Old Hastings House

Old Hastings House is a residential care home providing accommodation and personal care to up to 60 people. The service provides support to older people with a range of support needs including dementia and issues affecting their mobility. At the time of our inspection there were 45 people using the service.

People’s experience of using this service and what we found

Safeguarding policies were in place and staff knew what steps to take to protect people. People were safe and were protected from harm. People had risk assessments in place and care plans that were person centred and documented all support needs. Staff had been recruited safely and there were sufficient numbers of staff on every shift to support people safely. Medicines were stored, administered and recorded safely. When accidents and incidents occurred, they were managed appropriately with all details being recorded and close analysis of what had taken place. Steps were taken to minimise the chance of a recurrence and any learning shared with staff.

Pre-assessments were carried out by the registered manager or senior staff members to ensure that the service could support people’s needs. New staff went through an induction and were then supported by regular supervision and appraisal meetings. We were shown a training matrix confirming that staff had been trained in all areas required to support people. People’s nutrition and hydration needs were met and people all spoke highly of the food provided. People were supported by the service to keep social and medical appointments. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The registered manager was a visible presence and had developed a positive culture at the service. Auditing processes were thorough and people, relatives and staff all had opportunities to provide feedback about the service. The registered manager had complied with the duty of candour and had fostered positive working relationships with other health and social care professionals.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 November 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Old Hastings House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Old Hastings House is a residential care home providing personal care to up to 60 people. At the time of the inspection, there were 59 people living at the service. The service provides care to older people, people with conditions affecting their mobility and an area of the service is for people living with dementia.

Care is provided across one adapted building split into two main units. Care is provided on three floors with lift access. There are also lounges and communal dining spaces, as well as garden areas for people to access.

People’s experience of using this service and what we found

People told us they felt safe and received their medicines as expected, but we found shortfalls in how risk and medicines were managed. People and staff described strong leadership at the service and we saw examples of systems and processes that supported this. However, the internal governance systems had not been robust enough to proactively identify and address shortfalls found at this inspection.

People were supported to have maximum choice and control of their lives and supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not support this practice because the Mental Capacity Act 2005 was not always followed. People spoke positively about the food that was prepared for them and we saw evidence of people’s dietary needs being met. Staff worked alongside healthcare professionals to meet people’s needs.

People told us they were supported by kind and caring staff who they knew well. People were routinely involved in their care and staff were respectful of people’s privacy and dignity. Care was provided in a way that promoted people’s independence.

We received positive feedback on the variety of activities on offer and these were meaningful and reflected people’s interests. Care was planned in a personalised way, with end of life care being planned sensitively and in line with best practice. People were informed about how to complain and complaints were responded to appropriately.

People spoke positively about the leadership at the service and staff said they felt supported. There were strong values with systems and processes to ensure these were embedded in care delivery. The service had a strong presence in the local community and people benefitted from their fundraising works and links with local schools.

Rating at last inspection

The last rating for this service was Good (published 21 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risks, medicines, consent and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Old Hastings House provides accommodation for up to 60 older people that require support and personal care and for those who live with dementia. The service is divided into two units. The residential suite is for up to 45 people who require support with personal care and the Magdalen suite is for up to 15 people who live with a dementia type illness. The home has a range of pleasant communal areas throughout the buildings. The service is owned by The Magdalen And Lasher Charity and is located in Hastings, East Sussex.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Throughout our inspection, people spoke positively about the home. Comments included, “All the staff are really pleasant” and, “I am very happy here.”

Not everyone could tell us of their experiences, but those that could spoke highly of the home and commented they felt safe. Our own observations and the records we looked at reflected the positive comments people made. People had confidence in the staff to support them and we observed positive interactions throughout our inspection.

Care plans and risk assessments included people’s assessed level of care needs, action for staff to follow and an outcome to be achieved. Medicines were managed safely in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately, including the administration of controlled drugs.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. One person told us, “I feel safe here. It’s nice here.” When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Staff were knowledgeable and trained in safeguarding and what action they should take if they suspected abuse was taking place. Retention of staff was extremely high and most staff we spoke with had worked at Old Hastings House for many years.

Accidents and incidents were recorded appropriately and steps taken by the home to minimise the risk of similar events happening in the future. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the manager understood when an application should be made and how to submit one. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure any decisions were made in the person’s best interests.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, such as diabetes and advanced dementia. Staff had received both one to one and group supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. One person said, “I like the food, its nice food.” There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. People were advised on healthy eating and special dietary requirements were met. People’s weight was monitored, with their permission. Health care was accessible for people and appointments were made for regular check-ups as needed.

People could choose how to spend their day and they took part in activities in the home when they wanted to. Staff told of people's particular favourites, such as film afternoons. People themselves told us they enjoyed the activities, which included singing, puzzles and films. People were encouraged to stay in touch with their families and receive visitors.

People felt well looked after and supported, and were encouraged to be as independent as possible. We observed friendly and genuine relationships had developed between people and staff. One person told us, “They treat you well here.” Another person told us the staff supported them with?

People were encouraged to express their views and completed surveys, feedback received showed people were highly satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. One person said, “If there is anything wrong, I tell the staff.” Staff were asked for their opinions on the service and whether they were happy in their work. Staff enjoyed their work and felt that they were a family. They felt supported within their roles, describing an ‘open door’ management approach, where management were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.

Below is a summary of what we found. The summary describes what people using the service, their relatives 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.

Is the service safe?

People had been cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty with the appropriate skills and experience to meet the needs of the people living at the home. There were arrangements for senior staff including the manager to be on call out of hours. This was to provide support for staff in case of emergencies.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us "The staff help me with being more independent'. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us 'The staff are more like my friends". Another person told us "The staff look after me so well here'.

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us that staff discussed any changes to do with their care with them regularly, and that staff were approachable if there were any issues of concern. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. One person told us 'The staff cared for me well during a recent medical emergency, staying with me and reassuring me throughout'.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a quality survey. They confirmed they had been listened to and as a result of the survey, changes had been made to the way their food was presented and delivered. Staff told us they were clear about their roles and responsibilities. They said the management had consulted with them before implementing changes to the management of the home and their views had been taken into consideration.

We found that staff understood people's needs and discussed their care plans and activities with them. Staff told us that they enjoyed working in the home and felt supported.

The buildings and grounds were generally well maintained with a suitable design and layout.