Hinstock Manor is registered to provide accommodation and care for up to 51 older people who may have support needs owing to dementia and physical disabilities. There were 41 people living at the home at the time of our inspection.

This inspection took place on 14 March 2017 and was unannounced.

A registered manager was 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.

At the last inspection on 2 and 3 December 2015 we judged that the provider needed to improve the service in all five key questions. We found that improvements had been made in all areas of service delivery.

People were helped to feel safe. Staff knew what action to take to protect people from the risk of abuse. Staff understood the risks to individual people's safety and shared information with other staff so people's safety needs would be met. There were enough staff employed to care for people and people told us staff knew their care and safety needs well.

Staff had opportunities to develop the knowledge and skills they needed to care for people. Further training for staff was being planned, so people's needs would continue to be met. People's right to make their own decisions was respected by staff. People enjoyed their mealtime experience, and had enough to eat and drink to remain well.

Staff took action to support people if they required medical assistance, and advice provided by health professionals was implemented. As a result, people were supported to maintain their health.

Caring relationships had been built between people, their relatives and the staff who supported them. Staff took action to show people they were valued and knew about their histories and preferences. Staff offered people reassurance in the ways they preferred when they were anxious. People's right to privacy was taken into account in the way staff cared for them. People were encouraged to make their own day to day decisions about their care.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. Relatives told us their suggestions for developing their family member's care further were listened to.

People's care plans and risk assessments were updated as their needs changed. People and their relatives understood how to raise any concerns or complaints about the service. Systems for managing complaints were in place, so any lessons would be learnt.

People and their families told us the registered manager and senior staff were approachable and were positive about the way the home was run. The registered manager had introduced changes to benefit people living at the home. The registered manager checked the quality of the care provided and people and their relatives were encouraged to give feedback on the care provided.

We carried out this inspection in response to concerns we had received about Hinstock Manor Residential Home.

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?

As part of this inspection we spoke with three people who used the service, a relative, two care staff, the acting manager, deputy manager and the registered provider. We also reviewed records relating to people’s care.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We carried out this inspection in response to concerns we received from a person who wished to remain anonymous. It was alleged that there were insufficient staffing levels to safely meet people’s care and support needs. Concerns were also raised about the management of people’s prescribed medicines.

One person who used the service told us, “I feel safe here and well looked after.” “There is always someone around when you need them.” The acting manager confirmed that they were four care staff vacant posts which, equated to 144 hours per week. The acting manager said that these hours were covered by existing staff and agency staff. The rotas we looked at also confirmed this. We saw that staff were always nearby to assist people when needed. The acting manager confirmed that four care staff had been recruited and were awaiting the appropriate safety checks prior to commencing employment.

We found that the management of people’s prescribed medicines was not robust to ensure they received their treatment. For example, it was difficult to determine whether people had received their medicines as medication administration records (MAR) were not consistently maintained. A MAR is a record of people’s prescribed medicines that should be signed by staff to show when medicines have been administered. One MAR showed that the person had not received their prescribed treatment. However, discussions with the person confirmed that they had received their medicines. We were unable to find out whether other people had received their prescribed treatment because they were unable to tell us due to their health condition. The inadequate recording of medicines placed people at risk.

The room where medicines were stored was unclean and placed people at risk of cross contamination. Surfaces, floor and the washbasin were unclean and sticky. On the day of the inspection we found that the room where medicines were stored was warm. There was a thermometer in place that showed a reading of 23 Celsius. Discussions with the acting manager and the records we looked at confirmed that the room temperature was not consistently monitored. One record showed temperature of 29 Celsius. Medicines stored above 25 Celsius could affect the potency of medicines and make them less effective.

The acting manager confirmed that an audit of the management of medicines had not been carried since June 2014. We looked at the last audit that was carried out and found that no discrepancies had been identified. The poor management of medicines placed people at risk of not receiving their prescribed treatment.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that appropriate policies and procedures were in place. Mental capacity assessments had been carried out and records were maintained where DoLS were in place. One out of two care staff we spoke with confirmed that they had received Mental Capacity Act (MCA) training. However, both demonstrated a good understanding about MCA. The acting manager demonstrated a good understanding about when a DoLS application needed to be submitted.

Is the service effective?

We found that where people were at risk of falls appropriate action had been taken to reduce further risks. For example, one care record showed that a person had a history of falls. A falls risk assessment was in place that provided staff with information about the support the person required to reduce the risk. The doctor had been involved to ensure that there was no medical reason for the frequency of falls. A referral to a falls clinic had also been made. This meant the person could be assured that they would be provided with the relevant support.

Is the service caring?

One person who used the service said, “It is very nice living here and I do get to go out.” “The food is very good and we have a choice.” “We have access to drinks at all times.”

Another person told us, “The staff do look after you but you get use to the staff and then they leave.”

One person who lived there said, “I have no moans or grumbles.”

We saw that one person was agitated and a care staff reassured them in kind and gentle manner. This meant that people were provided with support when needed.

Care plans were in place and these provided staff with information about people’s care and support needs. We spoke with two care staff who demonstrated a sound understanding of people’s care needs and how to support them. This meant that people could be confident that staff would know how to care for them.

Is the service responsive?

One person who used the service told us that they were fairly independent with managing their personal care needs. However, they told us that they had recently required support from staff. They said, “The care staff was very kind and helpful.” This meant that staff were proactive in meeting people’s changing needs.

Is the service well-led?

The acting manager had been in post for eight months and had not applied for registration. The provider has a legal obligation as part of their condition of registration to appoint a registered manager. The acting manager assured us that they would apply for registration.

The acting manager demonstrated a sound understanding of people’s care and support needs. However, we found that they were aware that the management of medicines was not entirely robust and immediate action had not been taken to address this. The acting manager informed us that they had recently implemented competency assessments for staff to ensure that they had the skills and competence to safely manage medicines and we saw these assessments.

We talked with people who lived in the home and they said that they were well looked after. They said the staff always asked them how they would like things to be done. They said staff were always mindful of their privacy and treated them with respect.

People told us that they felt able to raise any issues with the manager or staff should they have any concerns. Staff spoke of their awareness of how to keep people safe from harm. Staff told us about the training that the home had arranged for them to attend so that they would recognise abuse and how to report it.

People told us that staff were always available when they needed help. They said that the staff were friendly and always acted professionally. One person said, “The staff are very good; very friendly” and another said, “The staff are really very good with me”.

We spoke with nine people who lived at Hinstock Manor and three relatives. There were 44 people living at Hinstock Manor on the day of the inspection. We also spoke with the manager, five staff and a visiting healthcare professional.

We saw that people were offered choices about how their care was delivered and how they spent their time. We observed staff being kind and courteous towards people. People told us that they were satisfied with the way that care and support was provided. One person said, "I like living here".

Care plans were kept securely and were generally well organised. Some care planning documents had not been completed.

Measures were in place to protect people from the risk of healthcare associated infections.

There were no effective management systems in place to monitor the quality of the service.

There were no systems in place to offer formal supervision and support to staff. People spoke positively about the staff that looked after them. One described staff as, "Very nice indeed".

Incidents affecting people's welfare were not reported to the Care Quality Commission.

We visited Hinstock Manor after we had been made aware of two incidents in relation concerns about the care and support of two people who had been living at the home. Social care professionals had also told us that they were concerned about management arrangements, care plans and risk assessment processes within the home.

During our visit we looked in detail at the care and support of three people living at the home who had complex needs in order to see how they were supported. We met with the three people whose care we looked at and also met with six other people who were in the lounge preparing for lunch.

People told us that they were well and were being well looked after. Everyone said that they were looking forward to their lunch.

One person told us that they were well cared for by the staff at the home. We observed them being supported to prepare for lunch. Staff knew how the person preferred to be seated and provided them with protective clothing and cutlery suitable for them to manage their meal as independently as they were able.

One person was unwell on the day of our visit and staff had alerted the manager to changes in relation to the person’s normal behaviour and shared their concerns. The manager responded immediately to ensure the person was seen by the doctor. Staff told us that they knew how the person normally responded and that they always notified the manager when people’s needs changed. Records also showed that information about people’s changing needs were kept and shared with the manager on a daily basis. This enabled them to update or change care plans and seek appropriate support from outside agencies.

Information was difficult to find in the current care planning system and the manager acknowledged this. As a result the manager could not demonstrate to us when medical support was given in relation to certain issues, or establish why it had not been sought on other occasions. We found evidence in care plans that guidance had been given to staff inappropriately, on one occasion, following an incident where people’s safety had been put at risk. This evidence supported information received from social care professionals prior to our visit. The provider had been notified by us prior to our visit about her responsibility to appoint a person to manage the home who had the skills and experience to do so.

On the day of our visit we found that there had been further changes to the management of the home. The person appointed, and notified to us as the new manager, had stepped down from the position and the deputy manager was now assuming management responsibilities for the home. They told us of planned changes to care planning and risk assessments that will make information easier to access and follow. They recognised the challenges with the current system. We were told that staff were enthusiastic about the changes. The new manager had a support network in place to assist them to make required changes within the home. The new manager could also demonstrate that training had been booked for them to attend in relation to assessing risks. In the interim they were receiving support from a management consultant with a social care background to ensure any new risks were appropriately assessed and managed to keep people safe and well supported.

Changes were seen to be taking place to systems and processes within the home. This suggested that the management of Hinstock Manor are recognising shortfalls and taking appropriate action to keep people safe.

When we visited Hinstock manor we found that people were very happy with the service that they receive. People felt involved and consulted in relation to how they were cared for and supported. Care plans reflected an individualised service that was delivered around people’s assessed needs in ways that they preferred.

People liked the meals on offer at the home and enjoyed a flexible and responsive service at mealtimes.

Staff ensured that people’s needs are understood and managed appropriately as they have received good training opportunities and have been able to implement their learning into home.

People were protected because staff were confident to recognise and report abuse. People felt that staff were able to meet their care and support needs well.

The home has implemented changes in response to two safeguarding investigations which were substantiated and closed. People are receiving a safer and more responsive service as a result.

The home benefits from strong leadership and management that is responsive to the views and needs of people living at the home.

Hinstock Manor has implemented a number of quality assurance and monitoring measures which mean that the manager and the provider were able to assess that the home was meeting the essential standards of quality and safety. This enabled them to ensure that they deliver a good quality service.

Hinstock Manor is registered to provide accommodation and care for up to 51 older people who may have support needs owing to dementia and physical disabilities. There were 41 people living at the home at the time of our inspection.

This inspection took place on 14 March 2017 and was unannounced.

A registered manager was 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.

At the last inspection on 2 and 3 December 2015 we judged that the provider needed to improve the service in all five key questions. We found that improvements had been made in all areas of service delivery.

People were helped to feel safe. Staff knew what action to take to protect people from the risk of abuse. Staff understood the risks to individual people's safety and shared information with other staff so people's safety needs would be met. There were enough staff employed to care for people and people told us staff knew their care and safety needs well.

Staff had opportunities to develop the knowledge and skills they needed to care for people. Further training for staff was being planned, so people's needs would continue to be met. People's right to make their own decisions was respected by staff. People enjoyed their mealtime experience, and had enough to eat and drink to remain well.

Staff took action to support people if they required medical assistance, and advice provided by health professionals was implemented. As a result, people were supported to maintain their health.

Caring relationships had been built between people, their relatives and the staff who supported them. Staff took action to show people they were valued and knew about their histories and preferences. Staff offered people reassurance in the ways they preferred when they were anxious. People's right to privacy was taken into account in the way staff cared for them. People were encouraged to make their own day to day decisions about their care.

People were involved in deciding how their care should be planned and risks to their well-being responded to. Where people were not able to make all of their own decisions their representatives and relatives were consulted. Relatives told us their suggestions for developing their family member's care further were listened to.

People's care plans and risk assessments were updated as their needs changed. People and their relatives understood how to raise any concerns or complaints about the service. Systems for managing complaints were in place, so any lessons would be learnt.

People and their families told us the registered manager and senior staff were approachable and were positive about the way the home was run. The registered manager had introduced changes to benefit people living at the home. The registered manager checked the quality of the care provided and people and their relatives were encouraged to give feedback on the care provided.