The inspection took place over two days on 30 and 31 October 2017. The inspection was unannounced.

We last inspected the service in September 2015 and rated the service as good overall. This inspection found that the service remained good overall.

Hamble Heights is a purpose built care home with nursing located in Park Gate, near Southampton. The home can accommodate up to sixty people who require either residential or nursing care. Some of the people using the service lived with dementia. At the time of the inspection there were 59 people using the service. The home is arranged over four floors with each of the main floors or units being led by a unit manager who was a registered nurse.

The service had a registered manager. 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 and associated Regulations about how the service is run.

There were a range of systems and processes in place to identify and manage risks to people’s wellbeing but also environmental risks. However, some improvements were needed. Post falls protocols were not being consistently followed. Food and fluid charts used to monitor risks to people’s nutrition hydration had not always been fully completed.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. However, some incidents which raised potential safeguarding concerns had not been escalated to the local authority safeguarding teams. The registered manger told us they would seek further advice from the local authority to support their understanding of expectations around reporting and escalating concerns.

Additional checks are being put in place to ensure that all of the required pre-employment checks are consistently completed before new staff start work at the service.

There were suitable numbers of staff deployed to meet people’s needs. The provider will continue to review staffing levels with people who use the service and is shortly implementing a new tool to facilitate consistent evidence-based decisions about staffing levels.

The home was clean and staff were observed to be using appropriate personal protective equipment (PPE).

Overall systems were in place to ensure the safe and responsive use of medicines.

Staff were provided with opportunities to develop their skills and knowledge and performed their role effectively.

Staff sought people’s consent before providing care and people were encouraged and supported to make decisions about their care and support.

Staff worked in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were applied appropriately.

People were supported to have enough to eat and drink. Plans were in place to improve the dining experience.

The premises were suitably adapted and pleasantly decorated. There were landscaped and fully accessible gardens which included a variety of areas for people to enjoy including sensory plants and seating areas.

Where necessary a range of healthcare professionals including GP’s, community mental health nurses, dentists and speech and language therapists, had been involved in planning peoples support to ensure their health care needs were met.

People were cared for by kind and compassionate staff. Staff were very motivated and spoke with enthusiasm about providing a family environment where people and their relatives felt safe, valued and cared for. Staff knew people well and had developed a meaningful relationship with each person.

Staff supported people to maintain the relationships and friendships with people who were important to them. Relatives felt involved and told us they could visit at any time and share in their loved ones care. Relatives felt a particular strength of the service was

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of our inspection. Their name appears because they had not applied to have their name removed from our register. The previous manager left their employment at the home in June 2014. A new manager was subsequently appointed in the middle of July 2014. This meant for a period of time senior staff had to continue to manage the day to day operation of the home.

We were accompanied on our inspection of Hamble Heights by a pharmacist inspector. This was because we had received information of concern about the management of medication at the home.

At the time of our inspection there were 60 people accommodated at Hamble Heights (the home) and 41 were receiving nursing care.

We used a number of different methods to help us understand the experiences of people who lived at the home. This was because many people were unable to talk with us because of physical frailty and/or mental health problems such Alzheimer’s disease.

The home has bedroom accommodation and communal rooms on four floors. We "pathway tracked" seven people who lived at Hamble Heights and ensured that we included at least one person accommodated on each of the four floors. This meant we looked at records the home kept about them, including care plans that contained information about how their needs were met. We were able to speak with two of the people we pathway tracked and the relative of another.

We spoke with a further nine people who lived at the home, five relatives and seven members of staff during our inspection. We also contacted a local authority adult social care manager who had recent contact with and knowledge of the home.

Where it was appropriate such as at mealtimes we observed the care and support people received. We also observed the day to day activities in the home’s communal lounges.

We looked at other documents that helped us understand how people were supported, such as staff training records, surveys, complaints, risk assessments and equipment servicing and maintenance records.

We gathered evidence against the outcomes we inspected to help answer our five key questions.

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found.

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

Is the service caring?

The service is caring. Relatives we spoke with described the home’s staff as caring. One said, “I am really impressed they really seem to care about my Mum … she came back here from hospital and was seriously ill, so much so the doctors thought she was dying, but she really bounced back”.

Another relative we spoke with told us their relative who lived at the home was “Very fussy” and said, “They always accommodate her”.

We saw staff were friendly, attentive, calm, patient, considerate and sensitive. They checked with people that they were comfortable, asked people what help they wanted, what choices they wanted to make and anticipated the needs of people who were unable to communicate verbally.

Is the service responsive?

The service is responsive. People’s needs and risks to their welfare were normally re-assessed/reviewed at least monthly. This ensured that support plans were amended and updated when people’s needs changed.

Records we looked at showed visits from or to healthcare professionals. Appointments had been arranged by the home’s staff to ensure people’s feet, dental or eye care needs were met. The records also showed the home’s staff contacted specialist healthcare staff for advice and support or when people’s needs changed. The specialists included speech and language therapists, stoma and tissue viability nurses, physiotherapists and mental health specialists. We saw a support plan for one person had been developed by a speech and language therapist for the home’s staff to ensure the specific needs of a person we pathway tracked was met.

People who lived at Hamble Heights, their representatives and staff were asked for their views about the service provided at the home and some suggestions they made were acted on.

A local authority adult care services manager told us that following recent concerns about the home the owner’s response had demonstrated they wanted to be a quality provider. They said the owner had invested in staffing and made other changes to improve the service they provided.

Is the service safe?

The service is not as safe as it could be. People were not always protected from the risks of unsafe or inappropriate care and treatment because information about them in records was not always complete and accurate.

People were not always protected from risks associated with medicines because arrangements in place to manage medicines were not always appropriate.

The home’s owner had arrangements in place that ensured the premises, equipment and utilities were regularly checked and tested by appropriately qualified personnel to ensure they were safe and effective.

Is the service effective?

The service is not as effective as it could be. The support and help people required with their personal care and health needs was not always planned and delivered in a way that met their individual needs and ensured their safety and welfare.

Is the service well led?

The service is not as well led as it could be. The absence of a manager for a period of time following the departure of the home’s previous registered manager in June 2014 disrupted the leadership of the home. It resulted in some of the home’s working procedures and practices not being consistently followed. Arrangements to regularly check and monitor the quality of their service and identify and manage risks to the health, safety and welfare of people, were not sufficiently robust or up to date to ensure people were properly protected.

We carried out this out this inspection of Hamble Heights (the home) because we had received anonymous information of concern. The informant alleged the numbers of staff on duty, the mix of skills and the competence of some staff was not always adequate to meet people’s needs.

We started our inspection at 6:06 a.m. on 16 June 2014. This was in order to meet and talk specifically with the home’s night staff. We spoke with six of the eight staff who had been scheduled for duty on the night of the 15 June 2014. We were unable to speak with one of the night staff as we were told they had left at 4:15 a.m. due to illness.

We spoke with a further nine staff after 08:00 a.m. when the day staff were on duty. The consisted of three registered nurses and 12 health care assistants as well as he home’s manager and deputy manager. This was in order to obtain their views about the sufficiency of staffing levels at different times of the day and to check whether they had received appropriate training. We also spoke with them to hear their views about the abilities of temporary staff provided to the home by employment agencies.

During our inspection we spoke with four people who lived at the home. Due to their physical and/or mental frailty we were unable to speak with many people during our inspection.

We also spoke with two visiting relatives in order to hear their views about the abilities of the home’s staff team and the adequacy of staffing levels.

We contacted a GP from a local surgery who regularly visited the home. They told us what they thought about the quality of care provided at Hamble Heights and the home’s staffing.

We gathered evidence against the outcomes we inspected to help answer two key questions about the concerns that had been raised with us.

• Is the service safe?

• Is the service effective?

Below is a summary of what we found.

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

Is the service safe?

During our inspection visit we spoke with a total of 15 nursing and care staff about the adequacy of staffing levels. All but one expressed satisfaction with the numbers of nursing and healthcare assistants on duty at all times. Many of the staff had previous experience of similar work in other care services and could compare their experiences.

The home had a nurse/alarm call system in place that enabled the response times to be checked. We saw that the average response time was less than 60 seconds which showed there were always enough staff on duty to respond quickly to requests for help.

One relative we spoke with said, “The staff are very good here. There are enough now and it has greatly improved. Sometimes when she first came here there were not enough”.

Is the service effective?

Relatives we spoke with described the home’s staff as “very good” and “excellent”.

A visiting GP from a local surgery told us they thought the home’s staff appeared “competent”.

The provider had measures in place to promote staff training and development and for staff to obtain further relevant qualifications. The provider promoted an environment where clinical excellence was encouraged.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

At the time of our visit Hamble Heights had been open for five months and there were 17 people using the service. We spoke with five of them, and four relatives who were visiting family members. They were all very happy with the care and support provided. One person described the home as “very good” and another said, “I couldn’t be anywhere better”. They told us they were consulted about their care needs and they received care and support according to agreed plans. People said they felt safe and comfortable and staff listened to them if they had concerns or requests.

We observed the care and support given to four people in a communal area of the home. We found people were involved in their care and support. Their privacy and dignity were respected. We saw that staff were caring and aware of people’s needs and preferences.

We spoke with six members of staff and the manager, and reviewed records related to people’s care. We found people’s care needs were assessed and their care plans reflected their needs. Care and support were delivered according to plans which were reviewed regularly. We found the necessary checks were made before employees started work, there were effective recruitment and induction processes, and people were protected from the risk of abuse. The provider was monitoring the quality of service provided by informal means and was preparing to establish more formal quality monitoring.

The inspection took place over two days on 3 and 4 September 2015. The inspection was unannounced.

Hamble Heights is a purpose built home located in Park Gate, near Southampton. The home is arranged over four floors and can accommodate up to sixty people who require either residential or nursing care. Some of the people using the service are living with dementia. At the time of the inspection there were 56 people using the service.

The service did not have a registered manager. 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 and associated Regulations about how the service is run. However, a manager had been appointed and was in the process of applying to CQC to register.

People and their relatives were positive about the care and support they received. Staff knew people well and understood how to meet their individual needs in a person centred way. We observed positive relationships between staff and people living at the home. Staff showed concern for people’s wellbeing and people told us this helped them to feel like they mattered.

We received mixed feedback about the staff arrangements within the home. Most people told us that there were enough staff to meet their needs in a timely way; however on one floor, some people told us there could sometimes be a delay in their needs being met because staff were supporting other people. The manager was taking action to review and adapt the deployment of staff and equipment in order that they might continue to improve the ability of staff to be responsive to each person’s individual circumstances. However, this is an area for improvement.

Recruitment practices were safe and relevant checks had been completed before staff worked unsupervised. These measures helped to ensure that only suitable staff were employed to support people in their homes.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect. Staff had clear guidance about what they must do if they suspected abuse was taking place.

Individual risk assessments had been completed for people who used the service and covered a wide range of activities and tasks. This helped to protect them from harm.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were either in place or had been applied for.

New staff received a comprehensive induction which involved learning about the values of the service, the needs of people using the service and key policies and procedures. The induction also introduced staff to the fundamental standards and aimed to ensure that the new staff member had a clear understanding of their role and responsibilities within the organisation.

Staff completed a range of essential training which helped them to provide effective care. More specialised training specific to the needs of people using the service was also provided, for example some staff had received training in continence care, and pressure ulcer prevention. This helped to ensure that staff were equipped with the right skills and knowledge to meet people’s needs.

People were supported to have enough to eat and drink and their care plans included information about their dietary needs and risks in relation to nutrition and hydration. The provider had a range of measures in place to seek the views of people about the quality of the food provided and planned to use this information to make on-going improvements to the dining experiences within the home.

People told us they were able to raise any issues or concerns and felt these would be dealt with promptly. Information about the complaints policy was available in the service’s welcome guide.

There was an open and transparent culture within the service and the engagement and involvement of people, their relatives and staff was encouraged and was used to drive improvements. The manager had a clear vision for the service which focused on the delivery of person centred care. The provider and manager demonstrated a commitment to making the staff team feel valued and appreciated for the care they provided. There were a range of systems in place to assess and monitor the quality and safety of the service and to ensure people were receiving the best possible support.