Hatfield Peverel Lodge 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 is set in large grounds in a rural location close to Hatfield Peveril. There are two units, Kingfisher House in the main building and Mallard House, which specialises in support for people with dementia. Since our last inspection the provider had reduced the number of people who could be supported at the service from 71 to 68. At the time of our visit there were 63 people using the service.

The inspection took place on 9 October and was unannounced.

At our last inspection in July 2017, the service was rated requires improvement overall. We had concerns staff did not have the necessary skills to meet people’s needs, care plans were not person centred and people being cared for in bed lacked stimulation and access to activities. There had been some improvements however, the service was rated requires improvement overall. This was because previous inspections had highlighted that the provider struggled to maintain good care standards over time, with overall ratings of requires improvement in 2015 and 2016 and an inadequate rating in February 2017.

At this inspection we found the provider had addressed our concerns and improvements were being implemented in a positive and sustainable manner. As a result, the rating improved to good.

There was a new registered manager and deputy 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.

The new management team worked very effectively together, with the deputy manager taking on the role of clinical lead. There was an open culture which focused on the people who lived there. Checks on the quality of the service were robust and improved the wellbeing of the people receiving care. The registered manager worked well with outside organisations to drive improvements.

People received the support they needed to remain safe. Staff demonstrated an enabling attitude to risk, ensuring people were not restricted unnecessarily. Learning from incidents and accidents was used to improve safety at the service.

Staff supported people to take their medicines safely and as prescribed. There were plans to improve the administration of medicines to ensure the task did not disrupt people’s enjoyment at meal times. Staff worked hard to minimise the spread of infection, despite the challenges posed by the age of the property.

Staff across the service had been supported to improve their skills when working with people with dementia. Care plans were being revised to provide more detailed guidance about people’s needs. Staff continued to be well supported and functioned well as a team.

People received the necessary support to eat and drink enough, to ensure they maintained a balanced diet. People were supported to access health and social care professionals when necessary. There was a positive focus on enhancing people’s quality of life through promoting their right to make choices about their daily routines. The registered manager ensured decisions were made in line with the Mental Capacity Act 2005.

There was a calm atmosphere at the service, which promoted a caring environment. Staff took time to support people in a dignified manner, encouraging their independence and respecting their right to privacy. Support to people being cared for in their rooms had become more person-centred. People engaged in varied activities, in line with their choice and preferences. Care plans were being adapted to become more person-centred and ther

In June, 2016 we inspected Hatfield Peverel Nursing and Residential Home and found them to be in breach of multiple regulations under the Health and Social Care Act 2008, (Regulated Activities) Regulations 2014. The service was found to be inadequate and we placed them in special measures, restricting admissions to the service and requiring them to send us weekly reports that detailed the level of risks they were managing for people at the service.

On the 27 February 2017 we returned to assess whether improvements had been made, carrying out an unannounced inspection. We carried out an announced inspection for a second day on the 28 February 2017. On the 9 March 2017 we returned to the service to meet with the manager, the area director and the management team to gather additional information and discuss our findings.

During this inspection we found that significant improvements had been made at the service, and where issues remained, the service was being proactive in making the necessary improvements. Consequently, we found that the service was no longer in breach of any legal requirements. The provider now needs to sustain those improvements.

Care provided at Hatfield Peverel Nursing and Residential Home is carried out over two separate units (Houses), caring for older adults who have nursing and residential care needs, and who may or may not be living with dementia. They can accommodate up to 70 people over these two houses, but at the time of inspection, only 40 people were residing at the service.

It is a requirement that the service has a registered manager, but at the time of the inspection an acting home care manager was in place, supported by additional managing staff in training to become the manager and seek registration with CQC.

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.

Since the inspection in June 2016, the service had worked hard to improve all safety concerns raised. We found that the service was safe and appropriate processes and systems were in place to identify and act on potential risks.

Staff were recruited and managed well. Safe systems were in place for monitoring, storing, and dispensing medicines.

Staff adhered to principles of the Mental Capacity Act (MCA), 2005 and Deprivation of Liberty Safeguards (DoLS). People were only deprived of their liberty if this was in their best interests, by the least restrictive option.

Staff had received training in a number of areas, however, still required additional knowledge in caring for people with behaviours that could challenge and those living with dementia. The service had plans to improve this area going forward.

There was a good choice of food and drink to meet people’s preferences and nutritional needs, and the monitoring of people at risk of malnutrition had been improved.

Managers, nursing, and care staff were caring and treated people with dignity and respect.

Care plans were not always responsive and did not always provide an accurate representation of needs, and how staff should support people with complex needs.

Care note entries did not reflect the person centred care provided. However, audit systems had identified these issues and following the inspection the manager was able to demonstrate that training was being accessed in response to these audits.

People who used the service, their, relatives, and staff felt able to make their needs and concerns known and these were received well and acted upon.

The culture of the service had significantly improved and managers and staff were cohesively working together to bring around positive changes. They acknowledged areas where improvements were still needed, but had identified how they woul

Hatfield Peverel Lodge Nursing Home provides accommodation, personal care, and nursing care for up to 70 older people. Some people have dementia related needs. The service consists of Mallard House for people living with dementia and Kingfisher House for people who require nursing or residential care, some of who may also have dementia and other complex health condition. Kingfisher house was split over two floors, with the top floor being named Robin.

The inspection was completed on 21 and 22 June 2016 and there were 61 people living at the service when we inspected.

A home manager had been seconded into the post with daily telephone support from the registered manager who had been deployed elsewhere within the organisation, but who had retained overall responsibility for 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.

The service has been inspected at regular intervals over the last two years due to concerns that people were not receiving care that was safe, effective, caring, responsive, and well led. We identified a number of concerns during the inspection on 19 March 2015 and 17 April 2015 where we found that the provider was not meeting the requirements of the law in relation to consent to care and treatment, staffing levels and the arrangements for quality assurance were not effective and improvements were required. An additional inspection in October 2015 identified that some improvements had been made, however there were still areas of improvement needed in medicine management, staff supervision, and quality assurance systems. The plan provided by the service had not insured that all improvements were made.

During this inspection, we found that improvements that had been made had not been sustained and that issues that remained had not been addressed effectively for the safety of people using the service. We found that quality assurance systems in place did not identify that people nursed in bed were not receiving timely care and treatment and that records to document care needs were not filled in at the time of care provided. We found that there were not sufficient systems in place to identify the safe level of staff needed to manage the dependency needs of people at the service.

We identified a number of concerns about the care, safety, and welfare of people who received care from the provider. We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.

We found that staffing was not sufficiently employed to meet peoples individual needs to promote independence and physical and mental well being and safety. We found lounge areas on Mallard unit at times unattended in spite high risk activity, and people nursed in bedrooms went without regular meaningful interaction for long periods.

When risks to people were identified, interventions to manage these risks were not always in place.

Systems in place to monitor and accurately record peoples dietary and nutritional intake were not always followed correctly. Consequently, in was difficult to ensure accuracy and consequently individual's level of risk and need.

Some staff we spoke to had a poor understanding of people's rights under the Mental Capacity Act. People told us that due to the restraints on staff time they did not always have care provided in a way that respected their capacity to make decisions or their wishes.

Whilst we observed a number of positive and caring interactions between staff and people at the service, we observed some interactions from staff and people were not caring or dignified.

Some care plan

When we visited Hatfield Peverel Lodge on 13 February 2013, we spoke with five people living at the service and observed four others to help us understand their experiences. Some people had complex needs which meant they were not able to easily communicate verbally with us. We observed that staff interacted well with the people using the service and made sure they were fully involved in making decisions about their care and support.

We found that people's capacity to consent was recognised and where appropriate, they were able to exercise consent in most daily activities. For those people who lacked capacity, this was clearly documented within their records.

One person told us, "I love living here and the staff are kind." We observed that care plans were person centred, with risk factors being appropriately assessed.

We noted that there was a policy for the management of medication and saw that staff had received training before administering medication.

Staff generally felt well supported at work and said they found the home manager to be approachable. They received supervision and were supported with appropriate training and development to assist them in their roles.

We observed a robust complaints policy prominently displayed. Both staff and people told us they would feel able to raise any concerns or issues that they had.

People we spoke with told us that they were well looked after. One person told us “I love it here. I couldn’t have wished for a better place. The food is lovely. I’ve put on a stone since I came here. I see the GP. They keep a good check on you. They watch you all night.” One person who had been at the home for six years told us, “I’m very happy here. They do take me out in the grounds.”

People we spoke with told us they were happy living at Hatfield Peverel Lodge and liked the staff that looked after them. One person told us “They look after me alright” and another person told us “The staff are polite and respectful.”

People told us that they liked living at the home and liked their rooms. One person said “It’s beautiful and clean. There is nothing I can find fault with.”

People we spoke with told us they were able to talk to staff about things they were concerned about and said that staff listened to them. We saw that staff spent time with people and took time to explain what they were going to do and gave them reassurance about their care needs.

Hatfield Peverel Lodge Nursing Home provides accommodation, personal care and nursing care for up to 70 older people. Some people have dementia related needs. The service consists of Mallard House for people living with dementia and Kingfisher House for people who require nursing or residential care.

The inspection was completed on 12 and 13 October 2015 and there were 62 people living at the service when we inspected.

A manager was in post but had yet to register with the Care Quality Commission. 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 our last inspection on 19 March 2015 and 17 April 2015 we found that the provider was not meeting the requirements of the law in relation to consent to care and treatment, staffing levels and the arrangements for quality assurance were not effective and improvements were required. An action plan was provided to us by the provider at regular intervals. This told us of the steps to be taken and the dates the provider said they would meet the relevant legal requirements. During this inspection we looked to see if these improvements had been made.

People’s medicines were not safely managed as staff did not always follow safe practices. Improvements were required in relation to risk management of pressure ulcers. Although staff said they felt well supported improvements were needed in relation to staff being provided formal supervision and appraisal.

Improvements were required to ensure that there was a clear audit trail of the investigation process and outcomes relating to people’s concerns and complaints. The quality assurance system although much improved was not effective because it had not identified the areas of concern that we found at this inspection.

People and their relatives told us the service was a safe place to live. There were sufficient staff available to meet their needs. Appropriate arrangements were in place to recruit staff safely. Staff were able to demonstrate a good understanding and knowledge of people’s specific support needs, so as to ensure their and others’ safety.

Staff received effective training and an induction to ensure that staff had the right knowledge and skills to carry out their roles and responsibilities effectively.

People’s capacity was assumed and sufficient efforts were made to routinely gain people’s consent. The dining experience for people was appropriate to meet people’s individual nutritional needs.

People and their relatives were positive about the care and support provided at the service by staff. Staff were friendly, kind and caring towards the people they supported. Staff demonstrated a good understanding and awareness of how to treat people with respect and dignity.

People’s care plans were reflective of their care needs and how care was to be provided. A programme of activities was available each day and opportunities were offered to ensure that people who lived at the service received the opportunity to participate.

The management team of the service were clear about their roles, responsibility and accountability and we found that staff were supported by the manager, deputy manager and senior management team. Staff told us that they felt valued and supported.

The provider had taken steps to mitigate the risks to people and address the shortfalls found at the last inspection. This included implementing systems to monitor the quality and safety of the service. However, further improvements were required to ensure that changes and improvements are embedded and sustained over time to ensure people are provided with a consistently safe quality service. The overall rating of the service will not change at this time.

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