Hengist Field Care Centre

Hengist Field Care Centre is a residential care home providing personal and nursing care to 62 people aged 65 and over at the time of the inspection. People living at the service had long term conditions, mobility needs and some were living with dementia. The service can support up to 75 people.

Hengist Field Care Centre accommodates people across three separate floors, each of which has its own lounges, dining area and activity spaces. People received care in rooms with en-suite facilities and the service had adapted bath and shower equipment.

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

People spoke positively about the management at the service and we saw that action plans had been implemented to ensure the legal requirements of the regulations were now met. However, we found some inconsistencies in record keeping whilst improvements to recording systems were implemented. There was a vision to improve the service and we saw evidence of plans to improve the environment and documentation. Checks and audits were used to identify areas for improvement and systems involved people, relatives and staff in decisions about the service.

People told us they felt safe at Hengist Field Care Centre and staff practice reflected this. Staff responded appropriately to risks or incidents and knew how to raise safeguarding concerns. People’s medicines were managed and administered safely, by trained staff. The home was clean with regular checks to ensure the environment was safe and hygienic.

People spoke positively about the food and there had been improvements to nutrition since our last inspection. Staff were trained and nursing staff spoke positively about the support they received to stay up to date with current practice. People’s healthcare needs were met and staff supported them to access healthcare professionals. People received assessments and were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People said they were cared for by a kind staff team who they got on well with. Staff were committed to their roles and we made positive observations of how they interacted with people. People received dignified care and staff were respectful of their privacy. Staff supported people in a way that encouraged them to retain skills and independence.

There was technology used to enable staff to engage with people in a meaningful and personalised way and we observed instances where this achieved positive outcomes for people. There was a variety of activities for people and care plans reflected people’s interests, as well as their needs and preferences. Complaints were acted upon and responded to in line with policy.

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 (Report published 5 September 2018)

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

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Hengist Field Care Centre is a ‘care home’. People in care homes receive accommodation and 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. Hengist Field Care Centre is registered to provide accommodation and personal care for a maximum of 75 people. The home specialises in providing care to older people, people who are frail and some people living with dementia. At the time of our inspection there were 65 people living in the service. Hengist Field Care Centre is arranged over two floors.

There was an acting manager at the service who was waiting to be registered with CQC. 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 management of the service had recently changed. The previous registered manager had left and a new acting manager had been recruited. The management structure of the service was that the acting manager was overseen and supervised by the operations director. There were three units in the service and each had a manager. The staff team included nurses, care workers, wellbeing staff, activities co-ordinators, administrators, receptionist, a chef, kitchen assistants and housekeeping staff.

People’s nutrition and hydration needs were not always being met. Staff were not always following guidance from other health professionals. Staff were not always maintaining accurate, complete and contemporaneous record in respect of each person. Governance systems were not always effective in ensuring shortfalls in service delivery were identified and rectified

People were protected from abuse from staff who knew how to identify and report it. Risks to the environment and people were assessed. Assessments gave staff guidance on how to minimise the risks. There were enough staff to meet the needs of people in the service. People received their medicines when they needed them from staff who had been trained and had their competency checked. People were protected by the prevention and control of infection. The acting manager took steps to ensure lessons were learned when things went wrong.

People's needs were assessed and their care was delivered in line with current legislation. Staff received training and had the skills and experience to meet people’s needs. Staff were recruited safely. People said they enjoyed the meals provided. Staff worked together across organisations to help deliver effective care and support. Staff knew how to seek consent from people before providing them with care. They were knowledgeable about the Mental Capacity Act and followed it in practice. People’s needs were met by the design and adaptation of the service.

People were treated with kindness, respect and compassion. Staff took time to listen to people, and knew them well. People were supported to express their views and were involved in making decisions about their care and support. Staff would refer to external lay advocates if the person needed further support. People’s privacy, dignity and independence was respected and promoted.

People’s care was provided in a personalised way. People were supported to follow their interests and took part in daily activities in the service. People said they were confident to raise complaints with managers and said they thought they would be taken seriously. People were supported at the end of their life to have a comfortable, dignified and pain free death. Staff worked well with other health professionals at this time.

The acting manager did not always have an oversight of the daily culture in the service, including the attitudes, values, performance and behaviour of staff. Management encouraged transparency and honesty within the service. People, their families and staff were encouraged to be engaged and involved with the service. There were strong and growing links with the local community.

During our inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report

Hengist Field Care Centre is a purpose built service in a rural location with 75 single occupancy rooms, all with en-suite facilities, over a 2 storey building, with a large central courtyard area for people to enjoy. The service provides nursing and personal care, accommodation and support for up to 75 people. There were 67 people at the service at the time of the inspection. People had a variety of complex needs including dementia, mental and physical health needs and mobility difficulties.

There was an acting manager at the service who was waiting to be registered with CQC. 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 management of the service had recently changed. The previous registered manager had left and a new acting manager had been recruited two months later. In the interim a new quality and development manager was in charge of the day to day running of the service. The new acting manager had started the day before our inspection. The management structure of the service was that the acting manager was overseen and supervised by the quality and development manager. There were two units in the service and each had a unit manager. The staff team included nurses, care workers, wellbeing staff, activities co-ordinators, administrators, receptionist, a chef, kitchen assistants and housekeeping staff.

People and relatives told us that there were not enough staff deployed at key times. We found some call bells were not answered quickly enough.

We received mixed feedback about the quality of food served. Some people were not supported to eat and drink sufficient amounts. We reviewed people’s fluid charts and saw that these had not been completed or people had not been supported to drink enough.

Some people’s health needs were not evidenced as being met. We viewed turning charts, food charts, and topical cream charts and found that people’s care needs were not being recorded as being delivered.

Activities did not always reflect people’s interests and hobbies and some people who were being cared for in their rooms were in danger of social isolation. Some people had received very few structured activities.

There were systems in place to monitor and respond effectively to complaints, although verbal complaints were being addressed informally and were not being recorded. Quality monitoring systems were in place but were not always being implemented effectively.

The registered provider had not fulfilled their responsibility to comply with the CQC registration requirements. They had not notified us of events that had occurred within the service so that we could have an awareness and oversight of these.

Risks to people were assessed and potential harm was reduced. However for people at risk of choking we found that some improvements could be made. We have made a recommendation about this in our report.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. We have made a recommendation about how decisions are recorded following an MCA assessment.

Privacy and dignity were not consistently upheld. We saw some people partially exposed in their bedrooms as we walked past their rooms. We have made a recommendation about this in our report.

The provider had systems in place to protect people against abuse and harm. The provider had effective policies and procedures that gave staff guidance on how to report abuse. Staff were trained to identify the different types of abuse and knew who to report to if they had any concerns. Medicines were managed safely and people had access to their medicines when they needed them. The service was clean and well maintained.

Staff were trained with the right skills and knowledge to provide people with the care and assistance they needed. When staff were recruited they were subject to checks to ensure they were safe to work in the care sector.

We observed some positive interactions between people and their staff and people told us that they liked their staff. People’s independence was being encouraged where possible.

People could decorate their rooms to their own tastes and visitors were encouraged and welcomed to the service. There were systems in place to monitor and respond effectively to complaints. And complaint were being used as a tool to improve services.

Quality monitoring systems were in place but were not always being implemented effectively. Some of the shortfalls we highlighted in our inspection had not been identified during audits.

The culture of the service was undergoing a change following a change in the management team. The new management team were providing effective leadership and had a plan to make improvements in the service.

During our inspection we found a number breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered providers to take at the back of the full version of the report.

What people told us and what we found

Two inspectors carried out this inspection over a period of seven hours. We spoke with the manager, the operations manager, two care workers on the night shift and seven care workers and one nurse on the day shift. We also spoke with two people who used the service and three of their relatives. We spoke with a visiting dietician and a local authority care manager. We looked at the service's policies and procedures, staff rotas, induction and training records, and six personnel files. We looked at six care plans for people who lived in the home.

Is the service safe?

CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We spoke with the manager and they demonstrated their knowledge of the procedures to follow if an application was needed to be made to deprive a person of their liberty at the home. We saw evidence that an application had been submitted following correct procedures and proper policies relating to DoLS were in place. However, we did see one patient whose care had become difficult and staff had been asked by a senior staff to restrain them during personal care. Staff were not comfortable with this and had reported it to the Care Quality Commission, this resulted in a safeguarding alert being raised. We saw evidence that all staff had been trained in DoLS, in the principles of the Mental Capacity Act 2005 (MCA) and in safeguarding of vulnerable adults. We found that people's mental capacity was assessed and best interest meetings were held according to legal requirements. We found risk assessments with clear action plans were in place to ensure people remained safe.

Is the service caring?

We found that the people who lived in Hengist Field Care Centre were supported by kind and attentive staff. We observed staff interacting with people who used the service and noted how staff provided encouragement, reassurance and practical help. Request for assistance were responded to promptly. We saw that staff showed kindness and patience when they supported people at mealtimes, during personal care and during activities. One person who lived at the home said 'The care workers and nurses are really amazing, they are so kind and professional ".

Is the service responsive?

People's needs had been assessed before they moved into the home and their care plans were reviewed regularly to reflect any change in their needs. We saw that people's records included their history, wishes and preferences and goals to be achieved. People and/or their representatives were kept informed of any changes and were welcomed to participate in their family members' reviews of care. We found that people had access to daily activities that included exercises, arts and crafts, pampering, reminiscence and entertainers. Staff also told us that they had two outings each week, going to places such as a garden centre and the pub.

A relative of a person who used the service told us, "There is something to do every day so our family member does not get bored ".Daily activities that were requested by people who used the service were facilitated when practicable. People participated with the planning of menus and they told us, "The food is really good", "I am never very hungry but I enjoy a glass of wine or sherry with my meals, I get what I ask for".

Is the service effective?

People and their relatives told us they were satisfied with the quality of care that had been delivered. A person who used the service said, "I like it here, they look after me well". We saw that the delivery of care was in line with people's care plans and assessed needs. We found that the staff had received training to meet the needs of people living at the home. Staff had received their mandatory training and had access to additional training when needed and when they requested it. Additional courses included palliative care, rehabilitation, diabetes care and challenging behaviour.

Is the service well-led?

We found that comprehensive policies and procedures were in place that addressed every aspect of the service. The manager and quality assurance manager operated a system of quality assurance and completed audits to identify how to improve the service. When audits identified the need for an improvement, this was implemented. People and their relatives or representatives were consulted about how the service was run and annual survey questionnaires were sent and the results were analysed. Three members of staff told us, "We can speak freely and raise any concerns we have", 'The manager is approachable and they respond quickly', and 'We are encouraged to gain qualifications and the training that we need is well provided'.

During this inspection we saw that improvements had been made. Time was spent observing the support provided to people who lived in the home. We looked at records and spoke with the management team, staff, people who lived in the home and visitors.

People we spoke with told us that they had seen improvements in the service. They said, 'You can't fault it here', 'It's really good here; much better', and 'We have seen an improvement in the home'. Surveys returned to the home included comments such as: 'Things have certainly picked up since X first came into the home' and, 'Home has improved dramatically'.

We found that people received care and support that was well planned and sensitively delivered.

There were effective quality assurance procedures to ensure that people were provided with a good service.

Overall we found that the home had achieved compliance with the standards we inspected. We have made some comments that the provider may find it useful to note to make sure that the home continues to provide a good service.

Visitors and people who lived in the home spoke positively of the care provided by staff.

We found that people were supported with regard to pressure area and wound care.

People's nutritional care needs had improved and appropriate health care support was accessed for people who were at risk of poor nutrition or hydration.

Staffing levels were generally improved with staffing based on people's needs rather than the amount of people who lived in the home.

We saw that people who lived on the Rowena unit benefitted from consistency of care that met their needs and monitored their support.

We still found, however, that people who lived on the Horsa unit did not benefit from clear care planning and robust monitoring of their care needs.

People who displayed challenging behaviours did not have appropriate risk assessments or care planning in place.

After our last visit the provider sent us an action plan that stated how they would address the issues raised in the home. We noted that this identified a number of auditing systems. At this visit we found that these had not all been fully implemented which resulted in a lack of effective monitoring processes that robustly checked against the risk of unsafe care and treatment.

We saw that pressure area care was poorly managed and people were not safeguarded against the risks of developing pressure sores. This meant that people did not experience effective, safe and appropriate care and treatment that met their needs.

People were not supported with their nutrition and hydration needs in accordance with their care plans. Professional guidance was not followed, regular weights were not taking place as planned and referrals were not made when required.

Staffing levels did not meet the needs of the people who lived in the home as people had to wait to get up or go to bed or wait for their call bells to be answered before they could be taken to the toilet. Records showed that the staff on duty did not always correspond with the staff rotas.

People told us that, 'They could do with more staff' and that when staff answered call bells, 'They just do what you need and leave'.