About the service: Hawksyard Priory is a residential care home providing personal and nursing care for up to 105 people. There were 61 people, some of whom were living with dementia, living at the location at the time of the inspection.

People’s experience of using this service:

People did not consistently receive safe care. Peoples needs were not effectively planned for, risk assessments were not followed and medicines were not managed safely.

The systems in place to monitor the quality of care were not effective and actions were not driving improvements. This was a sixth time the service had been inspected and had failed to achieve a good rating; people had been exposed to poor care for too long.

Staff were not consistently trained and able to support people’s needs. People were not consistently receiving effective support. People were not always supported by caring and responsive staff.

People felt safe and their privacy and dignity was protected. People could choose for themselves. People had their views sought about the care they received. There were sufficient safely recruited staff.

The service met the characteristics of Inadequate in most areas and was rated Inadequate overall.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 2 October 2018).

Why we inspected: This inspection was brought forward due to information shared with us which meant people may be at risk.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found and appeals is added to report after any representations and appeals have been concluded.

Follow up: The overall rating for the service is inadequate and the service will be placed in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures. We will continue to monitor intelligence we receive about the service until we return to visit.

This inspection took place on 16 and 17 August 2018 and was unannounced. At the last inspection completed on 20 April 2017 we rated the service Requires Improvement.

At this inspection we found improvements had been made but more were needed and the provider was not meeting the regulations for governance arrangements. You can see what action we asked the provider to take at the end of this report.

Hawksyard Priory Nursing Home 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.

Hawksyard Priory Nursing Home accommodates up to 106 people in one adapted building. At the time of the inspection there were 79 people using the service.

There was a registered manager in post at the time of 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 2008 and associated Regulations about how the service is run.

We have made recommendations about staff training on the subject of dementia and about the environment being adapted to support people living with dementia.

Governance systems were not always effective in identifying concerns and driving improvements. Risks to people were not always clearly documented and medicines were not always stored safely.

People were not consistently supported by sufficient staff to meet their needs at their preferred time. People were not always protected from the risk of cross infection.

Staff had received training, however further work was required to ensure staff competency was checked effectively. Staff felt supported in their role. Improvements were needed to ensure the environment was suitable for people living with dementia. People did not always receive consistent care.

People were not always supported to have maximum choice and control of their lives and staff were not always aware of how to support them in the least restrictive way possible; the policies and systems in the service were not always supportive of this practice.

People received support from staff that were caring however improvements were needed to make sure that this was consistent. People’s communication needs were not always planned for. People were respected, however sometimes care was received that was not always dignified.

People’s preferences were understood by staff however improvements were needed to ensure care records reflected people’s preferences. Peoples end of life wishes were not always clearly documented.

Staff were safely recruited. People were safeguarded from potential abuse. People were supported to meet their dietary needs. People were supported to take their prescribed medicines. People were supported to maintain their health and well-being.

People understood how to make a complaint and these were responded to. Notifications were submitted as required and the registered manager understood their responsibilities. We found improvements were needed to how people and their relatives were engaged in the service.

The location has previously been rated as Requires Improvement. At this inspection the provider had not made all the required improvements. We may consider enforcement action if there is a continued lack of improvement at our next inspection.

We inspected this service on 20 April 2017 and this was an unannounced inspection visit. Our last inspection visit took place in 9 May 2016 we found the provider needed to make further improvements with medicines as some medicines and nourishment supplements were not recorded correctly to demonstrate people had these. Where restrictions were placed upon people these had not always been identified to ensure any restriction was lawful. At this inspection we found improvements had been made in these areas. However, further improvements were required.

Hawksyard Priory provides nursing and personal care for up to 106 people some of whom may be living with dementia. At the time of our inspection visit there were 86 people living in the home.

There were two registered managers 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.

Staff were aware of the signs to look out for that might mean a person was at risk of harm but were not clear on when they should report concerns outside of the organisation when this was needed. Individual risks had been assessed and staff understood how to provide support although this information was not always recorded to ensure consistent care. Where people needed support to make decisions, capacity had not been assessed to ensure that it was clear why people could not make specific conditions.

Each area of the home had its own staff team and this had been organised around the number of people who used the service. There was not always support in all areas to keep people safe. There were opportunities for people to engage with activities although some people felt they were would like more opportunities to engage with others and spent a large amount of time unoccupied. Staff felt supported by the registered manager but some staff felt that more supervision and training would help them to be able to support people more effectively. Quality assurance systems were in place although these systems had not identified these concerns and improvements were needed in the service.

People felt that staff were kind and caring. Staff treated people with respect and ensured their privacy and dignity was upheld. People received prescribed medicines when they expected and needed them. The provider had a complaints procedure available for people who used the service and complaints were managed and investigated.

People received support to manage their health and saw specialists where needed. Recruitment checks had been carried out to ensure new staff were safe and suitable to work with people who used the service.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 9 May 2016 and this was an unannounced inspection visit. Our last inspection visit took place in July 2015 we found the provider needed to make improvements to protect people from the risk of harm, how medicines were managed and the systems that were in place to measure and improve quality. At this inspection we found improvements had been made in these areas. However, we found that the provider had not always identified where restrictions were placed upon people.

Hawksyard Priory provides nursing and personal care for up to 106 people some of whom may be living with dementia. At the time of our inspection visit there were 91 people living in the home.

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.

Further improvements were needed to ensure medicines were managed safely. Some medicines and nourishment supplements were not recorded correctly to demonstrate people had these. Hygiene practices needed to be improved to ensure hands were washed and medicines were not handled by staff.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. Staff sought people’s consent before they provided care and support. Where people were not able to make decisions for themselves, they were supported to make decisions that were in their best interests with the help of people who were important to them. Where restrictions were placed upon people these had not always been identified to ensure any restriction was lawful.

People were supported to eat and drink and there was a choice of foods available. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed assistance, this was done in a caring and supportive way.

There was sufficient staff to meet the assessed needs of people who used the service. The staff were kind and treated people with dignity and respect and helped them to make choices about how they wanted to spend their time and be supported. People’s care needs had been assessed and reviewed to ensure they received care to meet their individual needs. The care records detailed how people wished to be cared for and supported and evidenced where people had been involved with any review. Staff received training to meet identified needs.

Staff understood their responsibility to safeguard people from harm. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks. Risk assessments ensured people could continue to enjoy activities as safely as possible and maintain their independence

Health care professionals visited the service regularly to provide additional healthcare services to people and staff supported people to attend appointments and liaised with their GP.

People were confident they could raise any concerns with the registered manager or staff and were complimentary about the service provided. The registered manager was approachable and provided support to the staff team. People were encouraged and supported to provide feedback on the service and there were effective systems in place to review and improve the quality of the service provided.

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

This unannounced inspection took place on 22 July 2015. At our last inspection in November 2014 we found the provider was breaching the legal requirements associated with consent, person centred care and the management of the service. The provider sent us an action plan demonstrating how they would improve the service. At this inspection we found some improvements had been made. However, we found other breaches of the Health and Social Care Act Regulations 2014 in respect of safeguarding people from harm, the management of medicines and the accuracy of records.

Hawksyard Priory provides nursing and personal care for up to 106 people some of whom may be living with dementia. At the time of our inspection there were 92 people living in the home.

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.

Staff did not know how to report incidents of alleged abuse to the local authority and we identified some incidents involving people which had not been reported for investigation as required.

Risks associated with people’s care such as safe moving and handling had been assessed but there was a lack of review following incidents which meant people did not always receive safe care.

We found that people’s medicines were not managed safely. Some of the records relating to the administration of medicines were not accurate. There was no guidance in place to ensure staff understood when to give people ‘as and when’ required medicines for pain or to help settle them when they were distressed.

People were supported by sufficient numbers of suitably recruited staff. Newly recruited staff were provided with an effective induction period which supported them to understand people’s needs. Staff had access to training and demonstrated some of the skills required to care for people. However, staff did not understand the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards which meant some people’s legal rights were not respected.

Some people’s right to dignity and privacy was not recognised by staff. People’s care plans did not provide an accurate description of their care as staff did not understand the importance of keeping detailed records.

People were provided with food and drinks which met their individual requirements. Staff understood how to support people with specific dietary needs. However staff were not always recording if people had lost or gained weight. People were referred to their doctor and specialist health care professionals when additional support was required to maintain their health and wellbeing.

Staff were kind and considerate to people. Staff encouraged and reassured people. People were able to choose how they spent their time and their decisions were respected by staff. There were opportunities for people to socialise together or be supported independently to take part in games or activities which interested them. People were encouraged and supported to achieve experiences they wanted to do. Relatives were able to visit whenever they wanted and they were encouraged to be involved in social gatherings.

The registered manager was monitoring the quality of the service and listening to people’s views to improve their experience of care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of the report.

We inspected this service on 03 November 2014. The inspection was unannounced. At our previous inspection in July 2013, the service was meeting the legal requirements.

The service provides nursing and personal care for up to 106 older people who may have dementia. There were 101 people living at the home on the day of our 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 who were living at the service told us they felt safe. Medicines were administered and recorded correctly.

The recruitment processes were not consistently applied to provide assurance that suitable checks had been completed for staff prior to recruitment.

The human rights of some people who used the service were not being respected because staff had not fully understood their responsibilities under the Mental Capacity Act (MCA) 2005.

Staff received training which was linked to people’s needs and specific to staff requirements. Staff told us they received supervision and they felt supported to fulfil their roles.

We observed people being given day to day choices. People we spoke with told us they had not been given the choice to take part in reviews of their care.

People had differing views about the quality and choice of the food they received and some people had chosen to cater for themselves.

We observed that people were relaxed being with and talking to staff although some staff did not interact with people or show understanding of people living with dementia.

People we spoke with told us staff knew what they liked and how they wanted their care provided.

There were arrangements in place to involve people in hobbies, pastimes and outings which interested them.

People and their relatives told us they would feel comfortable raising complaints or concerns with staff or the registered manager and felt they would be listened to.

The provider had arrangements in place to listen to the views of people and their relatives through the provision of meetings however we could not see what actions had been taken in response to people’s comments.

The provider was assessing the quality of their service through an audit programme. The information captured was not used to identify trends which could affect people’s care.

Some of the records we viewed did not provide accurate and up to date information about people or the staff.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond with breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what actions we told the provider to take at the back of the full version of this report.

During this visit we spoke with 12 people and 20 visiting relatives and friends. We also spoke with eight staff, the manager and two visiting social care professionals.

We saw that people who lived at the service were happy with the care they received, and that they enjoyed activities and social events. One person told us: “I have no qualms at all”. Another person told us: “It’s lovely here, really wonderful”.

When we last inspected in January 2013 we had concerns about nutrition and the choice of food and drink available. At this inspection we found that menus were on display and that there were drink stations on every floor of the home with a wide range of drinks available.

We found that the home was clean and tidy throughout with clear cleaning and maintenance schedules. This meant that people had small repairs carried out to their rooms in a timely manner.

We saw that the home had staff rotas based on the needs of the people who used the service. One person told us: “They are usually swimming in staff here” Another person told us: “They have plenty of staff you can always find someone”.

We found that the service took appropriate steps to audit the quality of care it provided.

During our visit we spoke with eight people who lived at the service. We also spoke with four visitors, and four members of staff.

We saw that the people's plans of care reflected individual needs and were personalised. One of the people who lived there told us, "The care is lovely. The staff listen to what you want". A visiting friend told us, "It's always wonderful here. My friend receives very good care. Everyone is so friendly". We had some concerns with the way some elements of the planned care was recorded.

We had some concerns about the way people were supported to eat and drink. One of the people who lived at the home told us, "The food is always excellent. I am always offered something I would like". Another person told us, "I don't get enough choice".

We saw that medicines were stored and administered properly, and that best practice guidelines were followed. We saw one visitor requested some pain relief for their relative. The visitor told us, "They come straight away if we need anything".

We saw that there was a detailed training matrix for all members of staff. One member of staff told us, "There is plenty of training and we can ask for more if we want. It's really good".

We found that there was a system for raising complaints and concerns. One relative told us, "I have no cause for complaint, but if I did I could raise it and it would be sorted straight away".

People we spoke with told us staff kept them fully informed about their care and treatment. They understood what was happening to them and felt involved in their care. A person told us “the staff and matron always call the doctor for me if I’m ill but they always ask me what I want and if I’m happy. I have no complaints at all”.

We spent time talking to staff about the care, treatment and support they give to people who used the service. Staff told us they enjoyed working in the home, they felt supported by the management team and had been given appropriate training that enabled them to do their jobs.

We spoke with people about the care and treatment they had received. They said “the girls bring round my tablets when I need them, never a problem” and “if I am ill they don’t hesitate to get the doctor in for me”.

We looked at the processes the service had in place for keeping people safe and free from abuse and harm. We found that people were kept safe and free from harm.

We spent time talking with the manager about the systems the service has in place to monitor its performance.