The inspection took place on 20 and 21 December 2018. The first day of our inspection visit was unannounced.The Hunters Lodge Care Centre 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.
The home is registered to provide accommodation with nursing care or personal care for up to 90 people, some of whom are living with dementia, have physical disabilities or mental health problems. The accommodation is provided within three separate units located on the same site: Kitwood Unit, Terrace Unit and Pavilion Unit. Each of these units is designed to cater for people with specific categories of needs. For example, Pavilion Unit provides care and support to younger adults with mental health problems. At the time of our inspection, there were 73 people living at the home.
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 previous inspection in July 2017, we rated the service as 'Requires Improvement’ and identified a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the ineffectiveness of the provider’s quality assurance systems and procedures. As a result of the inspection, we asked the provider to send us a report explaining the actions they were going to take to improve the service. At this inspection, we found the provider was now meeting the requirements of Regulation 17, although improvements were still needed in the monitoring of recruitment practices and staff training provision.
The management team had not always adhered to the provider’s recruitment policy and safe recruitment practices through carrying out consistent per-employment checks on prospective staff. Some staff raised concerns regarding the adequacy of the night-time staffing levels on Terrace Unit, and we identified issues regarding staff deployment on the same unit. Some improvements were still needed in relation to the management of people’s medicines, including closer monitoring of medicines fridge temperatures. The provider had not fully promoted people’s rights under the Mental Capacity Act 2005 when introducing infra-red motion sensors across two of the home’s units. Mealtimes at the service still needed to be better organised to prevent significant delays in some people’s meals, and ensure people were effectively supervised and encouraged to eat. Staff training and supervision meetings had lapsed over recent months.
People told us they felt safe living at the home. Staff recognised their role in protecting people from any form of abuse or discrimination, and were aware of the different forms and potential indicators of abuse. The provider had systems and procedures in place to manage the risks associated with the home’s physical environment, the equipment staff used and people’s individual care and support needs. Staff recorded and reported any accidents or incidents involving people who lived at the home. The provider had measures in place to protect people, visitors and staff from the risk of infections. This included the provision of appropriate personal protective equipment for staff use.
People were supported by staff to make choices about what they ate and drank each day, and had input into the home’s menus. Any complex needs or risks associated with people's eating and drinking were assessed and managed, with advice from nutrition specialists. Prior to people’s care starting, the management team met with them and, where appropriate, their relatives to assess their individual needs. Staff and management then worked with a range of community health and social care professionals, with the aim of ensuring positive outcomes for people. Staff and management recognised the need to promote equality and diversity, and consider people’s protected characteristics, in the planning or delivery of their care. All new staff underwent the provider's induction training to help them settle into their new roles and understand what was expected of them at work. Staff helped people to access professional medical advice and treatment if they were unwell. Steps had been taken to adapt the home’s environment to people’s individual needs, including those who were living with dementia.
Staff approached their work with kindness and compassion, and they knew people well. People and relatives were supported to express their views and be involved in decision-making that affected them. People’s individual communication needs had been assessed, recorded and kept under regular review. Staff understood the need to treat people in a respectful and dignified manner, and protect their personal information.
People received care and support that took into account their individual needs and preferences. The management team took steps to involve people and their relatives in care planning and review meetings. People's care plans were individual to them and covered important aspects of their care. People had support to pursue their interests and participate in recreational and social activities at the service, although some staff felt the provider’s ‘wellbeing and lifestyle facilitator’ (activities coordinator) was overstretched at present. People and their relatives understood how to raise any concerns or complaints about the service, and the provider had a complaints procedure in place to ensure these were handled fairly. Staff and management took steps to identify people's preferences and choices for their end-of-life care, in order that they could work with community professionals to meet these.
The registered manager demonstrated a good understanding of the requirements associated with the provider’s registration with CQC. Most people and relatives described positive relationships and open communication with an approachable management team. Staff were enthusiastic about their work and felt well-supported and valued. The community health and social professionals we spoke with felt staff and management were receptive to, and normally acted on, their recommendations. The management team encouraged people and relatives’ involvement in, and feedback on, the service.