Hastings Care Home is registered to provide accommodation for up to 63 older people who need personal care. On the day of our inspection there were 57 people living at the home.

The inspection took place on the 1 and 2 March 2016 and was unannounced.

There was a registered manager at this home. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said there was sufficient staff available to keep people living at the home safe. However they said sometimes there were delays in staff responding to people’s needs. They told us that at certain times and in certain areas of the home more staff would improve the quality of their care. They told us staff were caring and promoted people’s independence as much as possible. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People and their relatives told us they had access to health professionals as soon as they were needed, and there was a weekly visit from their GP for most of the people living at the home.

Relatives said they felt included in planning for the care their relative received and were always kept up to date with any concerns. Relatives said a thorough assessment of people’s needs when they arrived at the service really supported staff to know their family member well. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. We saw the registered manager had put improvements in place as a result of complaints made, and monitored the results.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well, and took people’s preferences into account and respected them.

The management team had assessed people’s ability to make specific decisions about their daily life when needed. They had put in place support for people when they needed, to ensure decisions were made in a person’s best interest within the legal framework. We saw applications to the supervisory body were made when needed. This was to ensure any decisions to restrict somebody’s liberty were made by people who had suitable authority to do so.

People who lived at the home and staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. The registered manager also sought the views of relatives and professionals. The provider and registered manager had systems in place to monitor how the service was provided, to improve the quality of care provided. The actions needed to improve staffing levels had not been completed at the time of our visit.

Following our inspection in June 2013, we set a compliance action in one outcome area where we had concerns. This was about the storage and auditing of boxed medicines.

At this inspection we found that progress had been made in the storage and checking systems for people’s boxed medicines. This meant that where we had previously had concerns we found that improvements had been made.

We saw that there were systems in place that checked people’s boxed medicines to ensure people always received these at the right time as prescribed. This made sure people's health needs were effectively met.

Following our inspection in February 2012, we set compliance actions in two outcome areas where we had concerns. These were mainly about the accuracy of reflecting people's needs within their care plans at all times.

At this inspection we found that progress had been made in all the outcome areas where we had previously had concerns and improvements had been made.

We spent time at the home watching to see how staff supported people, and talking with people about life at the home. We spoke with four people who lived at the home and three relatives. We also looked at records, and spoke with four staff and the manager.

People were positive about the care provided at the home. One person said: "Care is good here and staff are lovely”. Another person told us: “They (staff) are kind and help me”.

We saw that staff were kind and caring when they provided support for people who lived at the home. Staff showed that they had a good knowledge of the people they were caring for. This enabled staff to offer effective care and support to the people.

The arrangements for boxed medicines needed to be improved. We found by counting some people's medicines we could not tell whether people were always receiving their medicines at the right time, as prescribed to meet their health needs.

The manager and the provider's representative were able to demonstrate that systems for monitoring the quality of the service were effective.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a practising professional.

Fifty seven people lived in the home when we visited. Some of the people were not able to talk directly with us because of their health conditions so we used different methods to see whether they received the care and support they needed.

We talked with four people who lived in the home and eight staff. We looked at the care records for four people to see how their needs should be met. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People who lived in the home that we were able to speak with were happy with the quality of the care provided. They said, ‘’I am quite happy here and staff help me when I need them to’’ and ‘’It’s excellent here and they (staff) all care.’’

People we spoke with told us that staff treated them with respect and helped them to be as independent as possible. Throughout the day we observed staff supporting people with words of encouragement where needed whilst completing tasks. We also saw that time was taken to pass the time of day through general chat between people who lived in the home and staff. It was evident that staff had a good rapport with people and it became evident that the manager and staff knew people’s likes and dislikes.

We observed lunch being served to people who lived in the home during our visit. Staff were seen to offer people choices of where they would like to eat their meal and assistance was provided at people’s own pace. Many of the people who lived in the home who we spoke with told us that they were happy with the meals provided at Hastings Care Home. They said, ‘’Meals are superb’’ and ‘’I enjoy all the meals.’’

When we visited Hastings Care Home we spoke with people who lived there, staff on duty, the registered manager and deputy manager. Some people who used the service were able to tell us about their experiences. People told us that they were cared for by male and female staff, and they were “all very good”. We were told that they were able to “get up and go to bed when they wanted to” and “can have a shower every morning if wanted”. People said that staff were respectful towards them. One person told us that they had a leaflet which informed them of the activities that were taking place. They told us that they had attended some activities in the home, but “found them boring”. We asked one person that we spoke with if they felt safe living at Hastings and they responded “very much so”.

We spoke with a person who was sitting alone in a communal room. They had access to a call bell to enable them to call for help. They told us that when they called for help the “speed of response varies between five to 10 minutes”. We observed on two occasions during our visit that staff were taking a considerable length of time to respond to the call bell. On one occasion it was 10 minutes before a response was provided, and on another it was over 15 minutes and that was only addressed as we told the registered manager about the length of time the same call bell had been ringing.

Some of the people that use the service at Hastings Care Home have dementia and therefore not everyone was able to tell us about their experiences. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. 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 saw some good interactions with staff and people who used the service but also saw some examples of staff missing important opportunities to engage with people, people being addressed using the terms “sweetie” and “good girl”, a person being rushed when being assisted to eat their breakfast and staff administering medication to a person without engaging with them during the process.

We pathway tracked the care of four people and looked at how their care was provided and managed. We found that people remained at risk of not receiving consistent and appropriate care, due to inaccurate or missing assessments, incomplete or inaccurate care records and poor communication.

We looked at the nutritional care of these people and found that appropriate action was not being taken when people were assessed as being at risk nutritionally, which placed them at risk of weight loss and malnutrition. People’s dignity and choice was not being respected at mealtimes by all care staff.

We found that systems and practice needed improving in auditing of the quality of the service. This information could then be used to improve the quality of care and treatment for people using the service and make it more effective.

CQC have met with the provider since this visit and an action plan has been produced to address any shortfalls. The provider showed us a new meal observation tool that has been introduced at the home since our visit.

When we visited the home we spoke with people who lived there. People made the following comments to us about their care; “Very happy here, they look after us well”. “Very well cared for”. One person told us they only had the opportunity to have a bath once a week and would have liked a bath twice a week. We spoke to the care worker on duty who agreed to ensure this request was actioned for this person. People told us that staff respected their privacy and dignity by drawing the curtains when they received care. We saw staff knocking on people’s doors before they entered the room.

We also spent a period of time sitting in one of the lounge areas observing people and recording what we saw. We were observing people who suffered with a dementia type illness as they may have greater difficulty expressing their wishes and communicating with staff. We watched how the people interacted with the staff, and how staff engaged with the people. We saw some good interactions with staff and people who use the service but also saw some examples of people being ignored when attempting to engage with staff or making requests for food and drink.

People told us that the home had recently employed two new activity co-ordinator’s. We received some mixed views from people about the quality of the current activities available in the home. The activity co-ordinator’s were putting a lot of effort into trying to improve the provision of social activities in the home. The staff were now working as a team to improve the range of activities.

There had been some improvement in the care and welfare of the people who use the service. Although people remain at some risk of not receiving consistent and appropriate care, due to inaccurate or missing assessments and incomplete or inaccurate care records. Act

We spoke with people about the quality and choice of food provided by the home. People made the following comments; “can’t complain about the food”, “always a choice of food”, “there is fresh fruit available”, “we are able to have snacks between meals if needed”, “very good”, “there are a couple of choices at each meal”, “gone down, we have egg sandwiches five out of the seven nights a week”. “The choice of sandwiches is poor”, “breakfast is good”, “the vegetables are overcooked and mushy”, “supper is the worse meal, it is so boring”, “by and large pretty good except for the soup”, “we have a snack and drink at 8pm”. People had a choice of nutritious meals available throughout the day and a drink was available at all times to ensure people were kept hydrated. Further attention was needed to the assessment of people’s nutritional status to ensure people were not placed at risk of malnutrition through not receiving the correct diet.

We spoke with people about the staff at the home. People told us the staff were; “very good”, “very kindly” and “very helpful if I need help”. “Never found anybody not prepared to help”. “Very courteous”. “Quite nice”. “Caring”. “Not very good, not enough staff”. “Most of them are OK, I do object to being called ‘my darling’ and ‘my sweetheart”. Not enough staff by any means”. “Pretty good”. “We have three here at night one on each floor”. “Not enough staff”.

We also heard people being addressed by staff using the terms ‘darling’ and ‘sweetheart’. It is evident from one comment received from one person that people do not always liked to be addressed in this manner. There were sufficient numbers of suitably trained staff on duty to meet the needs of the people who used the service. There are four waking night staff on at night, this has increased since our last visit.

Further improvement was needed to ensure that people benefit from higher standards of care, treatment and support through effective self assessment and monitoring of the service delivery at the home.

When we visited the home we spoke to people who live there and we looked at the care of two people in detail. This included looking at their care records, observing their care, and speaking to them and the staff who look after them. People told us the staff “are a great bunch”, but they also told us in their opinion the staff moral in the home was very low. People were of the opinion that this may be due to staff having to work extra hours, staff having left who had not been replaced, and that recent organisational changes may have affected the staff.

We spoke to people who spend a lot of time in their bedrooms and they told us staff did not come in and chat to them as much as they would like.

We saw some people’s dignity was not being respected by staff at all times. Some people were not always being helped to look their best as they had dirty finger nails and stained clothes. We found some care records that were not up to date or correctly written down for staff to refer to. This could cause confusion and put those people at risk due to staff not being clear about the correct care to give. We found some staff were not always following the care written in the care records.

We were concerned about the nutritional care for one person. Records completed showed this person was not being offered sufficient food and fluids which means they may be at risk of weight loss and dehydration. We have told the local authority about this concern.

People told us in their opinion “there is a severe lack of activities available in the home” and they have very little opportunity to go out on trips. “The activity programme is the same week in and week out”. The home does not currently employ an activity person. The manager designate told us they are now actively recruiting for a full time activity manager. Overall we found people may not receive appropriate care and recreational and emotional support as there are not always sufficient staff on duty with the correct skills and competencies to meet their needs at all times.

We looked at how the home measures the quality and any shortfalls in their service.

We found that procedures are not in place to effectively assess and monitor the quality of the service delivery to ensure that people receive safe and appropriate care and treatment.