This inspection took place on the 12, 15 and 19 February 2018 and was unannounced. At the previous inspection of this service in April and May 2017 the overall rating was requires improvement. At that inspection we found Breaches of Regulation 9, 10, 11, 12 and 17. This was because people’s safety was being compromised in a number of areas. Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic. People had not always received their medicines in a timely way and there was poor recording of topical creams, dietary supplements and ‘as required’ medication. The deployment of staff had impacted on the care delivery and staff were under pressure to deliver care in a timely fashion. The provider had not been meeting the requirements of the Mental Capacity Act (MCA) 2005 and staff were not following the principles of the MCA. Quality assurance systems were not robust as they had not identified the shortfalls found in care delivery and record keeping during that inspection process.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key questions safe, effective, caring, responsive and well led to at least good. This inspection found significant improvements had been made and the breaches of regulation met.

Hastings Court 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. Hastings Court provides accommodation and nursing care for up to 80 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. Hastings Court also provides ten short term care beds purchased by the Local Authority for people who were not ready to go home from hospital. There were 58 people living in the home during our inspection.

The service had a registered manager in place. 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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service now met legal requirements. We found improvements had been made in the required areas.

The overall rating for Hastings Court has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service and to ensure the improvements have been sustained.

People spoke positively of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. Care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and epilepsy. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home.

All staff had attended safeguarding training. They demonstrated a clear

We inspected Hastings Court on the 27 April, 28 April, 02 and 7 May 2017. Hastings Court provides accommodation and nursing care for up to 80 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. There were 58 people living in the home during our inspection.

The home was purpose built to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over three floors and split into four units. Peony unit provided nursing care, Poppy and Sunflower units provided care and support for people who lived with dementia and Bluebell unit provided 10 blocked beds for those who had left hospital and needed care and support before either going home or on to a long term placement.

Hastings Court is owned by Hastings Court Ltd and the organisation has one other care home in Essex.

This comprehensive inspection was brought forward by six months due to a large number of concerns raised by families, friends and staff.

Due to a high number of concerns raised about the safety of people, care delivery, deployment of staff and staffing levels we brought forward the scheduled inspection to the April 2017, so we could ensure that people were receiving safe care from sufficient numbers of suitably qualified staff.

At this inspection, people’s safety was being compromised in a number of areas. Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic. We found that people with specific health problems such as breathing irregularities, diabetes and skin conditions did not have sufficient guidance in place for staff to deliver safe treatment. We also found that not all care plans reflected people’s health needs such as care of people post-surgery, catheters and breathing issues. The deployment of staff impacted on the care delivery and staff were under pressure to deliver care in a timely fashion. Shortcuts in care delivery were identified in that person care was not delivered in the way people needed. We also found the provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not following the principles of the MCA. We found there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves, as required under the MCA Code of Practice.

The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes and dislikes. Information in respect of people’s lifestyle choices was not readily available for staff. The lack of meaningful activities at this time impacted negatively on people’s well-being.

Quality assurance systems were in place but had not identified the shortfalls in care delivery and record keeping. Incidents and accidents were recorded but there was no overview available that identified actions taken and plans to prevent a re-occurrence. We could not be assured that accidents and incidents were consistently investigated with a robust action plan to prevent a re-occurrence.

People’s medicines were stored safely and in line with legal regulations. However people did not always receive their medicines as prescribed. There were missing signatures for medicines. These had not been followed up to ensure that people received their prescribed medicines. We also found poor recording of topical creams, dietary supplements and ‘as required’ medication.

People and visitors we spoke with were complimentary about the caring nature of some of the staff, but said that the changes to staff, use of agency staff and staff leaving had impacted on how the home was run. Some people were supported with little verbal interaction, and some spent time isol

Hastings Court provides accommodation and nursing care for up to 80 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. There were 57 people living in the home during our inspection.

The home was purpose built to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over three floors and split into three units. One unit provided nursing care with the second and third units providing care and support to people living with dementia.

Hastings Court is owned by Hastings Court Ltd and the organisation has one other care home in Essex.

We last inspected Hastings Court in October 2015 where the overall rating was good. We received multiple concerns in September 2016 from whistleblowers in relation to people’s safety. As a result we undertook an unannounced focused inspection on the 18 and 21 September 2016 to look into those concerns and be assured of people’s safety. This report only covers our findings in relation to the key question of whether the service is safe.

The service did not have a registered manager. The registered manager resigned from post in August 2016. 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 is an acting manager in post who has a good knowledge of the home and the people who live there. Interviews are currently being held to recruit a manager.

Before this inspection we received concerns that medicines were not always dispensed and handled by appropriately qualified staff. We found all staff that dispensed and handled medicines had received training and been assessed as being competent. However the handling of medicines was not always safe and some people did not always receive their prescribed medicines. The staff in Hastings Court had identified the errors and taken immediate action to mitigate risk to people’s safety. We found that there were sufficient appropriate and qualified staff to meet people’s needs. Clarity to staff role and duty rotas was an area that required improvement as it was unclear of staffs’ qualifications and experience to take responsibility for safe care delivery.

People said they were happy and well looked after. We found people were comfortable and happy moving around the home and spending time where they wanted to. The provider ensured a thorough recruitment procedure was followed when new staff were employed. Staff understood how to recognise any possible abuse and how to respond to any suspicion or allegation of abuse to safeguard people.

We inspected Hastings Court on the 22 and 23 October 2015. Hastings Court provides accommodation and nursing care for up to 80 people, who have nursing needs, including poor mobility, diabetes, as well as those living in various stages of dementia. There were 34 people living in the home during our inspection.

The home was purpose built to provide a safe environment for people living there. Bathrooms were specially designed and doors were wide enough so people who were in wheelchairs could move freely around the building. Accommodation was provided over three floors and split into three units. One unit provided nursing care with the second and third units providing care and support to people living with dementia.

Hastings Court is owned by Hastings Court Ltd and the organisation has one other care home in Essex.

A registered manager was 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 and associated Regulations about how the service is run.

People commented they felt safe living at Hastings Court. One person told us, “I’ve never felt unsafe or seen anything that worried me.” Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

Policies and procedures were in place to safeguard people. Staff were aware of what actions they needed to take in the event of a safeguarding concern being raised. There was an open culture at the home and this was promoted by the management team who were visible and approachable.

Personalisation and care centred in the individual was at the forefront of the delivery of care. The management team told us, “We are a resident led home.” There was an outstanding focus on providing care and support that focused on the need of the person but empowered their individuality and identity. With pride, staff told us how they implemented the ‘Butterfly’ approach and provided high quality care to people living with dementia.

People spoke highly of the food. One person told us, “The food is very good; I’ve got no complaints whatever.” Any dietary requirements were catered for and people were given regular choice on what they wished to eat and drink. Risk of malnourishment was assessed and where people had lost weight or were at risk of losing weight, guidance was in place for staff to follow.

People told us they were happy living at Hastings Court. One person told us, “I’ve been here since it opened, and I love it, it’s wonderful.” Staff spoke highly about the people they supported and spoke with pride and compassion when talking about people. People’s privacy and dignity was respected and staff recognised that dignity was individual and should be based on what each person wants.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff.

The provider had processes to support staff to carry out their roles safely and effectively. Staff were encouraged to take further qualifications to develop their careers.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Staff said the management was fair and approachable, care meetings (handovers) were held after each shift to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management team was very good; and were always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The provider had systems in place to review the support and care provided. Audits were undertaken regularly, including those for care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.