The inspection took place on 10 April 2018 and was unannounced.

Huntington House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Huntington House accommodates up to 39 people in one adapted building. At the time of our inspection there were 32 people living at Huntington House.

There was a registered manager in post who was present during 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 our last inspection of Huntington House on 12 December 2016 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related concerns regarding insufficient staffing levels, care plans and assessments not containing detailed guidance and the management oversight at the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well-Led to at least good. At this inspection we found significant improvements had been made in all areas.

Sufficient staff were available to ensure people’s needs were met in a timely manner and that staff had time to spend with people. Staff employed underwent robust recruitment checks to ensure they were suitable to work at the service. A programme of training and supervision was available to support staff in their role and this was monitored by the registered manager. Staff told us they felt supported and that their ideas were listened to.

People were protected from the risk of abuse as staff understood their responsibilities in safeguarding people. Risk assessments were completed to identify potential risks to people’s safety and management plans implemented to reduce and monitor these. Accidents and incidents were reported and monitored to ensure any trends were identified and lessons were learnt. Safe infection control procedures were followed by staff. People lived in a clean and well-maintained environment which was adapted for their needs. Regular health and safety checks were completed and equipment was serviced as required. There was a contingency plan in place to ensure people would continue to receive their care in the event of an emergency.

People’s medicines were managed safely and staff competence was checked. People had access to healthcare professionals and advice provided was followed. Clinical review meetings were held weekly to review people’s healthcare needs. People’s legal rights were protected as the principles of the Mental Capacity Act 2005 were followed and staff understood how this impacted on their role.

People were cared for by staff who showed them kindness and compassion. Staff knew people’s needs well and took time to engage with them. There was a relaxed and friendly atmosphere throughout the service. People were encouraged to maintain their independence and keep in contact with those who were important to them. Visitors were made to feel welcome and there were no restrictions on the times they were able to visit.

Prior to moving into the service people were involved in an assessment process which ensured the service would be able to meet their needs. Detailed care plans were in place which were highly personalised and provided good guidance to staff. Staff knew people’s needs well and were able to describe the different approaches they took when supporting people. There was a range of activities offered which took into account people’s previous interests, hobbies and occupations.

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Huntington House is a family run nursing home that provides support to up to 39 people who may have a physical disability and may have dementia. The home is located in a rural area outside Hindhead. On the day of the inspection there were 35 people living at the home. The people who live at the home have a range of nursing needs and are supported with a full range of tasks, including maintaining their health and well-being, personal care, support with nutrition and activities.

Huntington House was last inspected on 13 January 2014 and there were no concerns.

On the day of inspection we met the registered manager. 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 inspection was unannounced and took place on 12 December 2016.

We found three breaches of regulation and have made one recommendation.

Although people felt safe at Huntington House there was not enough staff to meet the needs of people. People had to wait for call bells to be answered, some people had to wait for their lunch and staff did not have time to read people’s care plans. This is a breach of regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

A new auditing system had recently been started, which mirrored CQC methodology. Despite this, shortfalls in record keeping, confidentially and staffing levels had not been addressed. This meant that the support did not always meet the needs of people. The registered manager therefore did not have an oversight of the service delivered. This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although care staff understood the choices and preferences that people made their care plans sometimes lack this detail and were not always person centred. Needs reflected in people’s assessments did not always carry through to their care plans, which led to a lack of information on how to support people with specific diagnoses. This is a breach of regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although staff were adequately trained in safely administrating medicines prescribed medicines were not always managed safely. People’s care plan did not have adequate detail about medicines including “as required” medicines and Medicine Administration Records (MARS) were not always filled out consistently. We have recommended that the registered manager follows The Royal Pharmaceutical Society guidance.

Although equipment was generally used safely at Huntington House we saw that a pressure relieving mattresses was not as it was set to an incorrect weight. This increased the chances of this person developing pressure sores.

People were protected from harm. Staff had the training and the ability to understand risk, and reported accidents and incidents in a timely manner. Staff understood how to report suspected abuse so that action could be taken if necessary. Incidents and accidents were investigated and the manager reviewed reports to prevent them from re-occurring. Any potential risks to individual people had been identified and appropriately managed.

Risk assessments had been completed to ensure the home was safe for people to live in and there were arrangements in place should there be an emergency.

Staff were recruited safely and had the skills and knowledge to support people. All nurses had an up to date PIN number to prove they were registered.

The requirements of the Mental Capacity Act 2005 (MCA) were not being fully met as staff lack knowledge of The Act and what they need to consider to effectively carry out their roles and responsibilities. The provider lacked information on who could legally

We were told by people who used the service that their right to privacy was maintained at all times. They said the advice and support they received from the staff were given in a way that maintained their dignity. They said they were involved in the planning of their care.

We found the provider was not following their own guidelines in relation to enabling relatives of people who used the service to make written complaints on their relative’s behalf. The manager was not providing CQC with notifications of events that required people who used the service to receive treatment by other health care professionals.

People told us their nutritional needs were catered for and met. People told us staff were competent and knowledgeable about the need to keep them safe and that they received their medicines on time.

People who used the service told us that they or their families made the decision to use the services provided by this service. They said they were encouraged to visit the service and spend time such as having lunch or tea at the service before making a decision about the service's abilities to meet their care and social needs. Some people told us they had spent a period of respite at the service and so were aware of the care offered. They said this helped them to make the decision that the service was able to cater for their needs.

People told us they were invited to attend regular meetings on how the service was being run, and they had contributed to the decisions on how to improve the services provided, by returning their completed quality assurance questionnaire.

People said they had an assessment prior to being admitted into the service. However, a longer and fuller assessment was also undertaken when they were admitted into the service. They told us their plan of care and support needs were based on their individuality, such as religion, likes and dislikes, social and day time activities and to maintain relationships with their families.

People who used the service told us they felt safe in the service and they knew whom to speak to if they felt uncomfortable with a situation. They told us they would speak with the manager who would act on their behalf. They told us they have been provided with the service's complaints procedure but they have never had to use it. They told us the staff are kind to them.

This report documented the findings of two separate units under one provider. Huntington House provides mainly nursing and social care to elderly people, whilst Langham Court supports people diagnosed with dementia.

We were supported on this inspection by an Expert by Experience who has personal experience of using or caring for someone who uses these types of care services.

We found people expressed their views and were involved in making decisions about their care, treatment and support. They experienced effective, safe and appropriate care. These were a few of the quotes people used to describe the care and support they received. “I can’t fault the place and the girls are very good.” “It’s a very warm hearted place”. “All I have seen here is love and tenderness”. “The staff are tolerant and very patient” People had their medicines at the times they needed them from qualified staff . People's comments were considered and responded to appropriately.

People and their relatives spoke highly of the care they received. We have included some quotes from relatives and visitor spoken to during our visit. “I think the staff are fantastic, they are so patient with the difficult ones”. “The staff are tolerant and very patient”. “I am so happy X is here”. “They call the doctor and consult me with X’s care”.

Suitable staff support mechanisms were in place. The service had appropriate systems in place to effectively assess and monitor the quality of the service.