Hatherley Care Home limited 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 inspection of Hatherley Care Home Limited took place on the 10 May 2018 and was unannounced. The inspection was undertaken in the early morning as concerns had been raised with us about staffing levels at this time. As a result we looked at whether the service operated in a safe way. We looked at the availability of staff, the serving of breakfast and how people’s needs were met. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The previous inspection of 12 and 13 September 2017, found the service was good. At this inspection we concluded that the evidence continued to support the rating of good and there was no evidence from the inspection that demonstrated any serious concerns.

On the day of our inspection there were 34 people living at Hatherley Care Home Limited, overall the service can cater for 37 people in two units. The service was registered to provide accommodation and nursing care but was not providing nursing care at the time of the inspection.

Hatherley Care Home Limited supports people with a physical frailty and people living with dementia. There was a registered manager in post who had worked at the service for many years. 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.

People told us that they were well cared for by a staff team who knew them well. Staff were observed to be busy but attentive to people’s needs. A dependency tool was used to monitor people’s needs and staffing levels. There were some staff vacancies and the service was recruiting additional staff. The shortfalls in staffing were covered by the existing staff team and agency staff.

This report only covers our findings in relation to the areas we looked at under the key question of Safe. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk”

We carried out the inspection to Hatherley Care Home Limited on the 12 and 13 September 2017. The previous inspection was undertaken in July 2015 and the service was rated good overall but requires improvement in the safe domain with two breaches in regulation. At this inspection we found that improvements had been made and the service was now meeting the requirements.

On the day of our inspection there were 35 people living at Hatherley Care Home Limited, overall the service can cater for 37 people. The service was registered to provide accommodation and nursing care but was not providing nursing care at the time of the inspection. 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.

People told us that they were safe and they were supported by a stable staff team who knew them well. We observed that there were enough staff to meet people’s needs safely although on occasion people told us that they had to wait for staff to be available. Staff were well organised and the manager told us that staffing levels were being constantly reviewed to ensure that the numbers met people’s changing needs.

Risks were identified and steps taken to reduce the likelihood of harm to people using the service. There were checks undertaken on the environment and equipment was serviced to ensure it was safe for staff to use. The environment was tired in places and the lighting was poor in some areas. However we were assured by the manager that these fittings were being replaced as part of the upgrading programme. We saw that refurbishment work was underway to upgrade one of the communal areas.

Medicines were managed safely by staff who had been trained and assessed as competent.

Staff had access to training and were supported through supervisions and observations to develop their skills and knowledge.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. The manager and the staff were aware of their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and had made appropriate applications.

People’s health was monitored and staff sought advice appropriately when people’s needs changed. Staff had good working relationships with local health professionals.

People had access to a range of activities which promoted their wellbeing and enabled them to be involved in their local community.

Staff knew people well and could tell us about their needs and what they enjoyed. There were clear systems in place for communication both with relatives and with staff to ensure that they were aware of any changes in people’s wellbeing and health.

There were processes to address complaints although people told us that they had not had to formalise any concerns.

The manager was an experienced manager who had worked at the service for many years and was supported by two senior staff who had specific areas of responsibility. Morale among staff was good and people and relatives were positive about the leadership of the service and told us that the management team were approachable and helpful.

The manager told us that they were well supported by the provider, who visited the service on a regular basis to check on the quality of care. A range of audits were undertaken by the senior management team to identify areas for improvement. We have made a recommendation about how these could be further developed.

There was a quality assurance system which sought the views of peoples and relatives and enabled them to influence how the service operated.

We carried out this inspection on the 20 July 2015 and it was unannounced. The last inspection to this service was on the 4 August 2014 and the service was compliant.

The service provides residential care. On the day of our inspection there were 36 people using the service and one vacancy.

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.’

People expressed high levels of satisfaction with the service mainly attributed to a stable work force with permanent staff who were familiar with people’s needs, a dedicated and hands on manager and a robust activity programme.

We identified concerns around the safety of people using the service in two areas, one was around medication practices where we found audits were not particularly robust and staff training was not supported by frequent assessments of the competencies. The other was around care records which were not always updated when a person’s needs had changed, which meant records did not reflect the accurate levels of risks to people. However staff were familiar with people’s needs. This is a breach of regulation.

Care was provided by staff who had been adequately recruited and supported to do their role and they were employed in sufficient numbers to fulfil people’s needs. We observed cohesive team work. Staff were well supported through regular training, and good support systems.

Staff understood all aspects of their role and were confident in how to raise concerns should they think a person was at risk.

People were supported with decision making and the home worked with family and health care professionals to ensure people were adequately supported and had their health and welfare needs met.

People were supported to have enough to eat and drink. Staff understood people’s dietary requirements and provided support with meals in an appropriate, sensitive way. People’s weight was monitored to ensure that did not become malnourished and fluids were encouraged.

The home had a good relationship with health care professionals and worked in unison to ensure people’s health needs were monitored and met.

People were deemed as having capacity to make day to day decisions and staff consulted with people about their needs.

Staff were caring, professional and gave people the time and support they needed. People were consulted about the service provided to them. Feedback from people, professionals, and visitors was used to shape the service and provide a service around people’s wishes.

Activities were provided to keep people mentally stimulated and were based on people’s individual needs. Care plans were individualised and based on an original assessment of need and updated as needs changed but these were not completely up to date.

The home was well led and the service provided met people’s needs. There were systems in place to assess and monitor the quality of the service provision and take actions if this fell short.

The manager engaged well with external agencies and the local community to ensure people remained involved with the community and had their needs met in a comprehensive way.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt staff kept them safe and this was confirmed by relatives.

Staff received appropriate training and informal supervision which helped them understand people and keep them safe. Risk assessments had been carried out and plans put in place to reduce the risks to people of physical or emotional harm.

We saw records which showed all staff had attended training in safeguarding adults and the Mental Capacity Act (2005). All care workers and managers we spoke with demonstrated a good knowledge of the principles of safeguarding and gave us examples of raising concerns and of the provider following these concerns up.

We found that appropriate arrangements were in place in relation to safely obtaining, recording, storage and disposal of medicines. We also found appropriate procedures for the administration of medicines in tablet and liquid form.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

Is the service effective?

People all had an individual care plan which set out their care needs. People told us they had been fully involved in the assessment of their health and care needs and had contributed to developing their care plan. Staff were aware of people’s preferences, interests, aspirations and diverse needs and supported people to meet these.

The service had systems in place to monitor the care provided and to ensure people were happy with it.

Is the service caring?

People we spoke with said they felt staff treated them with respect and dignity and involved them and their relatives in decisions about their care. We saw staff introducing themselves and interacting with people in a respectful and warm way. Care workers showed patience and gave encouragement when supporting people. People told us "The staff are very kind and helpful" and "They're thoughtful and listen to me." People told us they felt safe and secure and this was confirmed by friends and relatives. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Staff were aware of people’s preferences, interests, aspirations and diverse needs.

Is the service responsive?

Information about the service was provided both verbally and in writing and focused on people having choices and on helping them maintain their independence. People told us they had been given opportunities to ask questions and had any concerns listened to and acted on. Most people and relatives knew how to make a complaint if they were unhappy. They told us the service took complaints seriously and looked into them quickly.

The service worked well with other agencies and services to make sure people received the right care. People told us they were involved in reviewing their plans of care when their needs changed.

Is the service well-led?

The service had quality assurance systems, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff showed us they were clear about their roles and responsibilities. They had an understanding of the ethos of the service and the quality assurance processes which were in place. This helped to ensure people received a good quality service at all times.

The provider ensured that feedback from people themselves, relatives, staff and other professionals was received and this influenced the development of the service and improved care for people.

During our inspection on 20 August 2013 we spoke with seven people who lived at the home and a regular visitor. We also spoke with eight staff employed in various roles at the home.

People told us that they felt staff met their needs. One person said, “The care here is really good.” We found that people’s needs were assessed and care and treatment was planned and delivered in line with their care plans.

There were enough qualified, skilled and experienced staff to meet people’s needs. A person who was receiving respite care at the home told us, “I can’t find fault it here. Staff are very good. I press the bell and they’re here right away. Sometimes I have to wait before they can help me, but it’s not unreasonable.” A regular visitor to the home told us, “I’m full of admiration for the staff. They have so much patience.”

People were provided with a choice of suitable and nutritious food and drink. People told us they liked the food and drink that was served and that there was enough of it.

There were appropriate procedures in place for administration of medicines in tablet and liquid form. However, arrangements for the administration of topical medicines, such as creams and gels, were not satisfactory.

People were aware of the complaints system. The seven people who lived at the home that we spoke with said they would tell the staff or manager if anything was worrying them or they were unhappy with any aspect of the service.

We spoke with seven people who told us that they were respected and treated with dignity. One person explained that they attended regular “Residents meetings” and added: “I would definitely say to the CQC if there was anything wrong.” We saw the minutes of the last meeting, just being prepared to be typed and displayed.

We checked four care plans that were up to date and contained sufficient details about how each person’s needs were to be met. We saw an example of a change in a care plan where the person initially wanted their bedroom door to be kept open, but since October this year wanted the door closed. They confirmed this to us.

We observed staff working in an organised way that reduced people’s waiting times when they called staff. An extra staff member was planned to work to ensure end of life care for a person was delivered with full respect.

The lift was out of order for three months and we saw improvements when it was finally mended in October this year, as staff were now able to respond to people’s calls more quickly.

We saw the forms used for a survey to monitor the quality of the service that had just been distributed to people and their relatives. We also saw the prepared analysis sheet that was going to be used when questionnaires were returned. This showed that the provider had improved their systems for monitoring the quality of the service.

Some of the people who use this service have difficulty understanding and responding to verbal communication. During our visit we were able to hold a verbal conversation with four people. Other people were able to make comments about specific issues, such as the meals, some of the information about people's experiences of this service was

gathered through our observations, review of records and discussions with the manager and care staff.

People with whom we spoke confirmed that they were listened to and respected by

staff. Some people told us that the staff ask them about their preferences, for example,

with regard to what they would like to eat, drink or wear.

When we visited the home on 07 November 2011 people told us that staff consulted with them about their care needs.

People told us that they were satisfied with the level of care and support they received

at Hatherley. One person with whom we spoke told us "The care is very good here."

Those people with whom we spoke said they could choose whether or not to join in

activities and could spend time alone in their room pursuing their own interests if they

preferred.

Staff spoken with told us they would like to have more time to spend talking to people they cared for and to take them out.

Everyone with whom we spoke told us that the staff at the home were very good. One person said, "They are lovely the staff here."

People told us that they feel well looked after by the staff at Hatherley. One person

with whom we spoke said "The staff are very good. They are friendly."

People told us that they felt comfortable talking to the staff about any issues that they

had and that the manager was also always available for them to talk to.