in a respectful manner. People told us that staff offered them choices of how and where they wanted to spend their time.

We saw that care planning was at times incomplete, which meant that staff lacked guidance in giving people effective care.

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns. A person using the service told us, “After living for years on my own, I feel safe. Safer than before.”

The systems in place for monitoring and assessing the service were ineffective and failed to identify and address issues that impacted on positive outcomes for people using the service.

There were 23 people using the service at the time of our inspection. We spoke with six of these people and the staff that were supporting them.

People told us that they were happy with how their care and support needs were being met. They told us that staff were available at the times they needed them and that they supported them in a respectful manner. People told us that staff offered them choices of how and where they wanted to spend their time. Comments included: “There are staff available to help me whenever I need them,” and “The staff treat me very well.”

People told us about the quality and choice of food and drink available. They told us that they were satisfied about the choice and quality of meals and that food and drink was readily available to them. A person using the service told us “The food is good and we get a choice of meals. I particularly enjoy the roast dinner on a Sunday.”

People told us that they felt safe living at the home and that they would speak to the staff if they had any concerns. A person using the service told us “I would talk to the staff if I had any complaints.”

During our inspection, we asked local authority staff involved in monitoring the home about the quality of service provided. They told us that they did not have any concerns about the service provided.

People who use the service told us that they were happy with the service provided at Hasbury Care Home. They told us that they received care and support in the way they preferred and in a respectful and timely manner. People told us that they were supported by care workers who had a good understanding of their care and support needs.

People told us:

“I couldn’t really be made more comfortable”

“I came from hospital to here. I am quite content”.

“The staff come very quickly to help us. They are very good staff”.

People that use the service told us that they were happy with the meals provided.

People told us:

“The food is excellent and there is plenty of it. We have a good Cook”.

People told us that they are encouraged to pursue any hobbies or interests that they may have. People told us that they are supported to maintain relationships that are important to them.

People told us:

“I am happy here. I go to a club at the church three times a week”

“My family are coming to visit me today and they are taking me out somewhere”.

People told us that they felt confident to raise any concerns that they may have about the service and that actions are taken in response to these.

People told us:

“If there was a problem we would speak to one of the staff or the owner”

People told us they had everything they needed and that their rooms were clean.

People told us:

“It is very clean here. I can vouch for that”.